To investigate the spectrum of bacteria and fungi in different sites in severe acute pancreatitis (SAP).The prospective study was performed in 205 patients with SAP treated from January 2000 to December 2008. The Infection rate of bacteria and fungi was observed prospectively in pancreatic necrosis and(or) pus form abdomen, body fluids and deep vein catheter in SAP. Body fluids and pancreatic necrosis were cultured twice a week. Central venous catheter was cultured when it had been placed for two weeks. Blood was cultured for bacteria and fungi when body temperature was more than 39 degrees C. Constituent ratio of bacteria and fungi was observed in different sites and in all sites within 28 days after onset of SAP.There were 937 pathogens, among which infection rates of gram-negative bacteria was higher than gram-positive bacteria and fungi (P < 0.05), the infection rates of gam-positive bacteria and fungi were similar. Infection rates of gram-negative bacteria in pancreatic necrosis (55.2%), bile (55.4%), blood (68.1%) and central venous catheter (44.4%) were increased significantly (P < 0.05) compared with gram-positive bacteria and (30.2%, 33.9%, 23.4%, 38.9%) and fungi (14.6%, 10.7%, 8.5%, 16.7%); however, infection rate of fungi (59.6%) was increased significantly (P < 0.05) compared with gram-negative bacteria (24.0%) and gram-positive bacteria (16.3%) in urine; infection rate of gram-negative bacteria (53.2%) was significantly higher (P < 0.05) than that of fungi (27.1%) and gram-positive bacteria (19.7%) in sputum. Infection rate of non-zymogenic bacteria (Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia) in gram-negative bacteria in pancreatic necrosis, bile, blood, central venous catheter and sputum was significantly higher than that of zymogenic bacteria (Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae) (P < 0.01); infection rate of zymogenic bacteria (Klebsiella pneumoniae, Escherichia coli) was higher significantly (P < 0.01) than that of non-zymogenic bacteria (Pseudomonas aeruginosa, Acinetobacter baumannii). Infection rate of staphylococcus aureus, Staphylococcus epidermidis and Staphylococcus haemolyticus was significantly higher (P < 0.05) than that of Enterococcus faecalis and Enterococcus faecium in pancreatic necrosis and sputum;but infection rate of Enterococcus faecium in bile and urine was significantly higher than other gram-positive bacteria (P < 0.05). There was not difference among gram-positive bacteria;however, infection rate of Staphylococcus epidermidis in central venous catheter was increased significantly (P < 0.05). Infection rate of candida mycoderma in pancreatic necrosis, bile, urine and sputum was significantly higher than that of tricho bacteria (P < 0.05). The peak of infection rate of microbes in body fluid was within 2 to 3 weeks.Constituent ratio in gram-negative, gram-positive bacteria and fungi as well as their species in different sites is diverse. The peak of infection rate of microbes is 2 to 3 weeks after onset of the disease.
Objective: To understand the etiological characteristics of bacterial diarrhea in different areas, including large cities, mid-sized/small cities and rural area, in China. Methods: A cross-sectional surveillance was conducted in 17 provinces of China from 2010 to 2014. The acute diarrhea outpatients were selected from clinics or hospitals in large cities, mid-sized/small cities, including rural-urban fringe zones, and rural areas. The demographical and clinical characteristics of the patients were collected by using questionnaire, and stool samples were taken from them for laboratory detection of 17 kinds of bacteria. The differences in pathogen positive rates (PPR) and pathogen spectrum across the cases from three-type areas were compared. The different infection risk in different cases were analyzed with unconditional logistic regression model. Results: In our study, we enrolled 9 253 cases from large cities, 5 138 cases from rural areas and 13 683 cases from midsized/small cites. The pathogen with largest differences in infection rate across the three-type areas was Shigella (S.) flexneri (rural area: 5.81%, mid-sized/small city: 2.78%, large city: 0.46%), followed by Aeromonas (A.) hydrophila (rural area: 2.14%, mid-sized/small city: 0.96%, large city: 0.48%). Compared with cases in large cities, the cases in mid-sized/small cities and rural areas had higher infection risks for S. flexneri (mid-sized/small city: OR=6.481, 95%CI: 4.666-9.002, rural area: OR=11.304, 95%CI: 8.018-15.938) and A. hydrophila (mid-sized/small city: OR=1.992, 95%CI:1.401-2.832, rural area: OR=4.083, 95%CI: 2.833-5.884). The constituent ratio of diarrheagenic Escherichia coli and Salmonella increased with the urbanization development, while the ratios of Shigella and A. hydrophila had an opposite trend. S. sonnei (60.00%) was the predominant serogroup of Shigella in urban infections, while S. flexneri (77.37%) was the predominant serogroup in rural infections. Conclusion: The differences in pathogen spectrum of bacterial diarrhea were obvious across large cities, mid-sized/small cities and rural areas in China, especially the differences in the infection rates of S. flexneri and A. hydrophila.目的： 了解我国不同城乡类型地区细菌性腹泻病原谱流行特征。 方法： 基于2010－2014年我国17省份腹泻症候群感染性腹泻病原学监测。收集门/急诊因急性腹泻就诊病例，采集粪便标本，并进行包括基本人口学信息、临床症状特征等个案调查。对粪便标本进行17种常见致泻细菌病原体的病原学检测。按就诊医院类别将病例分为传统农村、中小城镇/城乡过渡带、大型城市3种类型，比较其病原体阳性率及病原谱构成差异。应用非条件logistic回归分析，比较3种类型病例感染的风险。 结果： 共纳入传统农村病例5 138例、中小城镇/城乡过渡带病例13 683例、大型城市病例9 253例，3种类型地区病例病原体阳性率城乡差异最大的为福氏志贺菌（阳性率依次为5.81%、2.78%、0.46%）和嗜水气单胞菌（阳性率依次为2.14%、0.96%、0.48%）。中小城镇/城乡过渡带、传统农村相对于大型城市病例感染各种细菌风险差异最大的为福氏志贺菌[OR值及其95%CI分别为6.481（4.666~9.002）、11.304（8.018~15.938）]和嗜水气单胞菌[OR值及其95%CI分别为1.992（1.401~2.832）、4.083（2.833~5.884）]。细菌病原谱中致泻性大肠埃希菌、沙门菌的构成比随城市化程度的提高而增加，志贺菌、嗜水气单胞菌则随城市化程度的提高而降低。志贺菌属血清群构成中大型城市以宋内志贺菌为主（60.00%），传统农村以福氏志贺菌为主（77.37%）。 结论： 我国不同城镇化水平地区细菌性腹泻病原谱流行特征存在明显差异，其中以福氏志贺菌和嗜水气单胞菌的差异最为显著。.
A novel vapor-generation technique is described for iodine determination in aqueous solutions. The iodide and iodate in the solution are converted to volatile iodine vapor through solution cathode glow discharge induced advanced redox processes. It is achieved by in situ produced highly reactive chemical species in the discharge, thereby eliminating the need for externally supplied sources of any redox reagents. Iodine vapor is readily generated from a background electrolyte containing 0.01 mol L−1 HNO3. The generated iodine vapor is then transported to inductively coupled plasma for determination by optical emission spectrometry. The influences of the background electrolyte, pH, discharge voltage, carrier gas flow rate and ICP power were examined. The detection limits of plasma induced vapor generation for KI and KIO3 were 0.30 and 0.43 μg L−1, respectively. The repeatability, expressed as the relative standard deviation (n = 11) of a 0.05 mg L−1 standard, was 1.2% for KI and 1.9% for KIO3. Compared with conventional vapor generation technology, it offers several advantages. First, it eliminates the need for redox regents, and thus minimizes a source of contamination as well as hazards. Second, it is applicable to both iodide and iodate determination. In addition to iodide, iodate could also be directly converted to volatile iodine vapor without prior reduction. The method is sensitive and simple in operation, and requires no auxiliary reagents, served as a useful alternative to conventional vapor generation for trace iodine determination.
3119 Background: Li-Fraumeni syndrome (LFS, OMIM #151623) is an autosomal dominant cancer predisposition syndrome. Typical LFS tumors comprise adrenocortical carcinomas, sarcoma, breast cancer and central nervous system tumors. LFS is also associated with an increased risk of a multitude of other common types of cancer, such as prostate cancer, lung cancer, gastric cancer, colorectal cancer, ovarian cancer, melanoma, etc. TP53 germline mutations are the most common gene with LFS. Germline mutations of CHEK2 have been identified as another predisposing gene and associated with a range of cancer types. However, the pattern of TP53 and CHEK2 germline mutations in malignant tumors remains unknown. Methods: We identified 8535 malignant solid tumors patients without selecting age or family history in a retrospective cohort. Germline mutations were categorized based on ACMG (American College of Medical Genetics and Genomics) guidelines in pathogenicity. The patients were divided into three groups, P group (with pathogenic mutations), LP group (with likely-pathogenic mutations) and Non_P group (neither pathogenic nor likely-pathogenic mutation). Statistical significance was defined as P-value less than 0.05. Results: A total of 461 (461/8535) patients carried TP53 or CHEK2 germline mutations were identified, in which 15 patients with pathogenic mutations and 17 patients with likely-pathogenic mutations. One patient with lung cancer in LP group carried TP53 homozygous mutation ( p. Ser215Ile), and the remaining 31 patients all carried heterozygous mutations. Among these 31 carriers, 16 (51.6%) carried nonsense or missense mutations (10 for nonsense and 6 for missense mutations). 3 patients in the P group carried CHEK2 p. Y139* (one liver cancer patient and two lung cancer patients) were identified. The median age of group P, LP and Non_P was 55 (39 for TP53, 61 for CHEK2), 63 (52 for TP53, 66 for CHEK2) and 59, respectively. Somatic mutation analysis found no significant difference in tumor mutation burden (TMB) among three groups. The SNV/INDEL mutation frequency of LRP1B in the P or LP group was significantly lower than the Non_P group. Conclusions: Our data showed that 0.375% (32/8535) malignant solid tumor patients carried TP53 (16/8535) or CHEK2 (16/8535) germline pathogenic or likely-pathogenic mutations. The relationship between germline mutations and cancer susceptibility will be studied in the future.[Table: see text]
By applying the PDCA model to the care of children with Henoch-Schonlein purpura, the nursing process can be divided into four stages: planning, execution, inspection, and treatment. According to the age characteristics and disease progression of pediatric patients, a complete nursing plan is formulated to efficiently implement the nursing content and improve the nursing effect. This paper studies the application of the PDCA nursing model in the nursing of children with Henoch-Schonlein purpura and statistically analyzes the disappearance of skin rash, joint pain relief, disappearance of urine protein, disappearance of gastrointestinal symptoms, etc. Finally, this paper combines the experiment to evaluate the intervention effect of this nursing model and provides reference for the follow-up care of children with Henoch-Schonlein purpura. From the results of experimental research, it can be known that PDCA nursing can improve the comfort of children with Henoch-Schonlein purpura, shorten the time for symptom disappearance, and speed up the recovery process.
Apatinib has been widely applied for the treatment of gastrointestinal cancer since its development; however, available conclusive data regarding its use in non‑small cell lung cancer (NSCLC) are lacking. Thus, the present meta‑analysis aimed to compare the efficacy and safety of the use of apatinib plus chemotherapy vs. chemotherapy alone for the treatment of patients with advanced‑stage NSCLC. Published studies reporting the treatment response, progression‑free survival (PFS), overall survival (OS) and adverse events in patients with advanced‑stage NSCLC treated with apatinib plus chemotherapy or chemotherapy alone were searched using the PubMed, China National Knowledge Infrastructure, EMBASE, Chongqing VIP Information, Cochrane and Wanfang databases until February 2023. Finally, 18 studies involving 677 patients with NSCLC receiving apatinib plus chemotherapy and 672 patients with NSCLC receiving chemotherapy were included in the present analysis. Apatinib plus chemotherapy was found to increase the objective response rate [relative risk (RR), 1.60; 95% confidence interval (CI), 1.38‑1.86] and disease control rate (RR, 1.29; 95% CI, 1.21‑1.38) compared to chemotherapy alone. Of note, apatinib plus chemotherapy also prolonged PFS compared with chemotherapy alone (hazard ratio, 0.54; 95% CI, 0.35‑0.73), while no OS data were retrievable from the included studies. With regard to safety, apatinib plus chemotherapy elevated the risk of developing hypertension (RR, 3.78; 95% CI, 1.81‑7.93) and hand‑foot syndrome (RR, 6.51; 95% CI, 3.70‑11.46) vs. chemotherapy alone; however, no difference was observed between the two regimens in terms of the incidence of other adverse events. Furthermore, the bias was low and the pooled findings were reliable/stable, as indicated by a sensitivity analysis. On the whole, the present study demonstrates that apatinib plus chemotherapy increases the treatment response and PFS vs. chemotherapy alone, while it also elevates the risk of developing hypertension and hand‑foot syndrome in patients with advanced‑stage NSCLC.
To investigate therapeutic strategy of fulminant acute pancreatitis (FAP) in acute response stage.Sixty-four patients were divided into Death group (27 patients) and Survival group (37 patients). The time course of shock and recovery of enteral function, parameters of fluid resuscitation, PaO(2)/FiO(2) and AaDO(2) at 24 hours prior to mechanical ventilation, rate of continuous venovenous hemofiltration (CVVH) and abdominal compartment syndrome (ACS), severity of the disease in the acute response stage were investigated. And the effect of surgical manner and time on the prognosis was also analyzed.Compared with Survival group, the time course of shock and recovery of enteral function in Death group were prolonged significantly (P < 0.05). Between the groups, there was no difference in the amount of crystal fluid infused from admission to 72 hours after, but the amount of colloid fluid infused and ratio of amount of colloid and crystal fluid in Survival group were higher (P < 0.05). The amount of fluid retention in third space from admission to 72 hours after in Death group was higher than that of Survival group significantly (P < 0.05). The fluid infusing rate in Survival group in the first day of admission was faster than Death group (P < 0.05). PaO(2)/FiO(2) and AaDO(2) in 24 hours prior to mechanical ventilation in Death group were negatively changed significantly. Within 72 hours after the onset of the disease, the rate of CVVH in Survival group was higher than Death group. Incidence rate of ACS and the APACHEII scores within 72 hours after admission in Death group were higher than in Survival group. The cure rate of the patients operated in the day 7 to day 14 after admission was higher than that of patients operated prior and post this period. Time for the first operation in operated patients was earlier than patients received minimally invasive drainage (MID) and its cure rate was lower than that of MID Group.It is the key point to shorten the time course of ischemia, to control persistent systemic inflammatory response syndrome (SIRS) and to adopt reasonable surgical intervention in acute response stage for FAP.
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Background This study was performed to construct and validate an early risk warning model of urinary tract infection in patients with neurogenic lower urinary tract dysfunction (NLUTD). Methods Eligible patients with NLUTD admitted to Shenzhen Longcheng hospital from January 2017 to June 2021 were recruited for model construction, internal validation and external validation. The first time point of data collection was within half a month of patients first diagnosed with NLUTD. The second time point was at the 6-month follow-up. The early warning model was constructed by logistic regression. The model prediction effects were validated using the area under the Receiver Operating Characteristic curve, the Boostrap experiment and the calibration plot of the combined data. The model was externally validated using sensitivity, specificity and accuracy. Results Six predictors were identified in the model, namely patients ≥65 years old (OR = 2.478, 95%CI [1.215– 5.050]), female (OR = 2.552, 95%CI [1.286–5.065]), diabetes (OR = 2.364, 95%CI) [1.182–4.731]), combined with urinary calculi (OR = 2.948, 95%CI [1.387–6.265]), indwelling catheterization (OR = 1.988, 95%CI [1.003 –3.940]) and bladder behavior training intervention time ≥2 weeks (OR = 2.489, 95%CI [1.233–5.022]); and the early warning model formula was Y = 0.907 × age+ 0.937 × sex + 0.860 × diabetes +1.081 × combined with urinary calculi+ 0.687 × indwelling catheterization+ 0.912 × bladder behavior training intervention time-2.570. The results show that the area under the ROC curve is 0.832, which is close to that of 1,000 Bootstrap internal validation (0.828). The calibration plot shows that the early warning model has good discrimination ability and consistency. The external validation shows the sensitivity is 62.5%, the specificity is 100%, and the accuracy is 90%. Conclusion The early warning model for urinary tract infection in patients with NLUTD is suitable for clinical practice, which can provide targeted guidance for the evaluation of urinary tract infection in patients with NLUTD.
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