OBJECTIVE To study the lower respiratory tract infection caused by Stenotrophomonas maltophilia and the resistance situation. METHODS The clinical data of 79 cases of lower respiratory tract infection caused by(S.maltophilia) were analyzed and the susceptibility test was made using ATBPSE5 kits. RESULTS All patients had clinical symptoms,and the rate of empirical using of broad-spectrum antibiotics reached to 100%.In all these patients,74.68% were older than 60,and 51.90% received invasive operation such as trachea intubation or incision,and the immmunosystem function of 62.03% was compromised.All these were high risk factors resulting in the lower respiratory S.maltophilia infection.All cases showed resistance to most broad-spectrum antibiotics except ticarcillin/clavulanic acid and sulfamethoxazole/trimethoprim(Cotrimoxazole).The latter two antibiotics still showed high sensitivity to the pathogen. CONCLUSIONS It is necessary to avoid the risk factors causing nosocomial(S.maltophilia) infection.Ticarcillin/clavulanic acid and Cotrimoxazole are the first choice for clinical treatment.Using fluoroquinolone and ceftazidime simultaneously can improve the curing rate.

Objective To assess the right atrial(RA) function using two-dimensional speckle-tracking echocardiography(2D-STE) and the value of predicting WHO functional class in patients with pulmonary hypertension(PH).Methods Fifty-four consecutive PH patients were studied and compared with a control group of 24 healthy volunteers.RA function was evaluated by 2D-STE,and the following parameters were recorded:an average longitudinal strain (LS) curve that included LSpos during RA filling and LSneg representing RA active contraction (their summation is LStot),the phasic RA volumes,total RA emptying fraction (TotEF),RA passive(PassEF) and active emptying fraction(ActEF).The associations between these indices and the results of invasive pulmonary hemodynamics,cardiac structure and function level were evaluated.Results LStot,TotEF,LSpos,PassEF were significantly lower in PH patients than in controls(all P<0.01).ActEF/TotEF were significantly higher in WHO functional class (WHO-FC) Ⅱ and WHO-FC Ⅲ patients than in controls(all P<0.05),while were lower in WHO-FCIV patients than in controls(P<0.001).Among PH patients,LStot was negatively correlated with greater RA size and RA pressure (all P<0.01).LStot was also associated with right ventricular (RV) functional and overload parameters.In receiver-operator characteristic analysis,RA LStot was of optimal accuracy for prediction of WHO-FC≥Ⅲ in PH patients (P=0.002).Conclusions PH is associated with impaired reservoir and conduit function,but active contract function of RA is enhanced in WHO-FC Ⅱ and WHO-FC Ⅲ patients,and reduced in WHO-FCIV patients.RA LStot confers an optimal predictive effect of poor WHO-FC in PH patients and indicating prognosis.

OBJECTIVETo evaluate the changes of the semen quality in uremia patients before renal transplantation.

METHODSThe semen of 24 patients with uremia and 12 normal volunteers was analyzed.

RESULTSThe semen volume, sperm motility, survival rate, density and morphological normality percentage were (2.5 +/- 0.4) ml, (13.4 +/- 3.9)%, (25.4 +/- 5.6)%, (20.6 +/- 4.5) x 10(6)/ml and (16.8 +/- 2.1)%, respectively, significantly lower than those of the normal group (P < 0.01).

CONCLUSIONSemen qualities were lowered significantly and spermatogenesis severely affected in patients with uremia.

Adolescent ; Adult ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Semen ; physiology ; Sperm Count ; Sperm Motility ; Spermatogenesis ; physiology ; Uremia ; physiopathology

Breast cancer susceptibility gene (BRCA) is a tumor suppressor gene. The carriers of BRCA mutation have a significantly higher risk of breast, ovarian, pancreatic, prostate and rectal cancers than the general population. BRCA gene detection can effectively evaluate the risk of relevant malignant tumors. In this article, the recent research progress on the relationship between BRCA gene mutations and related cancers is summarized, and the roles of BRCA gene testing in the prevention and management of relevant malignant tumors are discussed.

Malacoplakia is a rare granuloma disease mainly occurred in the urinary system, it is even rarer for renal malacoplakia invading the descending colon complicated with bladder malacoplakia. In this study, one such case was reported. Imaging examination suggested that the left kidney was a large patchy mixed density shadow, and enhancement scan lesion was uneven enhancement. CT guided renal puncture biopsy was performed, and postoperative pathology suggested renal malacoplakia. Transurethral cystoscopy was performed, and postoperative pathology confirmed that it was malacoplakia of the bladder. The effect of conservative antibiotic treatment was not good. The patient underwent radical nephrectomy + left hemicolectomy under general anesthesia, and postoperative pathology confirmed the diagnosis of renal malacoplakia, which involved the mucosa of the intestinal tube and the entire muscular layer. The patient was followed up for 6 months after surgery, and no recurrence was seen on CT.

Objective:To investigate whether the fluctuation of blood pressure variability (BPV) before carotid endarterectomy (CEA) is related to postoperative cerebral perfusion changes in patients with carotid artery stenosis.Methods:A prospective observational cohort study was performed. Forty-seven patients with carotid artery stenosis accepted CEA in Department of Neurosurgery, Guangdong Provincial People's Hospital Affiliated to Southern Medical University from January 2019 to December 2022 were chosen. Patients' blood pressure was closely monitored 3 d before surgery (4 times/d) to obtain their BPV (the maximum △, based on the maximum absolute differences between systolic or diastolic blood pressures measured continuously during the observation period). At the same time, the changes of cerebral perfusion 3 d after surgery were monitored (criteria of cerebral hyperperfusion: newly-appeared delirium and hyperactivity after anesthesia resuscitation or intracranial hemorrhage found by imaging examination; criteria of cerebral hypoperfusion: newly-appeared speech and motor function deficits or aggravation of original cerebral ischemia symptoms after anesthesia resuscitation, or new-found cerebral infarction by imaging examination). Receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of BPV before CEA in postoperative cerebral perfusion changes.Results:In these 47 patients, 9 patients (19.1%) had postoperative cerebral perfusion changes: 2 had neurological deficits due to postoperative cerebral infarction, and the other 7 had short-term postoperative delirium or focal neurological deficits (returned to normal after appropriate adjustment of blood pressure). Area under the ROC curve (AUC) of BPV before CEA in predicting postoperative cerebral perfusion changes was 0.876 ( P=0.001, 95% CI: 0.775-0.977). These 47 patients were divided into high BPV group ( n=16) and low BPV group ( n=31) according to the optimal index threshold (27.00), and the statistics showed that significant difference in incidence of cerebral perfusion changes after CEA was noted between the 2 groups ( P<0.05); incidence of postoperative cerebral perfusion changes in the high BPV group was 15.5 times higher than that in the low BPV group ( RR=15.500, P<0.001, 95% CI: 2.120-113.320). Conclusion:BPV before CEA in patients with carotid artery stenosis can well predict the occurrence of postoperative cerebral perfusion changes.

Objective To investigate the early changes of left atrial structure and function using echocardiography in obstructive sleep apnea syndrome( OSAS) patients with and without left ventricular hypertrophy(LVH) . Methods Echocardiography was performed in 91 OSAS patients (64 without LVH , 27 with LVH) ,and the results were compared with those from age-matched and gender-matched controls ( n=40) . All subjects were examined with two-dimensional speckle tracking echocardiography ( 2D-STE) to obtain the apical four chamber and two chamber left atrium(LA) strain and strain rate curve image .Systolic strain and strain rate( Ss ,SRs) ,early diastolic strain and strain rate( Se ,SRe) ,late diastolic strain and strain rate(Sa ,SRa) were measured . Phasic LA volumes and empty fractions were calculated . The ratio of peak early diastolic mitral inflow and annulus velocity ( E/e′) was used to estimate left ventricular diastolic function . Results Compared with the control group ,LA volume ,LA stiffness index ,SRa and active empyting fraction ( AEF) increased ,Ss ,SRs ,Se ,SRe ,total empyting fraction ( TEF) and passive empyting fraction ( PEF) decreased in none LVH group ( P < 0 .05) . Importantly ,diastolic function was relatively normal in this subgroup without LVH( P > 0 .05) . Diastolic function decreased in LVH group ,and the changes of left atrial structure and function like above mentioned were more significant .The apnea-hypopnea index (AHI) was found to be negatively correlated with Ss ,SRs ,Se ,SRe ,TEF and PEF . Conclusions OSAS is associated with LA remodeling and dysfunction that occurs before the development of LVH and left ventricular diastolic dysfunction ,and it will be further aggravated along with the development of LVH .

Objective To investigate the changes of left ventricular systolic and diastolic function before left ventricular morphologic changes in obstructive sleep apnea syndrome (OSAS) patients.Methods A total of 111 OSAS patients were divided into left ventricular hypertrophy (LVH) group (n=29) and non-LVH group (n=82).Meanwhile,50 healthy subjects were enrolled as normal control group.Routine echocardiography and two-dimensional speckle tracking imaging (2D-STI) were performed.The differences of conventional echocardiography and 2D-STI parameters were compared among the three groups.The correlations between echocardiography and clinical parameters were analyzed.Results Compared with those of the other 2 groups,left ventricular mass index (LVMI),diastolic thickness of interventricular septum (IVST),diastolic ventricular posterior wall thickness (PWT),left ventricular internal diastolic dimension (LVIDd),the ratio between early diastolic peak velocity of mitral valve and early diastolic velocity of mitral annular (E/e') and left atrial volume index (LAVI) increased (all P＜0.05),and mitral annular early diastolic velocity (e') at interventricular septum and lateral wall decreased in LVH group (all P＜0.05).The mitral annular systolic velocity (s') in LVH group was less than that in normal control group (P =0.013).Compared with those of the other 2 groups,left ventricular global longitudinal systolic strain (S) and early diastolic strain rate (SRE) decreased (all P＜0.05),and the ratio of early diastolic peak velocity of mitral valve to SRE (E/SRE) increased in LVH group (both P＜0.05).Compared with normal control group,systolic strain rate (SRS) decreased in LVH group (P=0.001).S,SRS,SRE in non-LVH group were less than those in normal control group (all P＜0.05),and E/SRE was higher than that in normal control group (P＜0.001).S,E/SRE were independently associated with apnea hypopnea index (both P＜0.05).LVMI was independently associated with mean arterial oxygen saturation (β =-0.299,t =-3.273,P =0.001).Conclusion OSAS can affect the structure and functions of left ventricular independently.The systolic and diastolic functions of left ventricular have been impaired before morphology changed.

Objective:To compare the efficacy and safety of programmed death-1(PD-1)inhibitors in combination with chemotherapy versus chemotherapy alone in patients with metastatic bladder cancer.Methods:A retrospective analysis was performed on the clinical data of 77 cases of metastatic bladder cancer who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2014 to October 2022. According to the different clinical treatment regimens, they were divided into two groups. Patients treated with PD-1 inhibitors combined with gemcitabine and cisplatin (GC) regimen were referred to as IGC group, and patients who received GC chemotherapy alone were referred to as GC group. There were 24 cases in IGC group, including 18 males and 6 females, with a median age of 60 (56, 67) years old. Seventeen cases had a history of smoking. Fifteen cases had an Eastern Cooperative Oncology Group (ECOG) score of 0 and 9 cases had a score of 1. Twenty-three cases suffered distant metastasis (stage M 1). Two cases suffered lymph node metastasis only, 6 cases with liver metastasis, 8 cases with lung metastasis, and 8 cases with bone metastasis. There were 53 cases in GC group, including 45 males and 8 females, with a median age of 63 (55, 69) years old. Thirty-one cases had a history of smoking. Thirty cases had an ECOG score of 0 and 23 cases had a score of 1, 48 cases suffered stage M 1, 2 cases suffered lymph node metastasis only. Nineteen cases suffered liver metastasis. Twenty-seven cases suffered lung metastasis. And 23 cases suffered bone metastasis. There was no statistically significant difference in the above general information between the two groups ( P>0.05). Kaplan-Meier method was used to plot the survival curves, and the difference of median progression-free survival (mPFS) and median overall survival (mOS) between the two groups was compared by log-rank test. Finally, the difference in adverse reactions between the two groups was compared. Results:The objective response rate (ORR) was 41.7% and the disease control rate (DCR) was 87.5% in the IGC group.As a comparison, the ORR was 43.4% and the DCR was 83.0% in the GC group. The differences in ORR ( P=0.887) and DCR ( P=0.871) between the two groups were not statistically significant. All patients were followed up for 3 to 45 months, with a median follow-up time of 24 (14, 43) months. The mPFS was 7.0 (95% CI 5.7-8.3) months in the GC group and 8.0 (95% CI 3.0-13.1) months in the IGC group, and the difference was statistically significant between the two groups ( P=0.026). The mOS of patients in the GC group was 16.0 (95% CI 14.4-17.6) months, the mOS was not yet reached in the IGC group, and patients in the IGC group had longer mOS with a statistically significant difference ( P=0.022). All patients experienced treatment-related adverse reactions. Grade 3-4 adverse reactions occurred in 8 cases (33.3%) in the IGC group and in 16 cases (30.2%) in the GC group, and no adverse reaction-related deaths were observed( P=0.992). The most common adverse reactions in both groups were anemia, including 18 cases (75.0%) in IGC group and 38 cases (71.7%) in GC group. There were 4 cases (16.7%) of grade 1-2 hypothyroidism in the IGC group but no patients with hypothyroidism were found in the GC group, and the difference was statistically significant ( P=0.012). There were 8 cases (33.3%) and 4 cases (7.5%) of grade 1-2 skin adverse reactions in the IGC and GC groups, respectively, and the difference was statistically significant ( P=0.011). The immune-related adverse reactions of PD-1 inhibitors in IGC group were 1 case of hyperthyroidism (4.2%), 4 cases of hypothyroidism (16.7%), 1 case of adrenal insufficiency (4.2%), and 1 case of immune colitis (4.2%). Conclusions:Compared with chemotherapy alone, PD-1 inhibitors combined with chemotherapy for metastatic bladder cancer can effectively prolong the mPFS and median mOS. The adverse reactions of the two groups were tolerable, and there was no significant difference in the incidence of grade 3-4 adverse reactions. In general, PD-1 inhibitors combined with chemotherapy in the treatment of metastatic bladder cancer is safe and feasible, but attention should be paid to the immune-related adverse reactions of PD-1 inhibitors.

Objective:To assess global myocardial work in non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with no obvious regional wall motion abnormalities and preserved left ventricular ejection fraction (LVEF) by noninvasive left ventricular (LV) pressure-strain loops, and to explore its diagnostic value in patients with NSTE-ACS.Methods:A total of 169 NSTE-ACS patients with normal wall motion abnormalities and LVEF (>55%) were recruited in Beijing Chao Yang Hospital, Capital Medical University from June to December 2019. The patients were divided into two groups according to the degree of coronary stenosis, including severe coronary artery stenosis group ( n=121), and no severe stenosis group ( n=48). The patients of severe coronary artery stenosis group were further subdivided into single-vessel severe stenosis group ( n=52) and multi-vessel severe stenosis group ( n=69). Global longitudinal strain (GLS) analysis was performed by speckle tracking echocardiography before coronary angiography. Brachial cuff systolic pressure was used as left ventricular pressure to construct a non-invasive left ventricular pressure-strain loop. Global myocardial work index (GWI), global constructive work (GCW), global waste work (GWW) and global myocardial work efficiency (GWE) was computed by LV pressure-strain loops with a proprietary algorithm between groups. ROC curve analysis was used to determine the optimal cutoff value of the parameters to detect severe coronary artery stenosis. Independent factors affecting left ventricular myocardial function were assessed by Logistic regression analysis. Results:GLS, GWI, GCW and GWE were significantly reduced, and GWW was increased in severe coronary artery stenosis group than in no severe stenosis group(all P<0.05). GLS was significantly reduced in multi-vessel severe stenosis group ( P<0.05) but not in single-vessel severe stenosis group ( P=0.32). GWE was an independent factor affecting myocardial function in severe coronary artery stenosis group, GWE<96% had a area under the curve (AUC)=0.83 (74% for sensitivity, 81% for specificity) to identify severe coronary artery stenosis, and was superior to GLS (AUC=0.66, P<0.05) and GWI (AUC=0.70, P<0.05). Conclusions:In NSTE-ACS patients with severe coronary artery stenosis, no obvious regional wall motion abnormalities and preserved LVEF, LV global myocardial function is impaired based on noninvasive pressure-strain loops, GWI, GCW, and GWE are reduced, and GWW is increased, and GWE is a more sensitive index than GLS and GWI to predict severe coronary artery stenosis in NSTE-ACS patients.