Objective To understand the clinical characteristics of primary small vessel vasculitis with involvement of lungs in children and analyze the causes of misdiagnosis.Methods Clinical data from 16 patients with primary small vessel vasculitis were collected and their pathological,antineutrophil cytoplasmic antibody(ANCA),pulmonary lesion manifestations,image and misdiagnosis were further analyzed.Results Among 16 cases,9 cases were microscopic polyarateritis(MPA) and 4 cases were Wegeners granulomatosis(WG) and 3 cases were Churg-Strause syndrome(CSS).The ages of onset were from 3 to 14 years old with average age of 7.5 years old.Seventy-five percent(12/16) were ANCA positive.The patients with lung involvement had cough,chest pain,dyspnea,hemoptasis and asthma.Findings on lung X-ray films were variable.Some showed multiple patch shadows,others showed single or multiple masses or nodular shadows with or without cavity formation.After the treatments with corticosteroid and cyclophosphamide,10 cases turned better;including 8 cases with normal on lung X-ray films.Three cases given up;3 cases died.Conclusion It is very difficult to make diagnosis of primary small vessel vasculitis with involvement of lungs and should be paid more attentions to this issue.

OBJECTIVETo explore the operative skills and effect of unilateral pedicle screw combined with contralateral percutaneous transfacet screws fixation in treating degenerative low lumbar disease.

METHODSFrom January 2009 to December 2011,22 patients with degenerative low lumbar disease were treated with transforaminal lumbar interbody fusion, during the operations, unilateral pedicle screw and contralateral percutaneous transfacet screw fixation were performed. There were 16 males and 6 females, aged from 32 to 71 years old with an average of (51.1 ± 10.6) years, including single segment in 20 cases and two segments in 2 cases. Clinical effects were evaluated according to visual analogue score (VAS) and Oswestry Disability Index (ODI).

RESULTSAll patients were followed up from 1 to 2.5 years with an average of 18 months. One case complicated with leakage of cerebrospinal fluid after operation and 1 case with lower limb pain of decompression-side on the 3rd day after operation. Twenty-two patients got bony fusion. There were no instability and evidence of instrument failure during follow-up. The VAS and ODI score decreased from preoperative 8.24 ± 0.72, 36.72 ± 6.84 respectively to 3.18 ± 0.66, 4.36 ± 1.12 at the final follow-up (P < 0.05).

CONCLUSIONUnilateral pedicle screw combined with contralateral percutaneous transfacet screw fixation is safe and feasible surgical technique in treating low lumbar degenerative disease. It has advantages of little trauma, rigid fixation, high fusion rate, and less complication. etc.

Adult ; Aged ; Biomechanical Phenomena ; Female ; Humans ; Intervertebral Disc Degeneration ; physiopathology ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Pedicle Screws ; Spinal Fusion ; methods

Objective To investigate abnormal glucose metablism of patients with stroke in hospital in Foshan in order to design more reasonable diagnostic and treatment plans.Methods Our study was conducted in 557 patients with stroke who were in hospital in Neurology Department of the First Hospital of Foshan from June 2007 to April 2008 (all were consistent with diagnostic criteria of stroke).Sex,age,history of diabetes mellitus and smoking,height,weight,blood pressure,waist circumference,random blood glucose,fasting blood glucose and oral glucose tolerance test of all were recorded when they were in hospital Results All 368 individuals (66.1%) had abnormal blood glucose,including 185 cases (33.2%) of diabetes,183 cases (32.9%) of impaired glucose tolerance and 189 cases (33.9%) of normal sugar tolerance.Furthermore,about 89.1% (189/368) cases with impaired glucose regulation and 14.1% (26/185) cases of diabetes were misdiagnosed if they did not undergo oral glucose tolerance test.Conclusions Most of patients with stroke in Foshan have impaired glucose regulation,who have been diagnosed by oral glucose tolerance test,in favour of us to better design more reasonable diagnostic and treatment plans.

Objective To study the curative effect of nasal irrigation combined with backslapping for sputum suctioning on respiratory tract infections in infants . Methods Two hundred and forty-seven infants with respiratory tract infections were enrolled in the study and divided into the control group and the experiment group by the medical record number . On the basis of routine care , the experiment group was treated with nasal irrigation to clear secretions . Result The time for rales and cough disappearing in the experiment group was shorter than that in the control group , and the difference was statistically significant ( P<0 . 05 ) . Conclusions Nasal irrigation combined with backslapping for sputum suctioning can effectively ease the main symptoms and signs , enhance the ventilation function , enhance sleep quality and promote the rehabilitation of the disease .

Objective To investigate the pathogen distribution and drug resistance of gram-negative bacteria causing lower respiratory tract infections in patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) .Methods A total of 742 sputum samples were collected from AECOPD patients with lower respiratory tract infections in Taizhou Hospital of Zhejiang Province during January 2013 and December 2014.Vitek 2 Compact system combined with disk diffusion was used for strains identification and drug susceptibility test.Modified Hodge test and ethylenediamine tetraacetic acid (EDTA) synergic test were used to screen carbapenem-resistant strains.Statistical analysis was performed using WHONET 5.6 and SPSS 20.0 software.Results A total of 593 strains of gram-negative bacteria were isolated , in which 367 strains were nonfermentative bacteria (61.89%), 220 strains were enterobacteriaceae (37.10%), and the rest 6 strains ( 1.01%) were other gram-negative bacteria.Acinetobacter baumannii ( 186 strains ), Pseudomonas aeruginosa (99 strains), Stenotrophomonas maltophilia (33 strains) and Burkholderia cepacia (22 strains ) were top 4 nonfermentative bacteria , and they all showed high resistance to ampicillin , ampicillin/sulbactam, cefazolin, ceftriaxone, cefotetan and nitrofurantoin with resistant rates of 67.20%-100.00%. Drug resistance rates to other β-lactams, fluoroquinolones, aminoglycoside, compound sulfamethoxazole and minocycline were significantly higher in carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa strains than those in non-carbapenem-resistant strains , and the differences were statistically significant (P <0.05 or <0.01).Stenotrophomonas maltophilia and Burkholderia cepacia strains were only sensitive to levofloxacin , compound sulfamethoxazole and minocycline . Klebsiella pneumonia (89 strains), Escherichia coli (80 strains) and Enterobacter cloacae (25 strains) were top 3 enterobacteriaceae , which were almost completely resistant to ampicillin , but were sensitive to piperacillin/tazobactam , cefoperazone/sulbactam , amikacin and carbapenems ( with resistant rates <15%) .More than 50%strains of extended spectrum β-lactamases ( ESBLs )-producing Klebsiella pneumonia and Escherichia coli were moderately or highly resistant to ampicillin/sulbactam , most cephalosporins ( except cefotetan and cefoperazone/sulbactam ), gentamycin, tobramycin, fluoroquinolones, aztreonam, compound sulfamethoxazole and minocycline , and the resistant rates were higher than those in non-ESBLs-producing strains (P <0.05 or <0.01).Conclusions Nonfermentative bacteria and enterobacteriaceae are the most prevalent gram-negative bacterial pathogens in lower respiratory tract infections in patients with AECOPD . Carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa strains, as well as ESBLs-producing Klebsiella pneumonia and Escherichia coli strains are highly resistant to most antibacterial agents .

To determine the relationship between the urinary endothelin (ET-1), nitric oxide (NO) levels and the clinical, pathologic types of primary glomerulonephritis (GN) patients, urinary levels of ET-1 and NO were detected in 27 patients with biopsy-proven primary GN and 12 normal controls by radioimmunoassay and by copper-plated and cadmium column reduction assay, respectively. The results showed that urinary ET-1 levels in the patients with primary GN were significantly higher than in normal controls (p < 0.01), while the urinary ET-1 levels in patients with moderate mesangial proliferation GN were significantly higher than those in patients with mild mesangial proliferation GN (p < 0.05). Urinary ET-1 levels in patients whose clinical feature was nephrotic syndrome were found to be higher than in patients whose clinical feature was nephritic syndrome. However, urinary NO levels were to the contrary (p < 0.05). The ratio of ET-1/NO in primary GN patients was significantly higher than that in normal controls, and it positively correlated with the 24-hour urinary excretion of protein. These results suggest that urinary ET-1 levels are related to the proliferation of mesangial cells. The imbalance between ET-1 and NO may be related to the pathogenesis of primary GN and the occurrence of proteinuria.
Adolescence ; Adult ; Endothelin-1/urine* ; Endothelin-1/physiology ; Female ; Glomerulonephritis/urine* ; Glomerulonephritis/etiology ; Human ; Male ; Middle Age ; Nitric Oxide/urine* ; Nitric Oxide/physiology ; Nitric-Oxide Synthase/metabolism

OBJECTIVETo investigate the effect of respiratory syncytial virus (RSV) infection on the production of thymic stromal lymphopoietin (TSLP) and Th1/Th2 balance in asthmatic mice.

METHODSThirty-two female BALB/c mice were randomly divided into 4 groups, namely the PBS group, ovalbumin (OVA) group, RSV group and OVA/RSV group. The mice were sensitized by OVA and then stimulated with nebulized OVA, and RSV was inoculated into the nasal cavity of the mice. BUXCO noninvasive lung function detection was performed to examine the airway response to metacholine, and enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of IL-4, IL-5, IL-13, and IFN-gamma in the mice. The cells in the bronchoalveolar lavage fluid (BALF) were counted and classified, and the supernatants of the BALF were used for the detection of TSLP. Histopathological changes in the lung tissues of the mice were examined using HE staining, and immunohistochemistry using anti-mouse TSLP antibody was performed to examine TSLP expressions in the airway epithelial cells.

RESULTSRSV infection promoted the production of TSLP in the asthmatic mice, and the concentration of TSLP in OVA/RSV group (2.13-/+0.05 ng/ml) was significantly higher than that in the other groups (P<0.01). RSV infection increased the serum levels of IL-4, IL-5, IL-13, and IFN-gamma in the mice. The total BALF cells, eosinophils, lymphocytes and neutrophils in OVA/RSV group were significantly higher than those in the other groups; noninvasive lung function examination showed higher Penh value in OVA/RSV group (318.66-/+50.87) than in the other groups when the inhaled metacholine increased to 6.25 mg/ml (P<0.01). More obvious and extensive airway inflammatory cell infiltration in OVA/RSV group were observed, and immunohistochemical staining also showed higher expression of TSLP in the airway epithelial cells of OVA/RSV group.

CONCLUSIONSRSV infection promotes the production of TSLP in the airway epithelial cells and increases the level of Th2 cytokines in asthmatic mice. Concurrent RSV infection can exacerbate Th2 inflammatory reaction in asthmatic mice.

Animals ; Bronchoalveolar Lavage Fluid ; Cytokines ; biosynthesis ; secretion ; Female ; Immunohistochemistry ; Inflammation ; immunology ; virology ; Interferon-gamma ; blood ; Interleukins ; blood ; Lung ; immunology ; metabolism ; virology ; Mice ; Mice, Inbred BALB C ; Respiratory Syncytial Virus Infections ; blood ; immunology ; metabolism ; Th2 Cells ; cytology ; immunology ; virology

OBJECTIVETo explore the risk factors for nosocomial infection caused by imipenem-resistant Pseudomonas aeruginosa (IRPA).

METHODSA case-control study was carried out for the comparison of 2 groups of 'case' patients with 'controlled' patients. The first group of 'case' patients had nosocomial isolation of IRPA, and the second group had imipenem-susceptible Pseudomonas aeruginosa (ISPA). 'Control' patients were selected from the same medical or surgical services from which 'case' patients were receiving care when isolation of IRPA or ISPA occurred. Risk factors analyzed included the use of antimicrobials, comorbid conditions, and demographic variables. IRPA was recovered from 67 patients, and ISPA from 150 patients while the control case were 200 and 159 respectively. All patients were from Renmin Hospital of Wuhan University during Jan 2002 to Dec 2003. Data were analyzed with unconditional logistic regression and principal component analysis.

RESULTSData from multivariate unconditional logistic regression analysis showed that the independent risk factors for IRPA nosocomial infection were: time at risk (OR = 1.03, 95% CI: 1.01-1.04), imipenem (OR = 4.65, 95% CI: 1.35-11.52), PIP/TAZ (OR = 3.37, 95% CI 1.85-9.43) and quinolones (OR = 1.85, 95% CI: 1.25-5.34) while the third cephalosporins (OR = 2.54, 95% CI: 1.26-5.23) and aminoglycoside antibiotics (OR = 1.86, 95% CI 1.42-3.26) time at risk (OR = 1.05, 95% CI: 1.03-1.05) were associated with isolated ISPA.

CONCLUSIONNosocomial infection of IRPA could be caused by the use of imipenem and other antibiotics, suggesting that to limit the use of imipenem was not sufficient to contain the increasing incidence of IRPA.

Case-Control Studies ; Cross Infection ; etiology ; microbiology ; Drug Resistance, Bacterial ; drug effects ; Female ; Humans ; Imipenem ; pharmacology ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Pseudomonas aeruginosa ; drug effects ; physiology ; Risk Factors

Adult ; Antigens, Neoplasm ; genetics ; Carcinoma, Hepatocellular ; genetics ; pathology ; Female ; Humans ; Liver ; pathology ; Liver Neoplasms ; genetics ; pathology ; Male ; Middle Aged ; RNA, Messenger ; genetics

OBJECTIVETo explore the clinical features and diagnosis of obstructive sleep apnea syndrome (OSAS) in children.

METHODSSixty children with OSAS were reviewed, every patient was monitored with polysomnography (PSG) for 7 hours at night for 11 parameters, including the longest apnea time (LAT), apnea and hypopnea index (AHI), the lowest oxygen saturation (SaO(2)), and snore index etc., the parameters of the 2 groups were compared. Meanwhile, tonsillectomy and adenoidectomy were performed for 40 cases of OSAS, and the parameters obtained before and after operation were analyzed.

RESULTSAdenotonsillar hypertrophy and the loud snoring during sleep were found in all cases. The mean values of the PSG parameters were as follows: the longest apnea time was 53 (8-178) seconds (s); the total time of apnea was 310.5 (26-5,260) s; the time of apnea was 26 (3-240) s; the longest hypopnea time was 41 (5-94) s; the total times of hypopnea was 170 (5-2,860) s; the time of hypopnea was 10 (1-85); the apnea index was 4.1 (0.5-25.9); the hypopnea index was 1.4 (0-16.1); the apnea and hypopnea index (AHI) was 6.8 (0.5-38.2); the snore index was 81.7 (1.3-414.8); the lowest saturation of oxygen was 0.78 (0.25-0.93). There was not statistically significant difference in the parameters between 2-7 year group and over 7 year group (P > 0.05). The parameters of postoperation group: the mean value of the longest apnea time was 15.5 (0-60) s; the total time of apnea was 56.4 (60-205) s; the time of apnea was 10.33 (0-40); the longest hypopnea time was 13.25 (0-30) s; the total times of hypopnea was 44.6 (0-73); the hypopnea time was 4.32 (0 - 30) s; the apnea index was 0.6 (0-12); the hypopnea index was 0.62 (0-4); the apnea and hypopnea index (AHI) was 1.25 (0.1-12); the snore index was 30.08 (1.8-102); the lowest oxygen saturation was 93.5% (64%-97%). Compared with preoperation groups there was a statistically significant difference (P < 0.01). Clinically effective rate of the surgeries was over 90%.

CONCLUSIONAdenotonsillar hypertrophy seemed to be an important cause of OSAS in children. Snoring, dyspnea, apnea and low ventilation are the major clinical characteristics of OSAS in children. Confirmed diagnosis of the syndrome in children requires PSG recordings.

Child ; Child, Preschool ; Female ; Humans ; Male ; Monitoring, Ambulatory ; Polysomnography ; Sleep Apnea, Obstructive ; diagnosis ; physiopathology ; Time Factors