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1.
Artículo en Inglés | MEDLINE | ID: mdl-32165356

RESUMEN

BACKGROUND AND PURPOSE: Anoxic brain injury is a result of prolonged hypoxia. We sought to describe the nonquantitative arterial spin-labeling perfusion imaging patterns of anoxic brain injury, characterize the relationship of arterial spin-labeling and DWI, and evaluate the normalized diffusion-to-perfusion ratio to differentiate patients with anoxic brain injury from healthy controls. MATERIALS AND METHODS: We identified all patients diagnosed with anoxic brain injuries from 2002 to 2019. Twelve ROIs were drawn on arterial spin-labeling with coordinate-matched ROIs identified on DWI. Linear regression analysis was performed to examine the relationship between arterial spin-labeling perfusion and diffusion signal. Normalized diffusion-to-perfusion maps were generated using a custom-built algorithm. RESULTS: Thirty-five patients with anoxic brain injuries and 34 healthy controls were identified. Linear regression analysis demonstrated a significant positive correlation between arterial spin-labeling and DWI signal. By means of a combinatory cutoff of slope of >0 and R2 of > 0.78, linear regression using arterial spin-labeling and DWI showed a sensitivity of 0.86 (95% CI, 0.71-0.94) and specificity of 0.82 (95% CI, 0.66-0.92) for anoxic brain injuries. A normalized diffusion-to-perfusion color map demonstrated heterogeneous ratios throughout the brain in healthy controls and homogeneous ratios in patients with anoxic brain injuries. CONCLUSIONS: In anoxic brain injuries, a homogeneously positive correlation between qualitative perfusion and DWI signal was identified so that areas of increased diffusion signal showed increased ASL signal. By exploiting this relationship, the normalized diffusion-to-perfusion ratio color map may be a valuable imaging biomarker for diagnosing anoxic brain injury and potentially assessing BBB integrity.

2.
Zhonghua Xue Ye Xue Za Zhi ; 41(2): 117-122, 2020 Feb 14.
Artículo en Chino | MEDLINE | ID: mdl-32135627

RESUMEN

Objective: To explore the efficacy and prognostic factors of hematopoietic stem cell transplantation (HSCT) for the treatment of patients with anaplastic large cell lymphoma (ALCL) . Methods: The clinical records of 33 ALCL patients after HSCT were collected and analyzed retrospectively to evaluate the rates of overall survival (OS) and recurrence after autologous (auto-HSCT) and allogeneic HSCT (allo-HSCT) and the factors influencing prognosis. Results: The median-age of this cohort of 33 ALCL cases at diagnosis was 31 (12-57) years old with a male/female ratio of 23/10, 24 cases (72.7%) were ALK(+) and 9 ones (27.3%) ALK(-). Of them, 25 patients (19 ALK(+) and 6 ALK(-)) underwent auto-HSCT and 8 cases (5 ALK(+) and 3ALK(-)) allo-HSCT with a median follow-up of 18.7 (4.0-150.0) months. Disease states before HSCT were as follows: only 6 patients achieved CR status and received auto-HSCT, 16 patients achieved PR (14 cases by auto-HSCT and 2 ones allo-HSCT) , the rest 11 cases were refractory/relapse (5 cases by auto-HSCT and 6 ones allo-HSCT) . There were 7 cases died of disease progression (5 after auto-HSCT and 2 allo-HSCT) and 5 cases treatment-related mortality (TRM) (2 after auto-HSCT and 3 allo-HSCT) , TRM of two groups were 8.0% and 37.5%, respectively. Both the median progression-free survival (PFS) and OS were 15 months after auto-HSCT, the median PFS and OS after allo-HSCT were 3.7 (1.0-90.0) and 4.6 (1.0-90.0) months, respectively. There was no statistically significant difference in terms of survival curves between the two groups (OS and PFS, P=0.247 and P=0.317) . The 2-year OS rates in auto-HSCT and allo-HSCT groups were 72% and 50%, respectively. The 5-year OS rates in auto-HSCT and allo-HSCT groups were 36% and 25%, respectively. Conclusion: ALCL treated by chemotherapy produced high rates of overall and complete responses. Chemotherapy followed by auto-HSCT remained to be good choice for patients with poor prognostic factors. High-risk patients should be considered more beneficial from allo-HSCT.


Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Linfoma Anaplásico de Células Grandes , Adolescente , Adulto , Niño , Femenino , Humanos , Linfoma Anaplásico de Células Grandes/terapia , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Trasplante Autólogo , Trasplante Homólogo , Resultado del Tratamiento , Adulto Joven
3.
Zhonghua Yi Xue Za Zhi ; 100(10): 767-770, 2020 Mar 17.
Artículo en Chino | MEDLINE | ID: mdl-32192290

RESUMEN

Objective: To investigate the significance of quantitative fecal immunochemical test (FIT) for opportunistic screening of colorectal neoplasia, and to propose the most optimal thresholds to improve the screening level of early colorectal neoplasia. Methods: The opportunistic screening participants were recruited from the Department of Gastroenterology & GI Endoscopy Center of the Seventh Medical Center of PLA General Hospital, and stool sample was collected before colonoscopy and the quantitative FIT was analyzed by OC-MICRO analysator for each patient. We assessed test performance in detecting colorectal neoplasia (advanced adenoma and CRC)with different thresholds on sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: A total of 1 448 objects were enrolled in this study, including 714 male (49.3%)and 734 female (50.7%).All participants were classified according to the result of colonoscopy and pathology, and 242 cases of colorectal neoplasia were found, containing 157 advanced adnoma and 85 colorectal cancer. The FIT threshold increased from 50 µg/L to 200 µg/L, while the positivity rate dropped from 11.5% to 8.6% and the sensitivity in detecting colorectal neoplasia dropped from 47.9% to 38.8%. However, the specificity increased from 96.8% to 98.2% and the positive predictive value increased from 82.3% to 87.0%.The miss rate of colorectal cancer increased from 11.8% (n=10) to 17.6% (n=15) along with the increase in FIT thresholds, but the miss rate of 100 µg/L and 150 µg/L was the same as 12.9% (n=11). Conclusions: Quantitative FIT,which is simple and fast,with the threshold of 100 µg/L for opportunistic screening, has a high sensitivity and specificity for the diagnosis of colorectal neoplasia,and is an important index in screening and diagnosis of colorectal neoplasia.

4.
Zhonghua Zhong Liu Za Zhi ; 42(2): 127-132, 2020 Feb 23.
Artículo en Chino | MEDLINE | ID: mdl-32135647

RESUMEN

Objective: To deliver macro understanding of the latest research progress on clinical trials and approved products of cancer drugs in China in 2019. Methods: The number of clinical trials and related investigational products by domestic and foreign enterprises in 2019 were acquired in the China Food and Drug Administration Registration and Information Disclosure Platform for Drug Clinical Studies, while listed drugs were obtained in the China Food and Drug Administration Query System for Domestic and Imported Drug. Characteristics on stage, scope, indication of those trials, classification and mechanism of involved products, as well as listed anticancer drugs were summarized and depicted. Results: There were 474 cancer drug trials registered in China in 2019, accounting for 21.8% of the total, and 397 (83.8%) were initiated by domestic pharmaceutical enterprises. Overall, international multicenter trials accounted for 13.1%, and phase I trials accounted for 47.3%. Compared with global enterprises, the proportion of international multi-center trials initiated by domestic companies is lower (4.8% vs. 55.8%, P<0.001), and the proportion of phase I clinical trials and bioequivalence trials is higher (51.9% vs. 23.4%, 19.4% vs. 1.3%, P<0.001). An accumulative of 27 cancer types were involved for all the cancer drug trials, and lung cancer, solid tumor, and breast cancer were the most common cancer types, with 103, 95 and 49 trials, respectively. For the three cancer types unique to Chinese population, gastric, liver and esophageal cancer, the total number of initiated trials was 47. For all those trials, there were 335 cancer drug varieties, with 86.0% developed by domestic pharmaceutical enterprises, including 300 therapeutic drugs, 30 adjunctive drugs and 5 preventive drugs. In terms of mechanism, targeted drugs and immune drugs were the most popular, accounting for 74.6% and 20.3%, respectively. In addition, 17 anticancer drugs targeting on 11 cancer types were approved in China in 2019. Conclusions: Clinical trials on cancer drugs in China have ushered a booming era, with large number of innovative agents represented by targeted drugs and immune drugs under clinical development or putting into clinical practice. Those local enterprises are playing more and more critical roles. Strengthening clinical research and development on Chinese unique cancer types is the key direction of future work.


Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias Pulmonares/tratamiento farmacológico , China , Ensayos Clínicos como Asunto , Humanos , Estados Unidos
5.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(0): E038, 2020 Mar 18.
Artículo en Chino | MEDLINE | ID: mdl-32186172

RESUMEN

Severe and critical coronavirus pneumonia 2019 (COVID-19) often occurs in elder patients with multiple comorbidities, and severe hypoxemia events are an important factor in the deterioration of some cases. The critical type of COVID-19 could progress to acute respiratory distress syndrome and multi-organ dysfunction, which are the most important causes of death. Early start with non-invasive ventilation (NIV) against the possible physiological abnormalities could be helpful to improve prognosis. Close monitoring of oxygenation, reducing patients' oxygen consumption, active psychological intervention, and rapidly dealing with severe hypoxemia events are the key factors for the successful treatment of NIV. In addition, active adjuvant therapy is also important, such as correcting coagulation dysfunction, providing proper nutritional support, accurate volume control, and safe individualized blood glucose monitoring and control.

6.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(3): 306-313, 2020 Mar 06.
Artículo en Chino | MEDLINE | ID: mdl-32187937

RESUMEN

Objective: The existed economic evaluations of cancer screening in Chinese population are almost all single-cancer focused, evidence on parallel comparison among multiple cancers is lacking. Thus, the aim of this study was, from a priority setting perspective, to compare the cost-effectiveness of six common cancers(colorectal cancer, breast cancer, liver cancer, lung cancer, esophageal cancer and stomach cancer) to facilitate policy making in future scaled-up screening in populations in China. Methods: Partially based on our previous single-cancer systematic reviews (colorectal cancer, breast cancer, liver cancer, and lung cancer), evidence of economic evaluations of cancer screening in populations in mainland China were systematically updated and integrated. The main updates include: 1) Stomach cancer and esophageal cancer were newly added to the current analysis. 2) The literature searching was extended to 8 literature databases, including PubMed, EMbase, The Cochrane Library, Web of Science, CBM, CNKI, Wanfang Data, and VIP. 3) The period of publication year was updated to the recent 10 years: January 1, 2009 to December 31, 2018. 4) The study focused on populations in mainland China. Following the standard processes of literature searching, inclusion and exclusion from previous systematic reviews, the basic characteristics, evaluation indicators and main results of the included studies were extracted. All the costs were discounted to 2017 value using the by-year consumer price index of medical and health care residents in China and presented in the Chinese Yuan (CNY). The ratios of incremental cost-effectiveness ratio (ICER) to China's per capita GDP in 2017 were calculated (<1 means very cost-effective, 1-3 means cost-effective, >3 means not cost-effective). Given a specific indicator, the median value among all reported screening strategies for each cancer was calculated, based on which priority ranking was then conducted among all cancers when data available. Results: A total of 45 studies were included, 22 for breast cancer, 12 for colorectal cancer, 6 for stomach cancer, 4 for esophageal cancer (all conducted in high-risk areas), 1 for liver cancer and none for lung cancer (was not then considered for next ranking due to limited numbers of studies). When based on the indicator, the median ratio of cost per life-year saved to China's per capita GDP (reported in 12 studies), the lowest ratio (-0.015) was observed in esophageal cancer among 16 strategies of 2 studies (N=2, n=16), followed by 0.297 for colorectal cancer (N=3, n=12), 0.356 for stomach cancer (N=1, n=4) and 0.896 for breast cancer (N=6, n=52, P(75)=3.602). When based on another commonly used ICER indicator, the median ratio of cost per quality-adjusted life-year gained to China's per capita GDP (reported in 13 studies), the least cost was found in stomach cancer (0.495, N=3, n=8, P(75)=3.126), followed by esophageal cancer (0.960, N=1, n=4, P(75)=1.762) and breast cancer (2.056, N=9, n=64, P(75)=4.217). Data was not found for colorectal cancer. In addition, cost per cancer case detected was the most adopted indicator (32 studies). The median cost among all screening strategies for each cancer was 14 759 CNY for stomach cancer (N=5, n=7), 49 680 CNY for colorectal cancer (N=12, n=25) and 171 930 CNY for breast cancer (N=13, n=24), respectively. Data was not available for esophageal cancer and rare for precancer cases detected. Evidence related to cost per disability-adjusted life-year gained was not available. Conclusions: At China's national level and limited to the six cancers covered by the current study, the preliminary analysis suggests that stomach cancer and colorectal cancer were the most cost-effective target cancers and could be given priority in the future scaled-up screening in general populations. Esophageal cancer screening should be prioritized in high-risk areas. Breast cancer was also cost-effective in general but some of the intensive screening strategies were marginal. Data on liver cancer and lung cancer were too limited to conclude, and more well-designed studies and high-quality research evidence should be required. This priority ranking might be changed if other common cancers were involved analyses.


Asunto(s)
Detección Precóz del Cáncer/economía , Gastos en Salud/estadística & datos numéricos , Neoplasias/diagnóstico , China , Análisis Costo-Beneficio , Detección Precóz del Cáncer/métodos , Humanos , Neoplasias/economía , Años de Vida Ajustados por Calidad de Vida
7.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(3): 314-319, 2020 Mar 06.
Artículo en Chino | MEDLINE | ID: mdl-32187938

RESUMEN

Objective: To systematically evaluate the quality of gastric cancer screening guidelines/recommendations, and provide a reference for the update of gastric cancer screening guidelines/recommendations in China. Methods: "guidelines/consensus/specifications/standards" , "stomach/gastric tumors" , "screening/diagnosis" , "guideline/recommendation" , "gastric cancer/gastric tumor," "early detection of cancer/screening" were searched as keywords in PubMed, Embase, Web of knowledge, China Knowledge Network, Wanfang, China Biomedical Literature Database, and Cochrane Library, as well as the US Preventive Services Working Group, the American Cancer Society, the International Agency for Research on Cancer, the Australia Cancer Council and the International Guide Collaboration Network at the end of July 2018. The inclusion criteria were independent guidelines/recommendation documents for gastric cancer screening. The exclusion criteria were guideline abstracts, interpretation and evaluation literature, duplicate publications, updated original guidelines, and clinical treatment or practice guidelines for gastric cancer. The language was limited to Chinese and English. The European Guide to Research and Evaluation Tools (AGREE Ⅱ) and Practice Guideline Reporting Standard (RIGHT) for Gastric Cancer Screening Guidelines/Recommendations were used to compare and evaluate the quality and reporting standard of gastric cancer screening guidelines/recommendations. Results: A total of five guides/recommendations were included. The results of the AGREE Ⅱ quality evaluation showed that the overall quality of five guides/recommendations was different, including one recommended for "A", one for "B", and three for "C". Each guide/recommendation scored higher in the scope and purpose, clarity, and scores were more significant in the areas of rigor and independence. In the participants, the application field scores were generally low. The RIGHT evaluation results showed that the quality of five guides/recommendations should be improved. The six items with poor report quality were background, evidence, recommendations, review and quality assurance, funding and conflict of interest statement and management, and other aspects. Conclusion: The quality of the included gastric cancer screening guidelines/recommendations is generally low, and the standardization should be strengthened.


Asunto(s)
Detección Precóz del Cáncer/normas , Guías de Práctica Clínica como Asunto/normas , Neoplasias Gástricas/diagnóstico , China , Consenso , Detección Precóz del Cáncer/métodos , Humanos , Estándares de Referencia
8.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(3): 320-322, 2020 Mar 06.
Artículo en Chino | MEDLINE | ID: mdl-32187939

RESUMEN

From November to December of 2018, twenty 65-year-old or older women patients with knee osteoarthritis were recruited from the Department of Physical Therapy, the First Affiliated Hospital of Anhui Medical University. Meanwhile, twenty healthy 65-year-old or older women were recruited from the local community. The results showed that the knee contact angle of the patient group was more flexed (P=0.040), and the minimum angle of the knee joint increased (P=0.008) during the stance period compared to the healthy group. However, there was no significant difference in the maximum contact angle between the angle of hip and ankle joints. In addition, the tibialis anterior muscle of the patients was significantly smaller than the healthy group (P=0.023). Therefore, knee osteoarthritis could change the gait and muscle activity of older women, especially the knee joint.


Asunto(s)
Marcha , Articulación de la Rodilla/fisiopatología , Músculo Esquelético/fisiopatología , Osteoartritis de la Rodilla/fisiopatología , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Rango del Movimiento Articular/fisiología
9.
Zhonghua Shao Shang Za Zhi ; 36(0): E004, 2020 Feb 29.
Artículo en Chino | MEDLINE | ID: mdl-32111114

RESUMEN

2019 novel coronavirus (2019-nCoV) is one of the beta coronaviruses and was identified as the pathogen of the severe "coronavirus disease 2019 (COVID-19)" in 2019. China has formally included the 2019-nCoV in the statutory notification and control system for infectious diseases according to the Law of the People's Republic of China on the Prevention and Treatment of Infectious Diseases. Currently, the national defending actions on the 2019-nCoV in China is in a critical period. Burn Department is also confronted with risk of infection by the 2019-nCoV. According to the guidelines on the diagnosis and treatment of COVID-19 (6(th) trial edition), the latest relative literature at home and abroad, the features of the COVID-19, recommendations for the COVID-19 prevention and control issued by the National Health Commission of China, and management experience of diagnosis and treatment in the related disciplines, we put forward recommendations for the medical practices of burn treatment during the outbreak of the COVID-19 in outpatient and emergency treatment, inpatient treatment, operation and ward management, etc. We hope these recommendations could benefit the professionals of the same occupation as us and related hospital managers, improve the treatment of burn during the outbreak of the COVID-19, and avoid or reduce the risk of infection of medical staff .

10.
Artículo en Chino | MEDLINE | ID: mdl-32074744

RESUMEN

Objective: To explore the application of endoscopy and clinical effect of endoscopic resection of benign tumor in infratemporal fossa. Methods: The clinical data of 11 patients with benign tumors in infratemporal fossa admitted to the Department of Otorhinolaryngology Head and Neck Surgery and Skull Base Surgery of the Affiliated Hospital of Qingdao University from January 2016 to September 2018 were retrospectively analyzed. There were 6 males and 5 females, with the age ranging from 11 to 63 years old. The main clinical manifestations were pharyngeal foreign body sensation, submaxillary pain, maxillofacial numbness and tongue numbness. Imaging examination showed that the tumor was round and had a clear boundary with the surrounding tissue. All the patients underwent endoscopic surgery. Appropriate surgical approach was selected according to the location of the tumor and its relationship with the internal carotid artery. The endoscopic surgical approaches included trans-oropharyngeal approach in 7 cases, trans-lateral pterygomandibular raphe approach in 1 case and trans-medial pterygomandibular raphe approach in 3 cases. The pathological results, prognosis, complications and relapse of patients were summarized through descriptive statistics. Results: The tumors were completely resected under endoscope in all patients, and there was no significant complication occurred after surgery. The average pain VAS score was 3.1 after surgery and average hospital stay was 5.9 d. The postoperative pathological diagnoses consisted of 6 cases of pleomorphic adenoma, 4 cases of neurilemmoma and 1 case of basal cell adenoma. All patients were followed up regularly from 6 to 39 months without recurrence of tumor. Conclusion: Endoscopic resection of benign tumors in infratemporal fossa has the advantages of minimal damage, rapid recovery, few complications, and definite curative effect, which can be used as an important alternative for surgical treatment of benign tumors.


Asunto(s)
Endoscopía , Neoplasias de la Base del Cráneo/cirugía , Adenoma/cirugía , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Neurilemoma/cirugía , Estudios Retrospectivos , Adulto Joven
11.
Zhonghua Yi Xue Za Zhi ; 100(3): 197-201, 2020 Jan 21.
Artículo en Chino | MEDLINE | ID: mdl-32008286

RESUMEN

Objective: To explore the efficacy, adverse reactions, feasibility, and acceptability of transcranial alternating current stimulation (tACS) treating drug-naive adult patients with major depressive disorder (MDD), and provide basis for further study with a large sample. Methods: The study was performed in the Neuromodulation laboratory, Department of Neurology of Xuanwu Hospital, Capital Medical University (Beijing, China) from July, 2017 to June, 2018. Thirty Eligible first-episode MDD outpatients were randomized 1∶1 to receive active tACS or sham intervention. The tACS was administered in a 40 minute, 77.5 Hz frequency, 15 mA session with one forehead (Fp1, Fpz, and Fp2, in the 10/20 international placement system, 4.45 cm×9.53 cm) and two mastoid (3.18 cm×3.81 cm) stimulation for 20 times in 4 consecutive weeks at fixed day time frame once daily from Monday through Friday, with weekends off (week 4), followed by 4 weeks with no tACS treatment (week 8). By utilizing the Hamilton rating scale for depression-17 item (HRSD-17) to assess the depressive severity of MDD patients, adverse events were administered by the treatment-emergent adverse events, the Young mania rating scale, and the self-made common questionnaire on cranial electrical stimulation. The primary efficacy outcome was the remission rate defined as HRSD-17 score ≤7 at week 8. Secondary outcomes included the rates of remission at week 4 and response at weeks 4 and 8. Safety was assessed by evaluation of adverse events. Also the proportions of participants accepting the intervention and this study procedure were evaluated at weeks 4 and 8. Results: Thirty MDD patients completed the study, and both groups had no statistical differences on their demographic characteristics (P>0.05). At week 8, the active group had a remission rate of 10/15, which was higher than 3/15 in the sham group (P<0.05). Also, the remission rate (14/15) in the active group was higher than 5/15 of the sham group at week 4 (P<0.05). For the response rates, significant differences were found between groups at week 8. For safety, both groups showed no severe adverse events and no mania/hypomania. One participant per group had 2 times of tinnitus cerebri during the intervention days. All patients accepted the intervention and the study procedure. Conclusions: The pilot study indicated that tACS with 77.5 Hz and 15 mA may have a therapeutic effect on depressive symptoms. It is well-tolerated and safe, as well as feasible and acceptable for adults with MDD.


Asunto(s)
Trastorno Depresivo Mayor , Estimulación Transcraneal de Corriente Directa , Adulto , China , Trastorno Depresivo Mayor/terapia , Método Doble Ciego , Humanos , Proyectos Piloto , Resultado del Tratamiento
12.
Zhonghua Shao Shang Za Zhi ; 36(1): 24-31, 2020 Jan 20.
Artículo en Chino | MEDLINE | ID: mdl-32023714

RESUMEN

Objective: To analyze the distribution and drug resistance of pathogens isolated from patients with catheter-related bloodstream infection (CRBSI) in burn intensive care unit (BICU). Methods: From January 2011 to December 2018, among 2 264 patients who were peripherally inserted central venous catheter at the BICU of the First Affiliated Hospital of Army Medical University (the third Military Medical University), hereinafter referred to as the author's unit, 159 patients were diagnosed CRBSI, including 131 males and 28 females, aged 43 (1, 79) years. The pathogens primarily isolated from peripheral venous blood and central venous catheter blood/anterior central venous catheter specimen of patients with CRBSI were retrospectively analyzed. API bacteria identification kits and automatic microorganism identification instrument were used to identify pathogens. Broth micro-dilution method or Kirby-Bauer paper disk diffusion method was used to detect the drug resistance of the pathogens to 5 antifungal drugs including fluconazole and itraconazole, etc., and 37 antibacterial drugs including tigecycline and imipenem, etc. Modified Hodge test was used to further identify imipenem- and meropenem-resistant Klebsiella pneumonia. D test was used to detect erythromycin-induced clindamycin resistant Staphylococcus aureus. The WHONET 5.6 software was applied to analyze the annual incidence of CRBSI, mortality of patients with CRBSI, incidence of CRBSI cases, distribution of infection site, and duration of catheterization, detection of Gram-negative and Gram-positive bacteria, fungi, methicillin-resistant Staphylococcus aureus (MRSA), and methicillin-sensitive Staphylococcus aureus (MSSA), and drug resistance of fungi and major Gram-negative and Gram-positive bacteria to the commonly used antibiotics in clinic. Results: (1) The incidence of CRBSI was 7.0% (159/2 264) during the eight years, which was slightly higher in 2014 and 2017 with 13.6% (30/221) and 11.1% (24/217) respectively. The mortality rate of patients with CRBSI was 7.5% (12/159). (2) The incidence of CRBSI cases was 14.9% (338/2 264); the main infection site was femoral vein, totally 271 cases (80.2%), and the duration of catheterization of this site was 9 (2, 25) d. (3) During the eight years, totally 543 strains of pathogens were isolated, including 353 (65.0%) strains of Gram-negative bacteria, 140 (25.8%) strains of Gram-positive bacteria, and 50 (9.2%) strains of fungi. The top three isolated pathogens with isolation rate from high to low were Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa, accounting for 23.2% (126/543), 17.1% (93/543), and 15.7% (85/543), respectively. Fungi were mainly Candida parapsilosis. Among the Staphylococcus aureus, the detection rate of MRSA was 98.9% (92/93), and that of MSSA was 1.1% (1/93). (4) Except for the low drug resistance rates to polymyxin B, minocycline, and tigecycline, the drug resistance rates of Acinetobacter baumannii to the other antibiotics were considerably high (80.1%-100.0%). Pseudomonas aeruginosa was not resistant to polymyxin B but highly resistant to netilmicin (88.7%) and piperacillin (92.6%), with resistance rates to the other antibiotics from 34.5% to 62.7%. Klebsiella pneumoniae was not resistant to tigecycline and lowly resistant to imipenem and meropenem (28.9%, 9 imipenem- and meropenem-resistant strains were further confirmed by modified Hodge test), with resistance rates to the other antibiotics from 40.9% to 95.2%. The resistance rates of MRSA to most antibiotics were higher than those of MSSA. MRSA was not resistant to linezolid, vancomycin, teicoplanin, sulfamethoxazole, or tigecycline. The resistance rates of MRSA to clindamycin and erythromycin were 7.9% and 62.0%, respectively, and those to the other antibiotics were higher than 91.5%. Except for the complete resistance to penicillin G and tetracycline, MSSA was not resistant to the other antibiotics. Thirty-three strains of Staphylococcus aureus showed resistance to erythromycin-induced clindamycin. Fungi was not resistant to amphotericin B, with drug resistance rates to voriconazole, itraconazole, ketoconazole, and fluconazole from 4.2% to 6.2%. Conclusions: The incidence of CRBSI and mortality of patients with CRBSI are high in BICU of the author's unit, and the main infection site is femoral vein. There are various types of pathogens in patients with CRBSI, and most of them are Gram-negative. The top three isolated pathogens are Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa, accompanying with grim drug resistance phenomenon.


Asunto(s)
Bacteriemia , Staphylococcus aureus Resistente a Meticilina , Adolescente , Adulto , Anciano , Antibacterianos , Niño , Preescolar , Resistencia a Medicamentos , Farmacorresistencia Bacteriana , Femenino , Humanos , Lactante , Unidades de Cuidados Intensivos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
13.
Zhonghua Zhong Liu Za Zhi ; 42(1): 17-21, 2020 Jan 23.
Artículo en Chino | MEDLINE | ID: mdl-32023764

RESUMEN

Immune checkpoint inhibitors have been approved for clinical application in China. However, the increased immune-related adverse event (irAE) needs more attention. This review summarized the incidence, characteristic clinical manifestation and treatment of irAEs associated with programmed cell death protein-1(PD-1) and programmed cell death ligand-1(PD-L1) inhibitors. To have a deep insight into irAE, the potential mechanisms, the different incidences of cancer types, influencing factors and the direction of future research were also discussed here to provide guidance for clinical oncologist to identify and monitor irAE.


Asunto(s)
Inmunoterapia , Neoplasias , China , Humanos , Incidencia , Neoplasias/terapia
14.
Zhonghua Shao Shang Za Zhi ; 36(0): E002, 2020 Feb 20.
Artículo en Chino | MEDLINE | ID: mdl-32077677

RESUMEN

The prevention and control of novel coronavirus pneumonia (NCP) has already entered a key period . The patients treated in the burn and wound care ward are susceptible to viral infection because of disease, age and other factors, so it is very important to manage the burn and wound care ward during the prevention and control of NCP epidemic. In this paper, combining with the key clinical problems of prevention and control in hospital during the epidemic period of NCP infection, medical evidence, and clinical and management experience, the author formulates prevention and control management strategy of the author's unit in order to provide reference for prevention and control of burn and wound care ward.

15.
Sci Total Environ ; 716: 137132, 2020 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-32045768

RESUMEN

Reservoir bays, which are affected by the reservoir and watershed characteristics, are the initial and most sensitive areas in the evolution process of reservoir water quality. However, the relationship between the watershed characteristics and nitrogen and phosphorus concentrations in reservoir bays is poorly understood. We selected 66 bays from the Danjiangkou Reservoir and sampled twice per year (storage and discharge periods) from 2015 to 2018 to monitor the total nitrogen (TN) and total phosphorus (TP) concentration in the waterbodies of the reservoir bays. Four types of watershed characteristic indices (topographic variables, soil variables, land-use composition, and landscape patterns) around these bays were obtained. We quantified the relationship between the TN and TP concentrations and watershed characteristics in the waterbodies of the reservoir bays using partial least squares regression (PLSR). The results showed that the mean concentrations of TN and TP in the storage period (TN:1.69 mg·L-1, TP:0.088 mg·L-1) were higher than those in the discharge period (TN:1.22 mg·L-1, TP:0.063 mg·L-1). The optimal PLSR models explained 67.9% and 82.5% of the TN concentration variability, and 65.4% and 67.2% of the TP concentration variability during the storage and discharge period, respectively. Based on the variable importance in the projection (VIP) values, soil erodibility had significant effects on the TN and TP concentrations. The key factors affecting the TN concentration were the slope gradient, basin relief, topographic wetness index, forest and agricultural land use, whereas the factors controlling the TP concentration were the landscape shape index, edge density, Shannon's diversity index and grass land use, although the TP concentration was also controlled by the patch density and contagion during the storage period, and by mean patch size and largest patch index during the discharge period. This study provides critical insights into sustainable landscape planning and effective reservoir water quality management.

16.
Lupus ; 29(3): 290-302, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32041506

RESUMEN

BACKGROUND: The immune system is one of the most complex regulatory systems in the body and is essential for the maintenance of homeostasis. Despite recent breakthroughs in immunology, the regulation of the immune system and the etiology of autoimmune diseases such as lupus remain unclear. Systemic lupus erythematosus is a systemic autoimmune disease with abnormally and inconsistently expressed pro-inflammatory cytokines. Pyroptosis is a pro-inflammatory form of programmed cell death that is associated with systemic lupus erythematosus. The thymus and spleen are important immune organs involved in systemic lupus erythematosus. Therefore, this study investigated the difference in expression of pyroptosis-inducing pro-inflammatory cytokines between the spleen and thymus in lupus model mice and in control mice, to describe immune regulation at the organ level. OBJECTIVE: To investigate differences in the expression of pyroptosis-inducing cytokines in the spleen and thymus and to explore immune regulatory networks at the organ level. METHODS: Two groups of lupus mice and two groups of control mice were utilized for this study. Using the thymus and spleen of experimental animals, mRNA expression levels of five pyroptosis-inducing cytokines (interleukin 1ß, interleukin 18, NLRP3, caspase-1 and TNF-α) were determined via quantitative polymerase chain reaction. In addition, tissue distribution of these cytokines was investigated via immunohistochemistry. RESULTS: All five pyroptosis-inducing inflammatory cytokines showed higher expression in the spleen than in the thymus (p < 0.05). Moreover, the spleen/thymus expression ratios of all five pyroptosis-inducing cytokines were not statistically different between the four experimental groups. Expression of all five cytokines exhibited a stable ratio (spleen/thymus ratios). This distinctive stable spleen/thymus ratio was consistent in all four experimental groups. The stable spleen/thymus ratios of the five inflammatory cytokines were as follows: interleukin 1ß (2.02 ± 0.9), interleukin 18 (2.07 ± 1.06), caspase-1 (1.93 ± 0.66), NLRP3 (3.14 ± 1.61) and TNF-α (3.16 ± 1.36). Immunohistochemical analysis showed the cytokines were mainly expressed in the red pulp region of the spleen and the medullary region of the thymus, where immune-activated cells aggregated. CONCLUSION: The stable spleen/thymus expression ratios of pyroptosis-inducing cytokines indicated that immune organs exhibit strictly regulated functions to maintain immune homeostasis and adapt to the environment.

17.
Eur Rev Med Pharmacol Sci ; 24(3): 1325-1337, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32096162

RESUMEN

OBJECTIVE: LncRNA nuclear enriched abundant transcript 1 (NEAT1) has been reported to play an oncogenic role in the occurrence and development of diabetic nephropathy (DN). The aim of our study was to investigate the potential mechanism by which NEAT1 facilitates the progression of DN. PATIENTS AND METHODS: Quantitative Real-time polymerase chain reaction (qRT-PCR) was carried out to determine the abundance of NEAT1, kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), proliferating cell nuclear antigen (PCNA), Cyclin D1, P38, apoptosis signal-regulating kinase 1 (ASK1), Fibronectin, α smooth muscle actin (α-SMA) and miR-23c in the serum of DN patients, normal patients and mouse mesangial cells (MMCs). Cell proliferation was assessed by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), qRT-PCR and Western blot assays. Flow cytometry and Western blot were applied to measure apoptosis of MMCs. Cell fibrosis and epithelial-to-mesenchymal transition (EMT) were analyzed by qRT-PCR and Western blot. The binding sites between miR-23c and NEAT1 were predicted by starBase bioinformatics software, and the relationship was verified by dual-luciferase reporter assay. RESULTS: The enrichment of NEAT1 was elevated in the serum of DN patients and MMCs induced by high concentration of glucose. NEAT1 overexpression accelerated proliferation, fibrosis and EMT and restrained apoptosis of MMCs induced by high concentration of glucose. MiR-23c bound to NEAT1, and the inhibition of miR-23c counteracted the suppressive effect of NEAT1 depletion on proliferation, fibrosis and EMT of MMCs induced by high concentration glucose. CONCLUSIONS: LncRNA NEAT1 promoted proliferation, fibrosis and EMT while impeded apoptosis of MMCs through sponging miR-23c. LncRNA NEAT1 and miR-23c might be underlying therapeutic targets for the treatment of DN.

18.
Artículo en Inglés | MEDLINE | ID: mdl-31955469

RESUMEN

BACKGROUND: Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive type of haematologic precursor malignancy primarily often manifesting in the skin. We sought to provide a thorough clinical characterization and report our experience on therapeutic approaches to BPDCN. METHODS: In the present multicentric retrospective study, we collected all BPDCN cases occurring between 05/1999 and 03/2018 in 10 secondary care centres of the German-Swiss-Austrian cutaneous lymphoma working group. RESULTS: A total of 37 BPDCN cases were identified and included. Almost 90% of the patients had systemic manifestations (bone marrow, lymph nodes, peripheral blood) in addition to skin involvement. The latter presented with various types of cutaneous lesions: nodular (in more than 2/3) and bruise-like (in 1/3) skin lesions, but also maculopapular exanthema (in circa 1/6). Therapeutically, 22 patients received diverse combinations of chemotherapeutic regimens and/or radiotherapy. Despite initial responses, all of them ultimately relapsed and died from progressive disease. Eleven patients underwent haematopoietic stem cell transplantation (HSCT; autologous HSCT n = 3, allo-HSCT n = 8). The mortality rate among HSCT patients was only 33.33% with a median survival time of 60.5 months. CONCLUSION: Our study demonstrates the clinical diversity of cutaneous BPDCN manifestations and the positive development observed after the introduction of HSCT.

19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 44-50, 2020 Jan 25.
Artículo en Chino | MEDLINE | ID: mdl-31958930

RESUMEN

Objective: To summarize the experience of diagnosis and treatment of superior mesenteric artery compression syndrome (SMACS) secondary to chronic constipation according to the concept of Lee's triad syndrome. Methods: The concept of Lee's triad syndrome: (1) clinical symptoms: triad of constipation, malnutrition, upper gastrointestinal obstruction (vomiting, difficulty in eating); (2) anatomical manifestations: with triple anatomy anomaly of transverse colon sagging, elevated spleen flexure, and mesentery arterial compression; (3) treatment: with triple treatment of enteral nutrition support, chest-knee posture and fecal microbiota transplantation. A descriptive cohort study was performed. According to Lee's triad syndrome criteria, clinical data of 78 patients with superior mesenteric artery compression syndrome secondary to chronic constipation in the Tenth People's Hospital of Tongji University and General Hospital of Eastern Theater Command from June 2004 to November 2018 were prospectively collected, including basic information, symptoms and signs, imaging findings, nutritional indicators, gastrointestinal quality of life index (GIQLI) and Wexner defecation score. The above parameters based on Lee's triad syndrome criteria were followed up and recorded at 1, 3, 6, 12 months after comprehensive treatment. Results: All the patients had Lee's triple symptoms of constipation, malnutrition, upper gastrointestinal obstruction (vomiting, eating difficulties), and triple anatomy anomaly of transverse colon sagging, elevated spleen curvature, and mesentery arterial compression before treatment. After triple treatment of enteral nutrition support, chest-knee posture, and fecal microbiota transplantation, 69 (88.5%) patients had a significant improvement of symptoms, and 9 patients had no significant improvement of symptoms and then eventually received surgery. The 69 cases without operation received follow-up for 12 months. All the patients eventually returned to normal eating, and upper gastrointestinal angiography and superior mesenteric artery imaging showed duodenal compression disappeared. After 1 month, the constipation-related indexes were improved. After 12 months, the number of autonomous defecation per week increased from 1.0±0.8 to 5.0±1.6 (P<0.001). The GIQLI score increased from 52.7±8.5 to 93.2±7.5 (P<0.001), and the Wexner score decreased from 19.1±2.5 to 6.2±2.1 (P<0.001). After 1 month, nutritional indexes were improved gradually. After 12 months, the BMI increased from (17.9±1.8) kg/m(2) to (21.0±1.3) kg/m(2), total protein increased from (65.2±5.7) g/L to (68.3±4.2) g/L, albumin increased from (32.1±5.1) g/L to (40.4±3.0) g/L, prealbumin increased from (163.2±53.7) mg/L to (259.1±45.6) mg/L, fibrinogen increased from (1.9±0.5) g/L to (2.4±0.5) g/L, whose differences were statistically significant (all P<0.001). Upper gastrointestinal angiography and superior mesenteric artery imaging showed duodenal compression were relieved. The angle between superior mesenteric artery and abdominal aorta increased from (17.4±3.8)° to (37.8±5.8)° (t=-22.26, P<0.001). Conclusion: When patients with SMACS secondary to chronic constipation have Lee's triple symptoms and triple anatomy anomaly, the triple combination treatment of enteral nutrition support, chest-knee posture and fecal microbiota transplantation should be applied.


Asunto(s)
Estreñimiento/complicaciones , Síndrome de la Arteria Mesentérica Superior/diagnóstico , Síndrome de la Arteria Mesentérica Superior/terapia , Enfermedad Crónica , Estudios de Cohortes , Nutrición Enteral , Trasplante de Microbiota Fecal , Humanos , Posición de Rodillas al Pecho , Arteria Mesentérica Superior/diagnóstico por imagen , Calidad de Vida , Síndrome de la Arteria Mesentérica Superior/diagnóstico por imagen , Síndrome de la Arteria Mesentérica Superior/etiología , Síndrome , Resultado del Tratamiento
20.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 47-53, 2020 Jan 06.
Artículo en Chino | MEDLINE | ID: mdl-31914569

RESUMEN

Objective: To understand the health literacy and relevant factors of cancer prevention consciousness in Chinese urban residents from 2015 to 2017. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The self-designed questionnaire was used to collect the information of demographic characteristics and cancer prevention consciousness focusing on nine common risk factors, including smoking, alcohol, fiber food, food in hot temperature or pickled food, chewing betel nut, helicobacter pylori, moldy food, hepatitis B infection, estrogen, and exercise. The logistic regression model was adopted to identify the influencing factors. Results: The overall health literacy of the cancer prevention consciousness was 77.4% (24 980 participants), with 77.4% (12 018 participants), 79.9% (6 406 participants), 77.2% (1 766 participants) and 74.5% (4 709 participants) in each group (P<0.001). The correct response rates for nine risk factors ranged from 55.2% to 93.0%. The multivariate logistic regression analysis showed that compared with community residents, people with primary school level education or below, and the number of people living together in the family <3, the cancer risk assessment/screening intervention population, cancer patients, those with junior high school level educationor above and the number of people living in the family ≥3 had better health literacy of the cancer prevention consciousness (all P values <0.05). Compared with females, 39 years old and below, government-affiliated institutions or civil servants, from the eastern region, males, older than 40 years, company or enterprise employees, and from the middle or western region had worse health literacy of the cancer prevention consciousness (all P values <0.05). Conclusion: The health literacy of the cancer prevention consciousness in Chinese urban residents should be improved. The cancer screening intervention, gender, age, education, occupation, the number of people co-living in the family, and residential region were associated with the health literacy of the cancer prevention consciousness.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Alfabetización en Salud/estadística & datos numéricos , Neoplasias/prevención & control , Población Urbana , Adolescente , Adulto , China , Estudios Transversales , Femenino , Humanos , Masculino , Factores Socioeconómicos , Población Urbana/estadística & datos numéricos
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