Objective: To analyze the high risk factors and prognosis of patients with ventilator associated pneumonia(VAP) treated with mechanical ventilation(MV) in Intensive Care Unit(ICU), and to provide theoretical evidence for effective treatment and prevention. Methods: From January 2015 to January 2017, 156 MV patients treated in ICU of Shaoxing Municipal Hospital were enrolled retrospectively.According to the occurrence of VAP, the patients were divided into VAP group(76 cases) and non-VAP group(80 cases). The data including sex, age, ICU time, MV time, cases of withdrawing machine failure, prognosis, serum albumin, blood glucose levels, APACHE Ⅱ score, types of antibiotics and days of continuous applying were recorded.Single factor χ² test and multiple factor logistic regression analysis were used to analyze the high-risk factors and prognosis related to occurrence of VAP. Results: Univariate analysis showed that the age, mortality, serum albumin and blood glucose levels, MV time, weaning failure rate, APACHE Ⅱ score, antibiotic combination type and days of continuous use, application of H₂ receptor antagonists time between, the VAP group and non-VAP group had statistically significant differences (χ²=6.568, 16.558, 5.132, 5.896, 27.043, 15.018, 48.863, 46.752, 27.431, 3.981, P=0.010, 0.000, 0.023, 0.015, 0.000, 0.000, 0.000, 0.000, 0.000, 0.046). After age adjustment, logistic regression analysis showed that serum albumin <30g/L, blood glucose ≥7.8mmol/L, MV time >5 days, APACHE Ⅱ score>15 points, antibiotics continuous use>3 days, and antibiotic combination type>2 were independent risk factors for VAP(χ²=5.115, 5.984, 21.252, 18.043, 9.008, 14.545, P=0.030, 0.026, 0.000, 0.000, 0.007, 0.001). Compared with surviving patients with VAP, death patients lived longer in ICU and MV, and APACHE Ⅱ scores were higher(t=4.136, 6.382, 7.312, P=0.000, 0.000, 0.000). Conclusion There are multiple high-risk factors of VAP in patients treated with MV in ICU.The death demonstrated longer ICU time, MV time and higher APACHE Ⅱ score, need to be strengthened monitoring, early prevention and treatment.

To investigate the animals infection situation of novel bunyavirus in Xinyang City ,Henan Province ,China , animal serum samples such as cattle ,dog ,swine ,mice were collected in Shangcheng County and Guangshan County in Xinyang City .All the serum samples were detected by novel bunyavirus ELISA and real time RT-PCR method .A total of 292 animal serum samples were collected including 5 kinds of animals .The result of all the animal serum samples were negative by using real time RT-PCR ,and the positive rate was 45 .19% (141/312) by ELISA method .Of the 5 animal serum samples including mice ,cattle ,goats ,swine and dogs ,the positive rate were detected to be 1 .06% ,100 .00% ,76 .27% ,3 .57% ,and 75 .00%respectively .There was significant difference in results among 5 kind of animal serum antibodies .Animals such as cattle and dog may be the host of novel bunyavirus which were detected novel bunyavirus antibodies in cattle and dog in Xinyang City , Henan Province ,China .

To explore the relationship between meteorological factors and incidences of fever, thrombocytopenia and leukopenia syndrome (FTLS), incidence data of FTLS in Xinyang City were collected and described. The relationship between FTLS and monthly meteorological factors such as average atmospheric pressure, average temperature, average relative humidity, average wind speed and precipitation was analyzed with simple correlation and multi-stepwise linear regression. The results showed that there was a significant negative correlation between incidence of FTLS and monthly average atmospheric pressure (P<0.01), and there were significant positive correlations between monthly average temperature, monthly average relative humidity, monthly precipitation and incidence of FTLS (P<0.05). The multi-stepwise regression showed that the regression equation was Y (monthly cases) =-12.70 + 0.28X2 (monthly average temperature), and the coefficient of determination was 0.76. The incidences of FTLS are correlated with temperature.

Child ; Histiocytosis, Sinus ; diagnosis ; drug therapy ; Humans ; Lymphatic Diseases ; diagnosis ; drug therapy ; Male

Objective To investigate the diagnosis and the microsurgical treatment of intramedullary hemangioblastoma in cervical spinal cord.Methods The signs of MRI,and the results of operations were analysed in 26 patients with the tumors.Rusults The tumors can be classified into two types:Solid type (14 cases)and cystic type(12 eases).All the tumors underwent total removal and were all hemangioblastoma confirmed by histopathologic examinations.Postoperatively,neurological status were improved in 17 patients, remained in 7 cases and worse in 2 cases.Conclusion For intrameduUary hemangioblastoma of cervical spinal cord MRI is of significant importance in the diagnosis of localization and the nature of the tumors which is conductive to selecting appropriate operative methods.There is high risk in operating at cervical section,but microsurgical total resection is the optimal method to stop the development of the clinical presentation.Opera- tive methods varied with the different typer of the tumor.It is the most important principal that dissection is performed along the correct interface and the tumor should be removed en bloc after it is devascularized.

OBJECTIVETo observe the clinical effect of Guilu Erxian Glue Cataplasm (GEGC) on carcinoma of the large intestine patients with myelosuppression after chemotherapy, and further to confirm its efficiency and safety.

METHODSTotally 60 patients with carcinoma of the large intestine were randomly assigned to two groups. Meanwhile, they all accepted FOLFIRI chemotherapy. Patients in the treatment group were additionally applied at Shenque (RN8), exchanging once per every other day, for 14 successive days. Patients in the control group took placebos with the same dose and dosage as the treatment group. The blood cell counts (WBC, NE, and PLT) were detected before chemotherapy, at day 7, 10, and 14. The TCM symptoms integrals, Karnofsky performance score (KPS), liver and kidney functions were observed before chemotherapy, at day 7 and day 14. Adverse skin reactions were observed each day. And the usage of hematopoietic growth factors was recorded.

RESULTS(1) The KPS score at day 7 was more stable in the treatment group than in the control group; the WBC and NE counts in the peripheral blood at day 14 were higher in the treatment group than in the control group; and TCM symptoms integrals at day 14 was lower in the treatment group than in the control group, all with statistical difference (P < 0.05). (2) Compared with the control group, the PLT count was higher in the treatment group than in the control group, the usage of rhG-CSF and antibiotics was less in the treatment group than in the control group, all with no statistical difference (P > 0.05). (3) No obvious adverse reactions such as liver injury, renal injury, or skin allergy were observed.

CONCLUSIONSAdjuvant treatment of GEGC could improve carcinoma of the large intestine patients with myelosuppression to some extent. No relevant adverse reactions were found.

Adjuvants, Immunologic ; therapeutic use ; Adult ; Aged ; Bone Marrow Diseases ; chemically induced ; drug therapy ; Colorectal Neoplasms ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged

Adolescent ; Adult ; Child ; Child, Preschool ; DNA, Viral ; analysis ; Female ; Fluoroimmunoassay ; methods ; Hepatitis B Antibodies ; analysis ; Hepatitis B Surface Antigens ; analysis ; Hepatitis B e Antigens ; analysis ; Humans ; Male ; Middle Aged

Objective: To investigate human enterovirus (HEV) infection and clinical characteristics of viral encephalitis patients in Pingdingshan, Henan Province. Methods: Cerebrospinal fluid specimens and epidemiological information were collected from 274 viral encephalitis patients in the departments of pediatrics and neurology in hospitals in Pingdingshan, Henan Province, from April 2011 to August 2012. Patients with bacterial infections were excluded from the study. Demographic information was collected by questionnaires and clinical information was mainly obtained from hospital examinations. Viral RNA was extracted using magnetic bead extraction. Real-time RT-PCR was then performed for HEV, CV-A16, and EV-A71 testing. SPSS statistical software was statistical analyses. Significant differences were determined using the chi-squared test (P<0.05). Results: Among 274 cases of viral encephalitis, 180 cases (65.7%) were male and 94 cases were female (34.3%). The median age was 2.17 years. Approximately 61.3% (168) of patients were younger than 3 years of age. A total of 107 (39.1%), 2 (0.7%), and 42 (15.3%) cases were positive for HEV, CV-A16, and EV-A71, respectively. Eleven patients were younger than 6 months of age and one patient was co-infected with HEV and EV-A71. In the<3, 3-5, 6-15, and>15 years old age groups, HEV infections comprised 31.5% (53/168), 52.9% (18/34), 53.0% (35/66), and 16.7% (1/6) (χ²=13.10, P=0.003), respectively. The EV-A71 infection rates were 17.9% (30/168), 23.5% (8/34), 6.1% (4/66), and 0 (χ²=8.04, P=0.045), respectively. The other enterovirus (OEV) infection rates were 12.5% (21/168), 29.4% (10/34), 48.5% (32/66), and 16.7% (1/6) (χ²=35.19, P<0.001), respectively. The rate of vomiting in OEV and EV-A71 infected patients was 73% (44/60) and 26% (11/42), respectively, while the frequency of skin rash in OEV and EV-A71 infected patients was 32% (19/60) and 79% (33/42), respectively. Approximately 95% (99/104) of patients infected with HEV had a fever, and the breathing rhythm change rate was 19% (20/104), which was lower than that of patients without HEV infection (36.8% (60/163)) (χ²=9.35, P=0.002). Conclusion In Pingdingshan, HEV was a major causative agent of viral encephalitis and the rate of OEV infection was high, especially in children aged 3-15 years old. Fever was a common clinical symptom of patients infected with HEV. Patients infected with OEV primarily exhibited vomiting symptoms and EV-A71 infected patients showed skin rash.

OBJECTIVETo explore the clinical, pathological, and imaging features of autoimmune pancreatitis (AlP).

METHODSThe clinical data of 10 patients (all men; aged 47-80 years, mean 61.3 years) with AlP in our hospital between March 2000 and August 2007 were retrospectively analyzed. gamma-globulin, immunoglobulin C (IgG), rheumatoid factors, and autoantibodies were examined for all cases. The imaging findings were reviewed, which included helical computed tomography (CT), endoscopic ultrasonography (EUS), and B-mode ultrasound in all patients, magnetic resonance cholangiopancreatography (MRCP) in 9 patients, and endoscopic retrograde cholangiopancreatography (ERCP) in 7 patients. Follow-up imaging results were available in 5 patients.

RESULTSClinically, the most common early symptoms included obstructive jaundice (9/10) and non-specific abdominal pain (1/10), accompanied by the elevated levels of serum gamma-globulin, IgG or the presence of autoantibodies. Diabetes mellitus was detected at presentation in 2 patients. imaging findings included: CT showed diffuse (n=9) and focal (n=1) enlargement of pancreas. Minimal peripancreatic stranding was found in 7 patients, with no pancreatic pseudocyst and calcification. Six patients had enlarged peripancreatic lymph nodes. After contrast injection for 4 patients, delayed enhancement of the pancreatic parenchyma was observed, along with low-density capsule-like rim surrounding the pancreas. Magnetic resonance imaging showed diffuse enlargement of pancreas in 9 patients. MRCP showed diffuse (n=6) and segmental (n=3) irregular narrowing of the main pancreatic duct. B-mode ultrasound showed diffuse (n=9) and focal (n=1) enlargement of the pancreas. EUS showed diffuse (n=9) and focal (n=1) enlargement with hypoecho. ERCP showed stricture of distal common bile duct and irregular dilation of proximal bile ducts in 7 patients, diffuse stricture in main pancreatic duct in 4 patients, and segmental stricture in 3 patients. During the follow-up, abnormalities of imaging and serum markers were resolved after steroid therapy in 5 patients.

CONCLUSIONAIP is a distinctive type of chronic pancreatitis that shows specific imaging features.

Aged ; Aged, 80 and over ; Autoantibodies ; blood ; Autoimmune Diseases ; diagnosis ; diagnostic imaging ; immunology ; Endosonography ; Female ; Humans ; Male ; Middle Aged ; Pancreatitis ; diagnosis ; diagnostic imaging ; immunology ; Retrospective Studies ; Tomography, X-Ray Computed

Objective To explore the dynamic changes of Occludin gene and protein levels in lung tissues of newborn rats with hyperoxia-induced bronchopulmonary dysplasia (BPD) in the early phase and its effect on pulmonary epithelial permeability.Methods One hundred and sixty newborn Wistar rats were randomly assigned to hyperoxia group (900 mL/L oxygen)and normoxia group (210 mL/L oxygen) according to different oxygen concentrations,80rats in each group.Rats were sacrificed and lung tissues were removed on 1,3,5,7 d after treatment.Bronchoalveolar lavage fluid (BALF):serum FD4 ratio was detected;location and expression of Occludin were examined by immunofluorescence staining and Western blot; messenger RNA (mRNA) was studied by reverse transcription-PCR.Results There was no obvious difference in the BALF and serum FD4 ratio (1.533 ±0.122 vs 1.575 ± 0.140,P ＞ 0.05) between the hyperoxia group and the normoxia group on the first day.After 3 days of hyperoxia exposure,the ratio of FD4between BALF and serum was significantly higher than that in the normoxia group(1.365 ±0.159 vs 1.615 ±0.196,P ＜ 0.05).And after 5 or 7 days of hyperoxia exposure,the ratio of FD4 between BALF and serum was dramatically increased(1.245 ±0.152 vs 3.211 ±0.799,1.178 ± 0.594 vs 5.15 ± 0.967,all P ＜ 0.01).On the 7 day,immunofluorescence staining showed Occludin distribllted in a consecutive line along lung epithelial cell membrane in the normoxia group,while in the hyperoxia group Occludin was distributed in a discontinuous line and lacking intensity.There was no obvious difference in Occludin mRNA level between the hyperoxia group and normoxia group on the first day(2.15 ±0.33 vs 2.23 ± 0.39,P ＞ 0.05).Compared to the normoxia group,the decrease in Occludin mRNA level was statistically significant after 3 or 5 days of hyperoxia exposure(2.46 ± 0.27 vs 2.00 ± 0.19,2.62 ± 0.28 vs 2.15 ± 0.20,all P ＜ 0.05),and after 7 days of hyperoxia exposure,the Occludin mRNA level dramatically declined (3.08 ± 0.43 vs 2.01 ±0.34,P ＜0.01).There was no obvious difference in Occludin protein level between the hyperoxia group and normoxia group on the 1 st and the 3th day(1.00 ± 0.05 vs 1.05 ± 0.03,1.24 ± 0.06 vs 1.17 ± 0.04,all P ＞ 0.05).Compared to the normoxia groups,the decrease in Occludin protein level was statistically significant after 5 days of hyperoxia exposure (1.03 ± 0.04 vs 0.93 ± 0.05,P ＜ 0.05),and after 7 days of hyperoxia exposure,the Occludin protein level dramatically declined(0.96 ± 0.14 vs 0.65 ± 0.07,P ＜ 0.01).There was a significantly negative correlation between Occludin protein expression and pulmonary epithelial permeability after hyperoxia exposure (r =-0.755,P ＜0.01).Conclusions Downregulation of Occludin hyperoxia-induced may lead to the increase of pulmonary epithelial paracellular permeability,which participates in the development of pulmonary edema in the early phase of BPD induced by hyperoxia.