Objective To establish the model of invasive pulmonary aspergillosis (IPA) and assay the influence on the host defense against Aspergillus infection when immunity was suppressed in mice.Methods Immunocompromised mice were made by treatment with cyclophosphamide administered intraperitoneally (i.p.).Suspension of conidia was applied to the nostrils of mice to make the model of IPA.Lungs were harvested and homogenized.Portions of homogenates were cultured to determine the number of CFU.IFN-? in bronchoalveolar lavage fluid was determined by a cytokine-specific ELISA kit.Reverse transcription PCR (RT-PCR) analysis was done to determine the mRNA of IFN-? in lung cells.Mortality of different rice was calculated.Results Compared with immunocompetent mice,the immunocompromised mice demonstrated a high mortality and had significantly higher concentration of infectious Aspergillus organisms in their lung tissues.In accordance with the increase of Aspergillus organisms,the levels of IFN-? in lung tissues got higher.Lung sections from immunocompromised mice revealed patterns of lesions characterized by signs of bronchial wall damage,peribronchial necrosis,and the presence of numerous infiltrating inflammatory cells.Conidia and hyphae were seen in these mice.In contrast,these features were not observed in immunocompetent mice whose lungs were characterized by few inflammatory cells infiltration,and few fungal growth after inoculation.Conclusion The levels of IFN-? in lung tissues are related to the infectious Aspergillus organisms.The immunity and T cells play a major role in host defense against Aspergillus infection.

ObjectiveTo predict the opportunity of infection and evaluate the severity of illness and prognosis for patients with lower resp iratory tract infections in intensive care unit (ICU) using the acute physiology and chronic health evaluation Ⅲ (APACHEⅢ) MethodsThe clini cal data of 115 cases with infections of pseudomonas aeruginosa (PA) in lowe r respiratory tract and 116 cases without PA infections were analyzed and evalua ted with APACHEⅢ score system ResultsAPACHEⅢ scores of non -survivors were significantly higher than those of survivors [(55 29?15 83) vs (25 97?14 39),P

OBJECTIVE To evaluate the bioequivalence and safety of two k inds of Nadroparin calcium injection in healthy Chinese volunteers by subcutaneous injection. METHODS According to the block randomization method ，24 Chinese healthy adult volunteers were included and divided into TR （test preparation-reference preparation ）group and RT （reference preparation-test preparation）group at a ratio of 1∶1. A randomized ，open-labelled，single-dose and two-cycle crossover study was designed ，the fasting subjects of two groups were given test or reference preparation 6 150 AⅩaIU subcutaneously on the first day of each cycle and exchanged in the second cycle ，and the wash-out period was 7 days. The blood samples were collected at different time points before and after administration. The activity of anti-coagulant factor Ⅹa（Anti-Ⅹa）and Anti- Ⅱa in human plasma were determined by chromogenic substrate method ，and the pharmacodynamic parameters were calculated according to the non-atrioventricular model and the bioequivalence was evaluated. The occurrence of adverse events （AEs）was recorded. RESULTS After administration ，the main pharmacodynamic parameters for Anti- Ⅹa activity of test preparation and reference preparation were as follows ：t1/2 were（4.87±1.06） and（4.03±1.00）h，tmax were 4.50（2.00，8.00）and 5.50（2.50，8.00）h，Anti-Ⅹamax were（0.66±0.12）and（0.56±0.11）IU/mL；main pharmacodynamic parameters of Anti- Ⅱa activity of two preparations were as follows ：t1/2 were（3.64±1.60）and（5.74±7.23）h，tmax were 4.00（2.50，8.00）and 4.00（2.00，8.00）h，Anti-Ⅱamax were both （0.10±0.03）IU/mL. The values of 90％confidence interval of geometric mean ratio of Anti- Ⅹamax，AUEC0－t and AUEC 0－∞ were 110.98％-123.50％，112.11％-121.24％and 111.57％-120.00％， respectively. During experiment ，14 subjects reported 19 cases of mild AEs ，among which hematoma ，purpura and maculopapular rash may be related to drugs ；no serious AEs were observed. CONCLUSIONS The domestic Nadroparin calcium injection is bioequivalent to the reference preparation ，and both of them show good safety.

Objective: To explore and analyze the effect of comprehensive nursing care in endoscopic treatment of esophageal and gastric varicose bleeding. Methods: A retrospective analysis of 60 cases of patients with esophageal and gastric varicose hemorrhage admitted to the hospital was conducted. The patients were randomly divided into 30 cases of control group and 30 cases of observation group. Routine nursing and comprehensive nursing were adopted respectively to evaluate different nursing effects. Results: Intraoperative and postoperative heart rate of the observation group (91.0 ± 4.0) times/min, (89.2 ± 4.2) times/min, which were lower than (98.0 ± 4.2) times/min, (94.7 ± 4.5) times/min of the control group. There was statistically significant difference (t values were 6.610, 4.894, P < 0.05). The bleeding prevention effectiveness rate of the observation group (93.33%, 28/30) was higher than the control group (73.33%, 22/30), The difference was statistically significant (χ² value was 4.32, P < 0.05). The total nursing satisfaction rate (100.00%, 30/30) in the observation group was higher than that in the control group (86.70%, 26/30), the difference was statistically significant (χ² value was 4.29, P< 0.05). Quality of life, disease cognition, compliance behavior, proper rest, self-protection, General Quality of life Inventory (GQOLI) score in the observation group were (33.5 ± 3.5), (21.5 ± 3.7), (32.5 ± 2.8), (21.5 ± 3.3), (22.0±4.2), (130.2 ± 17.4) points, which were higher than those in the control group (28.2 ± 3.2), (17.5 ± 2.5), (28.5 ± 3.0), (17.2 ± 3.0), (18.0 ± 3.0), and (110.2 ± 15.2) points. The differences were statistically significant (t values were 4.245-6.121, P<0.05). Conclusions Endoscopic treatment of esophageal and gastric varicose bleeding patients combined with comprehensive nursing intervention, can effectively prevent the occurrence of rebleeding, improve the quality of life of patients. The application effect is significant.

Diabetes, obesity, and metabolic diseases are globally prevalent, and induction and increase of endogenous energy consumption, especially activation of brown adipose tissue (BAT), is a new therapeutic target. Non-invasive imaging techniques, including radionuclide imaging, MRI, ultrasound imaging, and optical imaging, have attracted wide attention in BAT monitoring and have good application prospects. This article reviews the progress and application of these imaging techniques in BAT monitoring.

Objective: To analyze the risk factors of delirium in intensive care unit (ICU) patients, and to investigate the predictive value of C-reactive protein (CRP), procalcitonin (PCT), lactic acid (Lac) and neuron-specific enolase (NSE) in the diagnosis of ICU delirium. Methods: The patients admitted to central ICU and respiratory medicine ICU of Changzhou First People's Hospital from August 2016 to November 2017 were enrolled. The patients were divided into two groups according to whether delirium occurred within 7 days or not, which was evaluated by using the confusion assessment method for ICU (CAM-ICU). The gender, age and blood CRP, PCT, Lac, NSE levels were compared between the two groups. Multivariate Logistic regression model was used to analyze the risk factors of ICU delirium. Receiver operating characteristic curve (ROC) was drawn to assess the predictive value of CRP, PCT, Lac and NSE in the occurrence of ICU delirium. Results: 133 patients were enrolled. Delirium occurred in 67 patients, and did not occurred in 66 patients, with a prevalence rate of 50.4%. There was no significant difference in gender or age between the two groups. Compared with non-delirium group, blood CRP, PCT and Lac levels in delirium group were significantly increased [CRP (mg/L): 110.75±77.31 vs. 51.32±36.51, PCT (μg/L): 3.95 (1.01, 23.90) vs. 0.09 (0.06, 0.36), Lac (mmol/L): 2.40 (1.70, 4.30) vs. 1.20 (0.90, 2.00), all P < 0.01], but no significant difference was found in NSE [μg/L: 12.59 (9.61, 17.69) vs. 13.39 (10.14, 19.05), P > 0.05].② It was shown by multivariate Logistic regression analysis that blood PCT and Lac were risk factors of ICU delirium [PCT: odds ratio (OR) = 1.185, 95% confidence interval (95%CI) = 1.006-1.396, P = 0.042; Lac: OR = 1.398, 95%CI = 1.011-1.934, P = 0.043].③ROC curve analysis showed that blood CRP, PCT and Lac had certain predictive value for ICU delirium, and the area under the ROC curve (AUC) of PCT was the highest (0.840 vs. 0.694 and 0.751). When the cut-off value of PCT ≥ 0.55 μg/L, the sensitivity was 72.7%, the specificity was 86.2%, positive predictive value was 84.48%, and negative predictive value was 75.68%. Blood NSE had no predictive value for ICU delirium (AUC = 0.446, P = 0.290). Conclusions Blood PCT and Lac are the risk factors of ICU delirium. PCT has predictive value for ICU delirium.

OBJECTIVETo characterize the differences between clinical manifestations in immunocompromised patients (ICPs) and non-immunocompromised patients (non-ICPs) with tuberculosis.

METHODSUnderlying diseases, clinical presentations, misdiagnosis, treatment and prognosis, etc, were analyzed retrospectively in 115 tuberculosis patients, including 39 ICPs and 76 non-ICPs.

RESULTSCompared with non-ICPs, the individuals who were ICP had more expectoration (64.1% vs 35.5%), pulmonary moist rale (41.0% vs 9.2%), miliary pulmonary tuberculosis (30.8% vs 2.6%), pleural effusion (48.7% vs 25.0%) and lymphadenopathy (18.0% vs 4.0%). ICPs had less lung cavity (15.4% vs 22.4%) and pleural thickening (15.4% vs 23.7%) compared to non-ICPs. Pulmonary tuberculosis in ICPs was prone to be misdiagnosed as pneumonia (23.1% vs 6.6%). Pulmonary tuberculosis was found in the apicoposterior segment (SI + SII) in more cases in non-ICPs (21.7%, 10/46) than ICPs (10.3%, 3/29). The diagnostic value of tuberculin skin test and adenosine deaminase in pleural effusions was limited in ICPs. ICPs had significantly poorer prognoses than non-ICPs.

CONCLUSIONThe clinical manifestations of ICPs with tuberculosis are atypical, misdiagnosis often occurs, resulting in a worse prognosis.

Adult ; Aged ; Female ; Humans ; Immunocompromised Host ; physiology ; Male ; Middle Aged ; Tuberculosis, Lymph Node ; diagnosis ; Tuberculosis, Miliary ; diagnosis ; Tuberculosis, Pulmonary ; diagnosis ; physiopathology

OBJECTIVE: To analyze the risk factors of delirium in intensive care unit (ICU) patients, and to investigate the predictive value of C-reactive protein (CRP), procalcitonin (PCT), lactic acid (Lac) and neuron-specific enolase (NSE) in the diagnosis of ICU delirium. METHODS: The patients admitted to central ICU and respiratory medicine ICU of Changzhou First People's Hospital from August 2016 to November 2017 were enrolled. The patients were divided into two groups according to whether delirium occurred within 7 days or not, which was evaluated by using the confusion assessment method for ICU (CAM-ICU). The gender, age and blood CRP, PCT, Lac, NSE levels were compared between the two groups. Multivariate Logistic regression model was used to analyze the risk factors of ICU delirium. Receiver operating characteristic curve (ROC) was drawn to assess the predictive value of CRP, PCT, Lac and NSE in the occurrence of ICU delirium. RESULTS: 133 patients were enrolled. Delirium occurred in 67 patients, and did not occurred in 66 patients, with a prevalence rate of 50.4%. (1) There was no significant difference in gender or age between the two groups. Compared with non-delirium group, blood CRP, PCT and Lac levels in delirium group were significantly increased [CRP (mg/L): 110.75±77.31 vs. 51.32±36.51, PCT (μg/L): 3.95 (1.01, 23.90) vs. 0.09 (0.06, 0.36), Lac (mmol/L): 2.40 (1.70, 4.30) vs. 1.20 (0.90, 2.00), all P < 0.01], but no significant difference was found in NSE [μg/L: 12.59 (9.61, 17.69) vs. 13.39 (10.14, 19.05), P > 0.05]. (2) It was shown by multivariate Logistic regression analysis that blood PCT and Lac were risk factors of ICU delirium [PCT: odds ratio (OR) = 1.185, 95% confidence interval (95%CI) = 1.006-1.396, P = 0.042; Lac: OR = 1.398, 95%CI = 1.011-1.934, P = 0.043]. (3) ROC curve analysis showed that blood CRP, PCT and Lac had certain predictive value for ICU delirium, and the area under the ROC curve (AUC) of PCT was the highest (0.840 vs. 0.694 and 0.751). When the cut-off value of PCT ≥ 0.55 μg/L, the sensitivity was 72.7%, the specificity was 86.2%, positive predictive value was 84.48%, and negative predictive value was 75.68%. Blood NSE had no predictive value for ICU delirium (AUC = 0.446, P = 0.290). CONCLUSIONS Blood PCT and Lac are the risk factors of ICU delirium. PCT has predictive value for ICU delirium.
C-Reactive Protein ; Calcitonin ; Calcitonin Gene-Related Peptide ; Delirium ; Humans ; Intensive Care Units ; Prognosis ; Retrospective Studies ; Sepsis

Objective: To explore the association between inflammation activity of left atrial epicardial adipose tissue (LA-EAT) measured by ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) and atrial fibrillation (AF). Methods: A total of 78 patients with AF, who underwent ¹⁸F-FDG PET/CT in the Nuclear Medicine Department of the Third Affiliated Hospital of Soochow University due to abnormally elevated levels of tumor indicators or malignant tumors from March 2018 to December 2019, were enrolled in this retrospective study. According to the examination date of PET/CT and basic characteristics of AF patients (gender, age), a 1∶1 propensity score matching was used to enroll a non-AF control group (78 patients). The maximum standard uptake value of left atrial epicardial tissue (LA-EAT FDG SUV_max) and total EAT volume (V-EAT) were measured by ¹⁸F-FDG PET/CT. Left ventricular ejection fraction (LVEF) and left atrial diameter (LAD) were obtained by echocardiography. Blood lipids and biomarkers of inflammation were measured. The differences of clinical data and EAT-related indicators were compared between the AF group and control group. Logistic multivariate regression analysis was used to determine the related factors of AF. Then the receiver operating characteristic (ROC) curve was used to determine the cutoff value of LA-EAT FDG SUV_max on the diagnosis of AF. Univariate and multivariate logistic regression analysis were used to analyze the relationship between the increase of LA-EAT FDG SUV_max and AF. Results: The age was (66.9±10.2) years and there were 55 males (70.5%) in the AF group. The age was (66.9±8.0) years, and there were 52 males (66.7%) in the control group (both P>0.05). The LAD ((44.2±5.8) mm vs. (35.4±4.4) mm), V-EAT ((122.1±42.0) cm³ vs. (91.6±34.5) cm³), and LA-EAT FDG SUV_max ((1.6±0.3) vs. (1.4±0.2)) values were significantly higher, while LVEF ((60.1±4.7)% vs. (63.9±2.9)%) was lower in the AF group than in the control group (P all<0.001). Multivariate logistic regression analysis showed that LAD (OR=1.340, 95%CI 1.195-1.502), V-EAT (OR=1.016, 95%CI 1.001-1.031), and LA-EAT FDG SUV_max (OR=1.375, 95%CI 1.095-1.723) were positively correlated with AF, LVEF (OR=0.781, 95%CI 0.659-0.926) was negatively correlated with AF(P all<0.05). The area under the ROC curve of LA-EAT FDG SUV_max for diagnosis of AF was 0.680 (95%CI 0.597-0.764, P<0.001), and the best cut-off value was 1.415 with a sensitivity of 65.4% and specificity of 61.5%. After adjusting for high-density lipoprotein cholesterol, LVEF, LAD and V-EAT, LA-EAT FDG SUV_max≥1.415 was independently associated with AF (OR=2.982, 95%CI 1.122-7.926, P=0.010). Conclusions: The inflammatory activity of LA-EAT measured by ¹⁸F-FDG PET/CT is an independent risk factor of AF, and the increased inflammatory activity of LA-EAT is positively correlated with AF.
Adipose Tissue/diagnostic imaging* ; Aged ; Atrial Fibrillation/diagnostic imaging* ; Fluorodeoxyglucose F18 ; Humans ; Inflammation/diagnostic imaging* ; Male ; Middle Aged ; Positron Emission Tomography Computed Tomography ; Retrospective Studies ; Stroke Volume ; Ventricular Function, Left

Objective: To evaluate the value and safety of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients. Methods: The clinical data of 377 elderly patients with therapeutic ERCP from January 2010 to September 2017 in Changzhou First People′s Hospital of Jiangsu Province were retrospectively analyzed. Among them, there were 34 patients (observation group) aged ≥ 90 years and 343 patients (control group) aged 75 to 89 years old. The results of ERCP examination, treatment of bile duct stones and related complications were compared between 2 groups. Results: There was no statistical difference in the success rate of ERCP between 2 groups (P>0.05). There were no statistical difference in detection rates of bile duct stones, cholangiocarcinoma and benign biliary stricture between 2 groups (P<0.05); however, the detection rates of duodenal papillary carcinoma and nipple diverticulum in observation group were significantly higher than those in control group: 11.8% (4/34) vs. 2.0% (7/343) and 38.2% (13/34) vs. 18.7% (64/343), and there were statistical differences (χ² = 10.326 and 7.294, P<0.01). There were 21 patients with bile duct stones in observation group, including 14 patients with multiple stones; there were 241 patients with bile duct stones in control group, including 188 patients with multiple stones. The maximum stone diameter, rate of in-line stent drainage and rate of extracorporeal lithotripsy in multiple stones patients of observation group were significantly higher than those in multiple stones patients of control group: (1.5 ± 0.3) cm vs. (1.2 ± 0.4) cm、9.5% (2/21) vs. 1.7% (4/241), 4.8% (1/21) vs. 0.4% (1/241), and there were statistical differences (P<0.05). There was no statistical difference in incidence of ERCP complications between observation group and control group: 14.7% (5/34) vs. 6.7% (23/343), P>0.05; but the incidence of cardiac accidents in observation group was significantly higher than that in control group: 5.9% (2/34) vs. 1.2% (4/343), and there was statistical difference (χ² = 4.393, P<0.05). There was no statistical difference in the length of hospital stay between observation group and control group: (11.5 ± 5.0) d vs. (13.2 ± 5.8), P>0.05. Conclusions Therapeutic ERCP is an important treatment for elderly patients with biliary and pancreatic diseases. For patients over 90 years old, ERCP is safe and reliable, but it is necessary to actively pay attention to comorbidities, especially cardiac function.