OBJECTIVE To investigate the cause and and prevention experience of lung infection in the aged patients with gastrogavage at home.METHODS Retrospective analysis of lung infection was proceeded in 108 aged patients with gastrogavage at home during three years.RESULTS Among 108 patients with gastrogavage at home 83 patients developed infection in which 69 patients developed lung infection.For the aged patients with gastrogavage at home,inspiration and increasing incidence of retrograde infection from stomach to pharynx and lower respiratory tract were the main causes in developing lung infection.Moreover the lower immunity status,catching cold,changing the stomach tube not on time were the related risk factors in developing lung infection.CONCLUSIONS Enhancing the prevention of respiratory tract infection,increasing the nutrition,changing the stomach tube in time and prevention education would effectively decrease the incidence of infection and enhance the rehabilitation.

OBJECTIVE To investigate the nosocomial infection circumstance in the acute cerebral vascular accident(CVA) in recently two years,and explore the risk factors of nosocomial infection,so that can obtain the methods of controlling the infection.METHODS An restrospective analysis of nosocomial infection circumstance had been accomplished among 656 acute CVA cases from our department ward from Jul 2004 to Jun 2006.RESULTS It was showed cases with nosocomial infection were found among 656 cases.The nosocomial infection rate was 32.67% among inpatients of acute CVA.Nosocomial infection mostly took place within the first 2 weeks after patients hospitalized.Among inpatients with nosocomial infection,the lower respiratory tract infection was the highest(59.15%),the second one was the urinary tract(16.90%).Pathogenic bacteria were mostly the conditional ones.Nosocomial infection was closely related with such factors as the invasive operation,disorder of consciousness,diabetes,age,chronic bronchitis,antibiotic prophylaxis,hospitalization days,and plasma total protein.CONCLUSIONS Nosocomial infection is still a high frequent complication in acute CVA and those related factors should be paid attenion.It is the most important step for the effective control of nosocomial infection and rehabilitation of acute CVA.

OBJECTIVE To investigate the cause and prevention experience of acquired lung infection(ALI) in neurological medicine department for patients with indwelling stomach tube.METHODS Retrospective analysis proceeded for all patients with indwelling stomach tube in recently two years.RESULTS Among 113 patients,87 patients developed hospital infection in which 57 patients with indwelling stomach tube developed ALI,that occupied 65.52% of total patients developing hospital infection.CONCLUSIONS For the patients with indwelling stomach tube,inspiration and increasing incidence of retrograde infection from stomach to pharynx and lower respiratory tract in sequence are the main causes developing ALI.In addition,the use of anti-acid drugs,the unreasonable use of antibiotics,and the patients immunity status are the related factors developing ALI.Enhancement of prevention of respiratory tract infection in neurological medicine department for patients with indwelling stomach tube would effectively decrease the incidence of infection and enhance rehabilitation.

Objective To investigate and analyze the health care seeking behavior,financial burden and relative factors of patients with rheumatic diseases in Fujian Province.Methods Patients diagnosed with rheumatic diseases were investigated in Fujian Provincial Hospital from December 2013 to February 2014,including demographic data,health care seeking behavior and financial burden.Relevant factors were analyzed by Logistic regression.Results ① In this study,474 patients were enrolled.The ratio of male to female was 1∶2.38.② At the onset of symptoms,51.9％(246 cases) of patients visited a doctor as soon as possible,and 36.1％(171 cases) of them went to hospital within a month after disease onset.③ 74.1％(351 cases) of patients could adhere to medication regimen prescribed by doctors,and the most common reason for stopping medication was symptoms relieved (33.3％,41 cases).④ 63.1％(299 cases) of patients learned about the knowledge of rheumatic diseases from hospitals and doctors.⑤ 34.2％(162 cases) of patients spent 1 000-5 000 yuan every month on treatment.⑥ Insurance type could affect the time of first visit to hospital (P=0.004),while income and cost of therapy might impact patients' compliance (P=0.013,P=0.004).Conclusion Most patients will go to hospital as soon as possible and adhere to treatment.Economic situation is the main factor influencing health care seeking behavior of patients with rheumatic diseases.

BACKGROUND:Animal model of infection is established using bioluminescent gene-labeled bacteria, which stimulate local environment of spine infection and reveal the pathophysiological mechanism of spine infection.
OBJECTIVE:To evaluate the feasibility and safety of anterior one-stage debridement, autogenous iliac bone grafting and titanium plate internal fixation in the management of pyogenic spinal infections in spine.
METHODS:Total y 24 Chinese dogs were adopted in the study to develop a canine model of acute pyogenic spondylodiscitis using a bioluminescent strain of Staphylococcus aureus Xen29. The animal models were detected by X-radiography, CT and MRI examinations. After 4 weeks of modeling, al the animals underwent one-stage debridement, autogenous iliac bone grafting and anterior titanium plate internal fixation. Antibiotics contained Cefazolin and Gentamicin were administrated daily since perioperative period to 4 weeks after surgery. The titanium plate and adjacent vertebra were removed surgical y at various postoperative time points (4, 8, 12, 24 weeks) when the dogs were kil ed. The excised tissues and retrieved implants were cultured with conventional bacteria, bacteria 16S rRNA and specific Nuc gene of Staphylococcus aureus. PCR and bioluminescence imaging technique were used to detect the presence of bacteria.
RESULTS AND CONCLUSION:The surgical wound was healed uneventful y. Gross observation and MRI examination of the specimens showed that there was no abscess formation or signs of infection recurrence. The infection rate was 41.7%(10/24) and 75%(18/24) in the procedure of conventional bacteria and bacteria 16S rRNA cultivation. The results showed that the sensibility of PCR technique used to detect the presence of bacteria by amplifying the highly conservative gene sequence of 16S rRNA was significantly higher than that of conventional bacterial cultivation procedure (P<0.05). The PCR detection of specific Nuc gene of Staphylococcus aureus showed the existence of Staphylococcus aureus (1/24). However, Staphylococcus aureus Xen29 with genetic marker was not detected around the implant by bioluminescence imaging technique (0/24). Al of the results showed that bacterium adhering to prosthesis in vivo is an universal phenomenon. The bacteria identified from prosthesis which was taken during the surgery and the bacteria by which the spine was infected before the surgery was not homologous. The one-stage debridement, autogenous bone grafting and anterior titanium plate internal fixation is safe and effective in the management of pyogenic spinal infections. Using of internal fixator can not lead to recurrence or persistence of infection.

Objective To analyze the clinical features of 6 patients with imported schistosomiasis mansoni,including the epidemic history,clinical manifestations,laboratory tests and therapeutic effect,so as to provide references for improving the levels of diagnosis and treatment of physicians. Methods The clinical data of 6 patients with imported schistosomiasis mansoni from January 2009 to July 2016 were collected and analyzed. Results All the 6 imported patients with schistosomiasis mansoni had a clear history of cercarial infested water exposure. The main manifestations were continuous fever and eosinophilia. Three (50%)patients were accompanied with diarrhea. Anti-Schistosoma japonicum IgG antibody were cross positive in 2(33.3%)pa-tients,while live eggs of S. mansoni were explored in intestinal mucosa specimens of all the patients. CD3+CD8+T cell ratio was decreased significantly but B cell ratio was elevated in all the patients,and the main immunoglobulin of the patients was IgG. Hydroperitoneum and splenomegaly signs were discovered by abdominal ultrasonography in 16.6%(1/6)of the patients. Multi-ple liver nodules and wall thickening of rectum and sigmoid colon were revealed by pelvic MR scan in 16.6%(1/6)of the pa-tients. Colitis was found in all the patients,and 66.6%(4/6)of the patients were combined with multiple colonic ulcers by the electronic colonoscopy examination. Chronic inflammation and eosinophil infiltration were found in all the patients by rectum pa-thology. All 6 patients were cured with chemotherapy named praziquantel. Conclusion Comprehensive analysis of clinical data including epidemiological history,specific manifestations,laboratory tests and intestinal mucosa pathology may be benefit of the management of schistosomiasis mansoni.

Objective: To investigate the incidence and prognosis of hypophosphatemia in critically ill children treated with continuous blood purification (CBP). Methods: The medical records of the critically ill patients, who were treated with CBP, admitted to pediatric intensive care unit (PICU) of Shanghai Children's Hospital from May 2014 to April 2017 were retrospectively analyzed. The serum phosphorus levels were tested before CBP, at 48-72 h during CBP, at the end of CBP and on the next day after CBP finished. Phosphorus supplement was given to the children with severe hypophosphatemia. Results: A total of 85 patients met the inclusion criteria. The serum phosphorus levels at the 4 indicated time points were (1.4±0.5), (0.7±0.3), (0.8±0.3), (0.9±0.4) mmol/L, respectively (F=45.21, P<0.05). Among the children, 66 cases (78%) had hypophosphatemia during CBP. The incidences of moderate and severe hypophosphatemia were 32 (48%) and 9 (14%), respectively. There were 41 patients with CBP replacement rates of (35-49) ml/(kg·h), while 44 patients with CBP replacement rates of 50-70 ml/(kg·h). There were significant differences at 48-72 h during CBP, the end of CBP and on the next day after CBP ((0.8±0.4) vs. (0.5±0.2), (1.0±0.3) vs. (0.6±0.2), and (1.1±0.4) vs. (0.8±0.2) mmol/L; t=7.672, 4.060, 14.440, P<0.05). Atotal of 9 cases were treated with sodium glycerophosphate. Among the 85 children, 24 (28%) patients died while 61 (72%) survived. There were no significant differences between the two groups in serum phosphorus levels at the indicated time points ((1.4±0.5) vs. (1.4±0.5), (0.7±0.3) vs. (0.7±0.3), (0.7±0.3) vs. (0.8±0.3), and (1.0±0.3) vs. (0.9±0.3) mmol/L, respectively, P>0.05). Conclusions Hypophosphatemia is prone to occur during CBP, which probably related to the replacement rate. There was no significant relationship between hypophosphatemia and mortality in critically ill children after giving phosphorus supplementation.

Objective:To evaluate the predictive value of lung ultrasound on mortality in children with severe acute respiratory distress syndrome (ARDS) undergoing extracorporeal membrane oxygenation (ECMO) support.Methods:A prospective observational study was used to enroll patients with severe ARDS who met the Berlin criteria in the Pediatric Intensive Care Unit of Children’s Hospital of Shanghai Jiao Tong University from January 2016 to December 2019. Patients with ECMO support <3 d, lack of appropriate acoustic windows, with severe pneumothorax, and secondary to congenital heart disease or chronic lung disease were excluded. ECMO parameters, respiratory mechanics parameters and outcome were collected and analyzed. Lung ultrasound score (LUS) was measured at the initiation of ECMO as LUS-0 h, then at 24 h, 48 h, 72 h, and 7 d after ECMO support as the value of LUS-24 h, LUS-48 h, LUS-72 h, LUS-7 d, as well as after weaning ECMO as LUS-w. The patients were divided into survivors and non-survivors according to hospital survival status. Receiver operating characteristic (ROC) curve and Kaplan-Meier survival analysis curve were performed to explore the predictive value of lung ultrasound on mortality in patients with severe ARDS undergoing ECMO.Results:A total of 26 patients were enrolled in this study, of which 18 patients survived and 8 died. There were no significant differences in PRISM Ⅲ, dynamic pulmonary compliance (Cdyn), oxygenation index, PaO 2/FiO 2, and PaCO 2 on PICU admission between the two groups (all P>0.05). The values of LUS-72 h and LUS-w in non-survivors were significantly higher than those in survivors [26 (24, 29) vs16 (13, 19), P<0.01] and [30 (26, 35) vs11 (10, 13), P<0.01]. The values of Cdyn-72 h, Cdyn-7 d and Cdyn-w in survivors were significantly higher than those in non-survivors [0.48 (0.42, 0.54)mL/cmH 2O·kg vs 0.36 (0.29, 0.40) mL/cmH 2O·kg, P<0.01; 0.60 (0.52, 0.67) mL/cmH 2O·kg vs 0.27 (0.13, 0.30) mL/cmH 2O·kg, P<0.01, and 0.66 (0.62, 0.70) mL/cmH 2O·kg vs 0.30 (0.13, 0.35) mL/cmH 2O·kg, P<0.01]. ROC curve analysis showed that an area under ROC curve (AUC) of LUS-72 h for predicting PICU mortality was 0.955 (95% CI: 0.864-1.000; P<0.01). The cutoff value of LUS-72 h was 24 with a sensitivity of 87.5% and a specificity of 100.0%. Kaplan-Meier survival analysis showed that PICU mortality of patients with LUS-72 h≥24 was significantly higher than that in patients with LUS-72 h < 24 ( P<0.01) . Conclusions:Lung ultrasound is an effective tool for monitoring progress of children with severe ARDS received ECMO support. LUS-72 h >24 is an index to predict the worsen outcome in children with severe ARDS under ECMO support.

Objective:To investigate the effects of therapeutic plasma exchange(TPE)as adjuvant therapy in children with myasthenia gravis(MG)in pediatric intensive care unit(PICU).Methods:A retrospective study was conducted in 7 children with MG admitted to PICU at Shanghai Children′s Hospital from January 2016 to December 2019.TPE was performed on unsatisfactory effect of acetylcholinesterase inhibitors, glucocorticoids or IVIG.The TPE dose was 50-70 mL/kg for 2 to 3 times for each case.The clinical symptoms, anti-acetylcholine antibody(AChR-Ab)level and prognosis were measured before and after TPE.Results:Seven children with myasthenia gravis admitted to PICU from January 2016 to December 2019, including 4 cases of systemic myasthenia gravis(1 case of myasthenia crisis with respiratory failure)and 3 cases of ocular myasthenia gravis.The AChR-Ab level decreased from 1.66(0.99, 3.33)nmol/L before TPE to 0.66(0.40, 10.97)nmol/L after TPE( Z=-2.545, P=0.011). The symptoms of muscle weakness and blepharoptosis were partially or completely relieved in 7 cases.There were no significantly changes in the levels of circulating immune complex, complement C3, CD4 + , CD8 + and NK cells before and after TPE(all P>0.05). During the process of TPE, 2 cases had mild rash, and 1 case had hypotensive shock, which were recovered after timely treatment.After TPE, the fibrin levelsdecreased from 1.90(1.40, 2.40)g/L to 1.10(1.00, 1.30)g/L( Z=-3.092, P=0.002). Conclusion:TPE reduce the AChR-Ab levels and improve the short-term symptoms in children with myasthenia gravis who have failed conventional treatment.TPE may be an optional therapy for pediatric severe MG.

OBJECTIVE: To analyze the accuracy of free-hand thoracic pedicle screw placement in severe idiopathic scoliosis via CT scan. METHODS: Twenty patients with complete CT data were chosen out of 58 patients of severe idiopathic scoliosis from June 1996 to December 2006. The Cobb angle of the main thoracic curve was from 82 degree to 142 degree (96.3 degree +/- 14.3 degree). The kyphotic angle in the main curve was 66.2 degree +/- 12.4 degree. The placement of thoracic pedicle screw was completed free-handedly, and the accuracy of screws placement was evaluated with CT thin-slice scan postoperatively. RESULTS: Altogether 174 thoracic pedicle screws were inserted, 157 (90.2%) of which were fully contained within the cortical boundaries of the pedicle.The other 17 screws (9.8%) were misplaced in 9 patients: 11 screws (6.8%) were lateral, 9 of which had a breach 0.05). There was no neural complication in all patients. CONCLUSION It is fairly accurate place thoracic pedicle screw in severe idiopathic scoliosis free-handedly, with some misplacements.
Adolescent ; Bone Screws ; Female ; Humans ; Male ; Orthopedic Procedures ; methods ; Scoliosis ; diagnostic imaging ; pathology ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult