Objective:To analyze the clincial characteristics and laboratory findings of patients with neurobrucellosis (NB).Methods:Using retrospective analysis, clinical diagnosed patients with NB from June 2016 to February 2019 in Heilongjiang Agricultural Reclamation Bureau General Hospital were selected to analyze the general characteristics, clinical symptoms, laboratory examination results [white blood cell (WBC), hemoglobin(Hb), c-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein (TP), albumin (ALB), cerebrospinal fluid routine and biochemical, serum tube agglutination test (SAT), blood culture and cerebrospinal fluid culture of Brucella] , diagnosis and treatment effect. Results:A total of 25 patients were diagnosed with NB, including 19 males and 6 females, with an average age of (41.7 ± 14.2) years old, ranged from 11 to 70 years old. The main clinical symptoms were fever, headache, joint pain, vomiting and sweating, which accounted for 92.0% (23/25), 88.0% (22/25), 76.0% (19/25), 64.0% (16/25), and 64.0% (16/25), respectively. Positive neck ankylosis and mumbness of lowerlimbs were both 9 cases (36.0%), and mental disorders were 7 cases (28.0%). In 25 patients with NB, the WBC increased in 5 cases (20.0%), Hb decreased in 4 cases (16.0%), CRP increased in 13 cases (52.0%), ALT and AST both increased in 6 cases (24.0%), TP decreased in 21 cases (84.0%); SAT was positive in 25 cases (100.0%), cerebrospinal fluid SAT positive in 7 cases (28.0%); and blood culture was positive in 2 cases (8.0%). Cerebrospinal fluid changes were mainly manifested in 14 cases (56.0%) of chloride reduction, 13 cases (52.0%) of gluose reduction and 19 cases (76.0%) of protein increase. In 25 patients with NB, 17 cases were treated with doxycycline + rifampicin + ceftriaxone, 7 cases with etimicin + rifampicin + ceftriaxone, and 1 case with doxycycline + rifampicin + piperacillin sulbactam. After 6 to 12 months follow-up, 21 cases recovered well, whereas mild sequelae were observed in 4 patients.Conclusion:Clinical features of NB are hetorogeneous, and nerurological symptoms and cerebrospinal fluid examination are of great value in the diagnosis of NB.

Objective:To investigate the clinical characteristics and influencing factors of mortality in patients with intra-abdominal candidiasis (IAC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 203 IAC patients who were admitted to 7 medical centers from June 2018 to June 2020 were collected, including 54 cases in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, 31 cases in Fujian Medical University Union Hospital, 25 cases in Beijing Hospital, 25 cases in the First Affiliated Hospital of Xi'an Jiaotong University, 24 cases in China-Japan Friendship Hospital, 22 cases in General Hospital of Eastern Theater Command of Chinese PLA and 22 cases in Chongqing University Cancer Hospital. There were 130 males and 73 females, aged (64±15)years. Observation indicators: (1) candida infection and treatment of IAC patients; (2) analysis of influencing factors for mortality of IAC patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analyses were performed by Logistic regression model. Results:(1) Candida infection and treatment of IAC patients: 134 cases of candida albicans were cultured in the initial abdominal drainage fluid or intraoperative abdominal specimens of 203 patients, and 49 cases were treated with fluconazole. Of 69 cases infected with non candida albicans, 13 cases were treated with fluconazole. The resistance rate of candida albicans to fluconazole was 5.91%(12/203). Of 203 patients, there were 68 cases with infections shock, 53 cases with renal failure, 84 cases with respiratory failure and 63 cases with multiple organ failure, respectively. There were 148 of 203 patients admitted to intensive care unit for 9 days(range, 3-20 days), and the total hospital stay was 28 days(range, 17-50 days). Of 203 patients, 86 cases were cured and discharged, 50 cases were improved and transferred to local hospitals, 32 cases gave up treatment and discharged automatically, 19 cases died, 16 cases had no follow-up data. The mortality was 25.12%(51/203). (2) Analysis of influencing factors for mortality of IAC patients. Results of univariate analysis showed that acute physiology and chronic health evaluation score, sequential organ failure assessment score, the Cr, bilirubin, albumin, procalcitonin, and PLT on the first day of candida positive culture, of the lowest value in a week and the highest in a week, heart disease, diabetes, infections shock, renal failure, respiratory failure, multiple organ failure, anti-fungal therapy were the related factors for mortality of IAC patients ( t=-2.322, Z=-2.550, -2.262, -4.361, t=2.085, Z=-3.734, -5.226, -2.394, -5.542, t=3.462, Z=-4.957, -5.632, 3.670, -5.805, t=3.966, Z=-3.734, -5.727, χ2=4.071, 4.638, 27.353, 18.818, 13.199, 26.251, 13.388, P<0.05). Multivariate analysis showed that the bilirubin, procalcitonin on the first day of candida positive culture and infections shock were independent risk factors for mortality of IAC patients ( odds ratio=1.021, 1.022, 6.864, 95% confidence interval as 1.010-1.033, 1.001-1.044, 1.858-25.353, P<0.05). Conclusions:The common fungus of IAC was candida albicans, and fluconazole can be used as the initial empirical treatment. The prognosis of patients with abdominal candidiasis is poor. Bilirubin, procalcitonin on the first day of candida positive culture and infections shock are indepen-dent risk factors for mortality of IAC patients.

SARS-CoV-2 can cause multiple organ injuries in some susceptible people in a short time, which seriously threatens the health and safety of people, and intensive care and multiple extracorporeal organ support are important means of treatment. Although many experts’ consensus and clinical guidelines have been published, a series of clinical problemsstill exist during the treatment procedure, and no consensushas not been reached until now. Therefore,in this paper wemake some reflections and explorations to provide experience and help for clinicians.

Objective:To investigate the clinical significance of six serological methods for diagnosis of brucellosis.Methods:Totally 160 cases of brucellosis patients were selected as the case group and 235 cases of health medical examiners were selected as the control group from January to June 2018 in Heilongjiang Agricultural Reclamation Bureau General Hospital. Six methods were used for detection of brucellosis, including Rose Bengal plate agglutination test (RBPT), fluorescence polarization assay (FPA), indirect enzyme linked immunosorbent assay (iELISA), cysteine agglutination test, standard tube agglutination test (SAT), and anti-globulin test (Coomb's). The consistency of the 4 preliminary screening methods (RBPT vs FPA, iELISA, cysteine agglutination test), and 2 diagnosis methods (SAT vs Coomb's) was compared, and the sensitivity, specificity, rates of missed diagnosis and misdiagnosis were analyzed. Results:In the preliminary screening methods, the consistency of RBPT with FPA and iELISA was relatively consistent (Kappa = 0.872, 0.784), and the consistency with cysteine agglutination test was generally consistent (Kappa = 0.543). In the diagnosis methods, the consistency between SAT and Coomb's was relatively consistent (Kappa = 0.861). The sensitivity of FPA, iELISA, cysteine agglutination test and Coomb's was 91.03%, 75.00%, 56.41% and 80.14%, respectively. The specificity was 95.81%, 100.00%, 98.74% and 100.00%, respectively. The rates of missed diagnosis were 8.97%, 25.00%, 43.59% and 19.86%, respectively. The rates of misdiagnosis were 4.19%, 0, 1.26%, and 0, respectively.Conclusions:FPA and iELISA have high sensitivity and specificity, and are suitable for clinical promotion. The combined detection of multiple serological methods will reduce the probability of misdiagnosis and missed diagnosis of brucellosis, thereby improving the diagnostic level of brucellosis.

Objective To evaluate the clinical efficacy and safety of continuous renal replacement therapy (CRRT) in patients with severe acute pancreatitis (SAP) receiving percutaneous drainage (PCD). Methods Clinical data of SAP patients receiving PCD admitted to department of hepatobiliary surgery of the First Affiliated Hospital of Xi'an Jiaotong University from November 11th 2015 to May 13th 2018 were retrospectively analyzed. The patients were divided into CRRT group and control group according to whether or not receiving CRRT. Demographic data, relevant variables before and after PCD, complication and outcome were all compared. Results A total of 75 patients were included in the study, 30 were treated with application of CRRT and 45 without CRRT. ① There was no significant difference in gender, age, body mass index (BMI), medical history (smoking, drinking), complications (cardiovascular disease, chronic lung disease, diabetes, chronic renal insufficiency), etiology (gallstone, alcohol abuse, hyperlipidemia and others), or white blood cell count (WBC), C-reactive protein (CRP), serum procalcitonin (PCT), fluid resuscitation, mechanical ventilation, vasoactive agent or intra-abdominal pressure within 48 hours after admission between the two groups. However, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score within 48 hours after admission of CRRT group was significantly higher than that of control group (18.3±4.5 vs. 12.8±6.2, P < 0.05). ② There was no significant difference in WBC, PCT, APACHEⅡ score or computed tomography severity index (CTSI) before PCD between the two groups. There was no significant difference in the position or times of PCD procedure between the two groups, but the time interval of PCD in the CRRT group was significantly longer than that in the control group (days: 19.4±5.4 vs. 12.8±2.2, P < 0.05). Meanwhile, there was no significant difference in drainage of fluid properties, incidence of abdominal bleeding, infection, gastrointestinal fistula, endoscopic removal of necrotic tissue, laparotomy for removal of necrotic tissue or the time from PCD to endoscopy or laparotomy between two groups. However, the length of intensive care unit (ICU) stay and the length of hospital stay in the CRRT group were significantly longer than those in the control group (days: 23.2±8.5 vs. 15.3±12.1, 51.2±21.2 vs. 31.2±14.0, both P < 0.01). ③ Kaplan-Meier survival analysis showed that there was no significant differences in 1-year or 3-year cumulative survival rates between the two groups (χ21 = 0.097, P1 = 0.755; χ22 = 0.013, P2 = 0.908). Conclusions CRRT is safe and feasible in the treatment of SAP patients receiving PCD procedure. It does not increase the risk of bleeding and may delay the time interval of PCD intervention. However, it may prolong the length of ICU stay and the length of hospital stay. It should be worthy of much attention for clinicians.

Objective To evaluate the efficacy and safety of oXiris hemofilter for septic shock patients. Methods Clinical data of septic shock patients receiving continuous renal replacement therapy (CRRT) with oXiris hemofilter in department of surgical intensive care unit (SICU) of the First Affiliated Hospital of Xi'an Jiaotong University from March 1st, 2018 to July 20th, 2019 were retrospectively analyzed. The heart rate (HR), mean arterial pressure (MAP), oxygenation index (PaO2/FiO2), lactate (Lac), platelet count (PLT), serum procalcitonin (PCT), interleukin-6 (IL-6) and C-reactive protein (CRP), noradrenaline (NE) dosage, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) and sequential organ failure score (SOFA) were compared before and after oXiris treatment and the prognosis were also analyzed. Results Six patients with septic shock were included [5 males, the average age was (56.3±11.8) years old]. A total of 13 oXiris hemofilter sets were performed during treatment. Compared with before treatment, the HR, IL-6 and CRP levels were significantly decreased after treatment [HR (bpm): 93.8±9.7 vs. 133.5± 18.3, IL-6 (ng/L): 509.2±169.6 vs. 3739.8±618.2, CRP (mg/L): 169.1±148.3 vs. 277.8±68.7, all P < 0.05], MAP, PaO2/FiO2 and PLT were significantly increased [MAP (mmHg, 1 mmHg = 0.133 kPa): 73.3±2.2 vs. 63.3±1.6, PaO2/FiO2 (mmHg): 166.8±40.4 vs. 95.1±56.2, PLT (×109/L): 73.3±27.5 vs. 41.2±21.4, all P < 0.05]; meanwhile, NE dosage, APACHEⅡ and SOFA scores were significantly decreased [NE (μg·kg-1·min-1): 0.4±0.3 vs. 1.2±0.7, APACHEⅡ:18.8±6.9 vs. 30.0±7.3, SOFA: 11.7±4.2 vs. 17.3±2.1, all P < 0.05]. Although Lac and PCT decreased after treatment, there was no significant difference [Lac (mmol/L): 3.5±2.1 vs. 6.1±3.2, PCT (μg/L): 37.7±48.3 vs. 85.1±32.8, both P > 0.05]. At the end, 3 of the 6 patients survived and the others were discharged again medical advice. The length of SICU stay was 3 to 23 days, with an average of (13.0±8.5) days. No adverse events occurred during the treatment. Conclusion oXiris hemofilter can effectively remove inflammatory mediators in circulation, significantly improve hemodynamic status and severity, and may be considered as a safe and reliable treatment modality for septic shock patients.

Objective: To evaluate the efficacy and safety of oXiris hemofilter for septic shock patients. Methods: Clinical data of septic shock patients receiving continuous renal replacement therapy (CRRT) with oXiris hemofilter in department of surgical intensive care unit (SICU) of the First Affiliated Hospital of Xi'an Jiaotong University from March 1st, 2018 to July 20th, 2019 were retrospectively analyzed. The heart rate (HR), mean arterial pressure (MAP), oxygenation index (PaO₂/FiO₂), lactate (Lac), platelet count (PLT), serum procalcitonin (PCT), interleukin-6 (IL-6) and C-reactive protein (CRP), noradrenaline (NE) dosage, acute physiology and chronic health evaluationⅡ(APACHEⅡ) and sequential organ failure score (SOFA) were compared before and after oXiris treatment and the prognosis were also analyzed. Results: Six patients with septic shock were included [5 males, the average age was (56.3±11.8) years old]. A total of 13 oXiris hemofilter sets were performed during treatment. Compared with before treatment, the HR, IL-6 and CRP levels were significantly decreased after treatment [HR (bpm): 93.8±9.7 vs. 133.5±18.3, IL-6 (ng/L): 509.2±169.6 vs. 3 739.8±618.2, CRP (mg/L): 169.1±148.3 vs. 277.8±68.7, all P < 0.05], MAP, PaO₂/FiO₂ and PLT were significantly increased [MAP (mmHg, 1 mmHg = 0.133 kPa): 73.3±2.2 vs. 63.3±1.6, PaO₂/FiO₂ (mmHg): 166.8±40.4 vs. 95.1±56.2, PLT (×10⁹/L): 73.3±27.5 vs. 41.2±21.4, all P < 0.05]; meanwhile, NE dosage, APACHEⅡ and SOFA scores were significantly decreased [NE (μg·kg^-1·min^-1): 0.4±0.3 vs. 1.2±0.7, APACHEⅡ: 18.8±6.9 vs. 30.0±7.3, SOFA: 11.7±4.2 vs. 17.3±2.1, all P < 0.05]. Although Lac and PCT decreased after treatment, there was no significant difference [Lac (mmol/L): 3.5±2.1 vs. 6.1±3.2, PCT (μg/L): 37.7±48.3 vs. 85.1±32.8, both P > 0.05]. At the end, 3 of the 6 patients survived and the others were discharged again medical advice. The length of SICU stay was 3 to 23 days, with an average of (13.0±8.5) days. No adverse events occurred during the treatment. Conclusion oXiris hemofilter can effectively remove inflammatory mediators in circulation, significantly improve hemodynamic status and severity, and may be considered as a safe and reliable treatment modality for septic shock patients.

Objective: To analyze the epidemiologic and clinical features of preschool children with brucellosis, and improve awareness of brucellosis and level of diagnosis. Methods: In-patients treated for brucellosis in preschool children from December 2016 to November 2018 in Heilongjiang Agricultural Reclamation Bureau General Hospital were retrospectively analyzed for epidemiology, clinical feature, laboratory data, treatment and prognosis. Results: There were 29 males and 16 females among the 45 preschool children brucellosis cases, with an average age of (3.7 ± 1.6) years old, ranged from 6 months to 6 years old. The patients of > 3-6 years old of age had the highest incidence (64.44%, 29/45). The patients were mainly rural residents (97.78%, 44/45). The onset time was mainly from March to June of the year (46.67%, 21/45). Clinical symptoms were mostly fever and joint pain, which accounted for 97.78% (44/45) and 57.78% (26/45), respectively. And lymph node enlargement and hepatosplenomegaly were also commonly seen, which accounted for 42.22% (19/45) and 35.56% (16/45). After treatment, the test results of patients with alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine kinase isoenzyme (CK-MB), α-hydroxybutyrate dehydrogenase (HBDH) and lactate dehydrogenase (LDH) were compared with those of before the treatment, the differences were statistically significant (t=4.774, 2.970, 2.229, 5.664, 5.805, P < 0.05). Before the treatment, 36 patients (80.00%, 36/45) had positive blood culture, which turned negative after the treatment. Conclusions The epidemiologic and clinical features of preschool children with brucellosis are not typical. In the epidemic area of the disease and multiple seasons, for children with unexplained fever, the clinician should inquire about the epidemiological history and combine the clinical feature, consider the possibility of brucellosis, and strive for early diagnosis and treatment.

Objective: To investigate the safety and feasibility of laparoscopic remedial surgery in patients who didn′t reach the cure criterion of early colorectal cancer after endoscopic resection. Methods: The clinical and follow-up data of 12 patients who didn′t reach the cure criterion of early colorectal cancer and then underwent endoscopic resection was collected. The clinicalpathological features and remedial indications were analyzed to evaluate the effects of laparoscopic remedial surgery. Results: The average number of lymph nodes in the lymph node dissection was 15 during remedial surgery, and 3 of them had lymph node metastasis. Among the 3 patients with residual cancer, two cases were poorly differentiated, 1 case was moderately differentiated, 1 case was positive for basal margin, and 1 case had vascular invasion. No lymph node metastasis occurred in the 9 patients who had no residual cancer. Among these, 8 cases were moderately differentiated, 1 case was poorly differentiated and 2 cases had positive basal margin. The average follow-up duration was 40 months and all 12 patients were in a state of survival at the last follow-up. During the follow-up of the 3 patients with residual cancer, 1 patient received adjuvant chemotherapy with unknown prognosis; 1 patient received postoperative adjuvant radiochemotherapy, and lung metastasis occurred; 1 patient did not receive any treatment after surgery and survived for 33 months. Conclusions Laparoscopic remedial surgery is a safe and feasible remedy for patients who didn′t reach the cure criterion of early colorectal cancer after endoscopic resection. However, the choice of remedial strategy for colorectal carcinoma needs further investigation for patients with no vascular invasion, high degree of differentiation, and negative basal margin.