Objective To investigate the high risk factors for pneumonia-related bloodstream infection (BSI) caused by Acinetobacter baumannii (AB) in ventilated patients. Methods A retrospective observation was conducted. The data of invasive-ventilated patients underwent AB pneumonia admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease from January 2011 to December 2015 were enrolled. The patients were divided into non-AB-BSI group and AB-BSI group. The following factors were evaluated including gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score at admission of intensive care unit (ICU), clinic pulmonary infection score (CPIS), underlying disease, neutropenia or agranulocytosis, hemoptysis, treatment of steroid or immunosuppressant in recent 3 months, central venous catheter (CVC), parenteral nutrition (PN), combined antibiotic therapy after the diagnose of AB pneumonia, duration of mechanical ventilation and the resistance of AB. The risk factors were analyzed by logistic regression analysis to confirm the independent high risk factors for the pneumonia-related BSI caused by AB in ventilated patients. Results 612 patients were enrolled, 561 patients in non-BSI group, and 51 in BSI group with 5-year BSI incidence of 8.3%. There was no significant difference in gender or age between the two groups. Compared with non-BSI group, the APACHE Ⅱ score (20.8±9.2 vs. 17.3±5.5) and CPIS (7.1±3.9 vs. 5.6±1.6) in BSI group were significantly increased (both P < 0.05). The patients with CPIS > 6 [80.4% (41/51) vs. 28.0% (157/561)], chronic obstructive pulmonary diseases [COPD, 86.3% (44/51) vs. 46.7% (262/561)], diabetes mellitus [DM, 25.5% (13/51) vs. 14.8% (83/561)] in BSI group were more than patients in non-BSI group, the incidence of heart failure [HF, 5.9% (3/51) vs. 23.5% (132/561)] was significantly decreased, and the incidence of hemoptysis [27.4% (14/51) vs. 3.4% (19/561)], therapy of steroid or immunosuppressant [19.6% (10/51) vs. 7.8% (44/561)] and duration of mechanical ventilation > 14 days [80.4% (41/51) vs. 48.5% (272/561)] were significant increased (all P < 0.05); no significant difference was found in other parameters between the two groups, including gender, age, other underlying diseases, neutropenia or agranulocytosis, CVC, PN, combined antibiotic therapy, and resistance of AB. It was showed by logistic regression analysis that CPIS > 6 [odds ratio (OR) = 2.513, 95% confidence interval (95%CI) = 1.400-20.439, P = 0.011], history of COPD (OR = 1.921, 95%CI = 0.068-5.603, P = 0.030), the treatment of steroid or immunosuppressant (OR = 2.012, 95%CI = 0.556-16.313, P = 0.021) and hemoptysis (OR = 1.866, 95%CI = 1.114-6.213, P = 0.037) were the independent risk factors for the pneumonia-related BSI caused by AB in ventilated patients. Conclusion CPIS > 6, history of COPD, the therapy of steroid or immunosuppressant and hemoptysis were the independent risk factors for the pneumonia-related BSI caused by AB in ventilated patients.

Objective To investigate the effect of the modified spontaneous breathing trail (SBT) on the weaning procedure for elderly ventilated patients with chronic obstructive pulmonary disease (COPD). Methods Ventilated acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients ready for SBT from January 2013 to November 2014 were enrolled and were divided into 2-hour SBT (conventional SBT) group and 6-hour SBT (modified SBT) group randomly. The following factors were recorded and analyzed: age, gender, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)score before SBT, mechanical ventilation time before SBT, the oxygenation index before SBT, rapid shallow breathing index (RSBI), maximum inspiratory pressure (MIP), the outcome of SBT and weaning, the ICU mortality and the length of stay in ICU. Results Forty-one cases were enrolled with 20 cases in 2-hour SBT group and 21 cases in 6-hour SBT group. Patients′age, gender, APACHE Ⅱ score before SBT, mechanical ventilation time before SBT, the oxygenation index before SBT, RSBI and MIP indicated no significant difference in two groups (P > 0.05). There was a significantly higher SBT successful rate (90.0%) in 2-hour SBT group than that in 6-hour SBT group (57.1%)(P = 0.018), but patients passing SBT successfully in 2-hour SBT group showed a significant lower weaning successful rate (72.2%) than those in 6-hour SBT group (100.0%)(P = 0.046). No significant difference was found in ICU morality and the length of stay in ICU in two groups (P > 0.05). Conclusions For elderly ventilated COPD patients , a modified SBT may serve as a useful procedure to predict weaning outcome which will increase the ICU mortality and the time of stay in ICU.

Objective To study the plasma TNF-α and endothelin (ET) levels in patient with subarach-noid hemorrhage(SAH). Methods The plasma TNF-α and ET levels were measured by ELISA and radioimmunity at 1,3,7,14 and 21 d after onset of SAH in 45 patients. Results The plasma TNF-α and ET levels in patients with SAH were higher than the normal controls(P<0.01),among which the highest levels appeared at 3 d and 7 d,and the levels of plasma TNF-α and ET in patients with SAH were decreased at 14 d. Those of high Hunt-Hess grade～groups was higher than those of lower grade～groups(P<0.01). Conclusion The plasma TNF-α and ET levels are significantly elevated in the patients with SAH,which suggests that TNF-α and ET may play an important role in the pathogenesis of SAH,and which suggests that is one of the possible ways to prevent and treat cardiovascular spasm (CVS) after SAH by inhibiting TNF-α and ET.

Objective To investigate the value of N-terminal pro-B type natriuretic peptide (NT-proBNP) in predicting the outcome of spontaneous breathing trial (SBT) in ventilated elderly renal dysfunction patients. Methods The clinical data of patients who received mechanical ventilation in the Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease from January 2011 to December 2014 were analyzed retrospectively. AU the patients conformed to the following criteria: age > 65 years, endogenous creatinine clearance rate (CCr) < 60 mL·min-1·1.73 m-2, the duration of mechanical ventilation > 72 hours and undergone at least one SBT. The patients were assigned to a SBT success group and a SBT failure group according to the outcome of first SBT. The following factors were recorded: gender, age, the underlying disease [chronic obstructive pulmonary disease (COPD), heart failure (HF) and others], body mass index (BMI), serum pre-albumin (pre-ALB), and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, CCr and the concentration of the plasma NT-proBNP before SBT. Receiver operator characteristic curve (ROC) was plotted, and the predict value of NT-proBNP for the outcome of SBT in elder patients with kidney dysfunction was determined. Results A total of 58 patients with complete data were enrolled, with 41 cases in SBT success group, and 17 in SBT failure group. There were no significant differences in gender [male/female (cases): 26/15 vs. 13/4, χ2 = 0.930, P = 0.335], age (years: 70.2±7.4 vs. 74.6±10.1, t = 0.833, P = 0.339), the stratification of underlying diseases [COPD/HF/COPD+HF/others (cases): 15/9/13/4 vs. 7/3/5/2, χ2 = 0.242, P = 0.971], BMI (kg/m2: 25.2±11.3 vs. 27.4±6.43, t = 1.038, P = 0.221), pre-ALB (mg/L: 201.0±13.2 vs. 189.0±7.6, t = 0.688, P = 0.519), and APACHE Ⅱ score (12.2±3.2 vs. 13.5±6.3, t = 1.482, P = 0.147) and CCr (mL·min-1·1.73 m-2: 51.3±7.7 vs. 54.2±6.4, t = 0.711, P = 0.487) before SBT between SBT success group and SBT failure group. The concentration of plasma NT-proBNP in SBT failure group was significantly higher than that of the SBT success group (μg/L: 4.162±1.128 vs. 2.284±1.399, t = 4.905, P = 0.000). The area under ROC curve for plasma NT-proBNP in predicting successful SBT among elder patients with kidney dysfunction was 0.878, with 95% confidence interval (95%CI) 0.786 - 0.970. The cut-off method was used, and it was identified that the concentration of NT-proBNP < 3.350 μg/L as a predictor for successful SBT, with sensitivity of 82.4%, specificity of 87.8%, positive prediction value of 88.1% and negative predictive value of 76.5%. Conclusion The concentration of plasma NT-proBNP may increase in elderly kidney dysfunction patients undergoing ventilation, and NT-proBNP < 3.350 μg/L can serve as a good predictor for SBT success.

Objective To introduce Curve Harmony Angle (CHA)to quantify the relationship between adjacent curves of the spine and pelvis and evaluate sagittal balance in spinal deformities. Methods Radiographic analysis of 93 asymptomatic vol-unteers and 95 patients including Degenerative Scoliosis(DS), Adolescent Idiopathic Scoliosis(AIS)and Ankylosing Spondylitis (AS)was performed by measuring sagittal parameters. Correlation study among parameters was further conducted. Curve Harmony Angles(CHAs)including the following three parameters were measured. Cervical-Thoracic Angle (CTA), Thoracic-Lumbar Angle (TLA) and Lumbar-Sacral Angle (LSA). Comparative study between normal population and different spinal disorders were per-formed in order to describe the characteristic changes of CHAs. Besides, according to Schwab SRS adult deformity classification, comparative study of CHAs in different balance status was performed to test the reliability of CHA on sagittal balance evaluation. Results All subjects showed typical changes of sagittal parameters. Different spinal disorders showed characteristic patterns of CHAs. In Schwab-SRS Adult Deformity Classification, Compensatory Balance group showed smaller LSA compared to Balance group;Imbalance group showed significantly smaller CTA, LSA and significantly greater TLA. Conclusion CHAs are parame-ters used to quantify the relationship between adjacent curves. Comparative study of CHA between normal population and different spinal disorder or among different balance status showed specific characters respectively. It is feasible to use CHA to evaluate the clinical sagittal balance and the results of deformity correction.

Tooth bleaching agents contain powerful oxidizing agents, which serve as the main part of bleaching agents because of its release of effective bleaching component. It has been a hot topic whether tooth bleaching agents exert negative influence on oral health. In order to provide train of thoughts and reference for further clinical researches and treatments, this review paper focuses on bleaching agents' effects on the growth of oral microbes and the formation of biofilms.
Bacteria ; drug effects ; growth & development ; Biofilms ; drug effects ; growth & development ; Humans ; Hydrogen Peroxide ; Mouth ; microbiology ; Oral Health ; Oxidants ; pharmacology ; Tooth Bleaching ; Tooth Bleaching Agents ; pharmacology

Objective:To investigate the incidence and risk factors of human cytomegalovirus (HCMV) reactivation in immunocompetent severe pneumonia patients with mechanical ventilation and their effects on clinical outcomes.Methods:A prospective observational study was conducted. Forty-eight immunocompetent patients requiring invasive mechanical ventilation due to severe pneumonia in the department of critical care medicine of the First Affiliated Hospital of Guangzhou Medical University from June 30th, 2017 to July 1st, 2018 were enrolled. Meanwhile, all cases were followed up until 90 days after inclusion and were required to quantitatively detect HCMV DNA in serum at regular weekly intervals until 28 days after transferring to intensive care unit (ICU). Patients were divided into HCMV reactivation group (≥5×10 5 copies/L) and non-reactivation group (<5×10 5 copies/L) based on HCMV DNA at any time point within 28 days. Demographic data, basic indicators, respiratory indicators, disease severity scores, laboratory indicators, complication and clinical outcomes of the two groups were collected and analyzed. Multivariate Logistic regression analysis was performed to screen independent risk factors for HCMV reactivation. Results:All 48 subjects were tested positive for HCMV immunoglobulin G (IgG), so HCMV seropositive rate was 100%. HCMV reactivation occurred in 10 patients within 28 days after admission to ICU, and the reactivation incidence of HCMV was 20.83%. There was no significant difference in gender, age, body mass index (BMI), underling disease reasons for ICU transfer (except sepsis), basic vital signs, disease severity scores, or laboratory findings including infection, immune, blood routine, liver, kidney and circulatory indicators except neutrophils count (NEU), hypersensitivity C-reactive protein(hs-CRP), hemoglobin (Hb), blood urea nitrogen (BUN), N-terminal pro-brain natriuretic peptide (NT-proBNP) between the two groups. The height (cm: 160±6 vs. 166±8), body weight (kg: 49.4±11.2 vs. 57.6±10.5), Hb (g/L: 87±18 vs. 104±24) in HCMV reactivation group were significantly lower than non-reactivation group, as well as NEU [×10 9/L:12.7 (9.9, 22.5) vs. 8.9 (6.2, 13.8)], hs-CRP [mg/L: 115.5 (85.2, 136.6) vs. 39.9 (17.5, 130.2)], BUN [mmol/L:13.7 (8.9, 21.5) vs. 7.1 (4.9, 10.5)] and NT-proBNP [ng/L: 6 751 (2 222, 25 449) vs. 1 469 (419, 4 571)] within 24 hours of admission to ICU. The prevalence of sepsis [60.0% (6/10) vs. 15.8% (6/38)], blood transfusion [100.0% (10/10) vs. 60.5% (23/38)], hospitalization expense [ten thousand yuan: 35.7 (25.3, 67.1) vs. 15.2 (10.4, 22.0)], 90-day all-cause mortality [70.0% (7/10) vs. 21.1% (8/38)], length of ICU stay [days: 26 (16, 66) vs. 14 (9, 19)], the duration of mechanical ventilation [days: 26 (19, 66) vs. 13 (8, 18)] in HCMV reactivation group were significantly higher than non-reactivation group, and there were significant statistical differences between the two groups (all P < 0.05). Logistic regression analysis showed that sepsis was an independent risk factor for HCMV reactivation in immunocompetent mechanical ventilation severe pneumonia patients with mechanical ventilation [odds ratio ( OR) = 9.35, 95% confidence interval (95% CI) was 1.72-50.86, P = 0.010]. Conclusions:HCMV infection is very common in immunocompetent severe pneumonia patients on mechanical ventilation and incidence of HCMV reactivation is high. Moreover, HCMV reactivation could adversely affect clinical prognoses, and sepsis may be a risk factor for HCMV reactivation.

Objective To investigate the effects of sepsis bundles in China.Method An observational study of 43 patients with severe pneumonia and septic shock admitted to the respiratory intertive care unit(1/11/2006-31/12/2007)was carried out.The selection criteria were in accordance with criteria set by International Conference On Sepsis in 2001.Implementation of 6 hours and 24 hours sepsis bundles was divided into 3 continu-ous phases consisting of education,trial,and application phase.A cohort of 43 patients with matched disease his-tory(1/1/2004-31/10/2006)was enrolled as control group.The percentages for categorical variables and mean±SD for continuous variables were reported.Chi-Square test.unpaired Student's t -test.paired-samples t test,univariate and multivariate logistic regression models were used.Statistical significance was defined as P＜0.05.Results There were very little significant differences in basic characteristics of patients between the two groups.Compared with control group,the differences in serrum lactate,fluid resuscitation and fluid volume infused within 6 hours and blood glucose control in shock subgroup were significant(P values were 0.024,0.009,0.045,and 0.000,respectively).Compared with control group,the differences in respiratory rate and oxygenation index of bundles group at 72 hours later were significant(P values were 0.033 and 0.041,respectively).Compared with control group,the differences in APACHE Ⅱ score and predicted mortality in shock subgroup of bundles were sig-nificant(P values were 0.017 and 0.040,respectively).Compared with control group,the reduction in absolute mortality was 23.30% in bundles group(P=0.019).Conclusions Implementation of sepsis bundles con-tributes noticeably to the significant reduction in mortality of patients with severe pneumonia and septic shock.

ObjectiveTo explore the effect of prone position ventilation (PPV) on respiratory mechanics and prognosis in patients with acute respiratory distress syndrome (ARDS) concurrent with interstitial lung disease (ILD). Methods The data of 36 severe ARDS patients admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University from February 2013 to January 2015, were retrospectively analyzed. They were then divided into two groups according to the presence of ILD or not. The changes in respiratory mechanics and oxygenation indexes were compared before and after PPV treatment in all the patients. Kaplan-Meier method was applied to draw the 60-day survival curves of both groups.Results There were 17 cases with ILD among these 36 severe ARDS patients.① No significant difference was found in baseline data between ILD group and non-ILD group.② Respiratory mechanics and oxygenation pre-PPV and post-PPV: compared with pre-PPV, oxygenation index (PaO2/FiO2, mmHg, 1 mmHg = 0.133 kPa) post-PPV was significantly increased in both groups [ILD group : 132.0 (93.5, 172.0) vs. 118.7 (92.0, 147.8); non-ILD group: 126.1 (100.9, 170.0) vs. 109.2 (89.0, 135.0), bothP< 0.05]. Compared with pre-PPV, positive end-expiratory pressure (PEEP, cmH2O,1 cmH2O = 0.098kPa) post-PPV was significantly higher in ILD group [10.0 (10.0, 12.0) vs. 10.0 (9.2, 12.0),P< 0.05], and respiratory rate (RR, times/min) was significantly lower in non-ILD group [24.5 (22.0, 27.0) vs. 25.5 (22.8, 28.0),P< 0.05]. The compliance of the respiratory system (Crs, mL/cmH2O) post-PPV in non-ILD group was significantly lower than that of the ILD group [19.7 (16.1, 28.6) vs. 23.0 (19.0, 29.7),P< 0.05].③ Respiratory mechanics and oxygenation pre-PPV and post-PPV in total: after all the PPV therapy, PaO2/FiO2 (mmHg) was significantly increased in non-ILD group [135.0 (86.0, 200.0) vs. 97.4 (69.2, 127.5), P< 0.05], PaO2/FiO2 after all the PPV therapy in non-ILD group was also higher than that in ILD group [135.0 (86.0, 200.0) vs. 78.7 (59.3, 114.9),P< 0.05]. No significant difference in Crs (mL/cmH2O) before PPV treatment was found between non-ILD and ILD groups [24.3 (15.9, 48.9) vs. 18.9 (12.7, 27.3),P> 0.05], and Crs was lower after PPV treatment in both groups, but without significant difference [non-ILD group: 22.7 (15.2, 27.1) vs. 24.3 (15.9, 48.9); ILD group: 16.2 (12.8, 25.6) vs. 18.9 (12.7, 27.3), bothP> 0.05].④ The 60-day mortality in ILD group was significantly higher than that in non-ILD group [88.2% (15/17) vs. 57.9% (11/19),P = 0.047). It was shown by Kaplan-Meier curves that 60-day survival patients in ILD group was significantly lower than those in non-ILD group (χ2 = 5.658,P = 0.017). Conclusions PPV can improve oxygenation in severe ARDS. Compared with non-ILD group, though the compliance of respiratory system in ILD group is increased during PPV, long-term effect is better in non-ILD group.

Objective:To investigate the relationship between serum matrix metalloproteinase-9 (MMP-9) level and the location and severity of bleeding in patients with cerebral microbleeds(CMBs).Methods:A total of 60 CMBs patients admitted to the Department of Neurology of the First Affiliated Hospital of the Xinxiang Medical University from January 2019 to August 2020 were selected as subjects as the CMBs group, and 60 healthy controls without nervous system diseases in outpatient physical examination during the same period were selected as the control group. The clinical data and biochemical indicators of the two groups were collected. Serum MMP-9 levels were measured by enzyme linked immunosorbent assay (ELISA). According to susceptibility weighted imaging (SWI), CMBs patients were divided into grade 1 group ( n=24), grade 2 group ( n=19) and grade 3 group ( n=17), and according to the micro analytical rating scale (MARS), the CMBs patients were divided into the lobar group ( n=19), the deep or infratentorial group ( n=17) and the mixed group ( n=24).The relationship between serum MMP-9 level and the location and severity of CMBs was analyzed. SPSS 19.0 software was used for data statistical analysis.One-way ANOVA, t-test and rank sum test were used for comparison. Logistic regression analysis was used to analyze the influencing factors. Pearson correlation analysis and Spearman correlation analysis were used for correlation analysis. Results:The level of MMP-9 in CMBs group was significantly higher than that in control group (208.13(142.25, 285.88) μg/L, 149.50(93.40, 186.51)μg/L), and the difference was statistically significant ( P<0.05). Serum MMP-9 level was a risk factor of CMBs ( β=1.322, OR=3.750, 95% CI=2.038-7.997, P=0.002). The difference of level of MMP-9 in different severity of CMBs was statistically significant (147.55(109.25, 266.47)μg/L, 242.12(147.55, 288.80)μg/L, 270.42(203.43, 364.27)μg/L, P=0.017). Serum MMP-9 level was positively correlated with the number of CMBs ( r=0.371, P=0.003). The difference of MMP-9 level of CMBs in different locations were statistically significant (249.77(158.43, 338.46)μg/L, 188.83(138.52, 243.15)μg/L, 210.65(144.25, 255.78)μg/L, P=0.013). The increased serum MMP-9 level was a risk factor for CMBs( β=0.401, OR=1.122, 95% CI=1.004-1.204, P=0.036). Conclusion:The increased level of serum MMP-9 may be a risk factor of CMBs, especially for CMBs in cerebral lobesand, and the level of MMP-9 is positively correlated with the severity of CMBs.