Objective:To analyze the clinical features, risk factors and prognosis of IPA combined with lung infection, aiming to further improve clinicians' understanding and diagnosis and treatment of it.Methods:Patients with IPA admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to October 2021 were retrospectively enrolled, and their clinical data was collected from the electronic medical record, including demographic information, clinical characteristics, biochemical indicators, auxiliary examination, microbial data and prognostic indicators. Patients were divided into two groups of IPA with pulmonary infection and IPA alone, and the clinical features, risk factors and prognosis of IPA patients with pulmonary infection were compared and analyzed in comparison with IPA patients alone.Results:A total of 156 IPA patients were finally recruited, with an average age of (67.12±12.89) years old and a main male proportion of 69.20%. Among them, there were 86 cases (55.13%) with IPA with pulmonary infection and 70 cases (44.87%) with IPA alone. Half of the IPA patients with pulmonary infection were mixed with one pathogen. The main pathogen of mixed infection was bacteria (82.72%), whereas acinetobacter baumannii accounted for the most common pathogen(25.93%, 42/162). Multivariate logistic regression analysis found that mechanical ventilation ( OR 4.89, 95% CI 2.23-10.70) and prior neutropenia ( OR 6.41, 95% CI 1.33-30.93) were independent risk factors for the occurrence of IPA with pulmonary infection. Compared with IPA alone, IPA patients with pulmonary infection were more likely to develop septic shock(69.80% vs. 32.90%, P <0.05), and have longer lengthes of hospital stay [16.00(8.00,36.50) vs.13.50 (7.00,20.50)] and ICU stay[11.50(6.00,31.25) vs.8.50(1.75,11.00)], and mechanical ventilation days [12.00(6.75, 25.25) vs.8.00(2.00,10.00)], as well as a higher 28-day mortality (55.80% vs.35.70%) and in-hospital mortality (64.00% vs. 35.70%). Conclusions:IPA patients with pulmonary infection accounts for more than half of IPA patients. The main respiratory etiology of IPA with pulmonary infection is acinetobacter baumannii. The independent risk factors of IPA patients with pulmonary infection are mechanical ventilation and neutropenia. The prognosis of IPA patients with pulmonary infection is worse than patients with IPA alone, which is worthy for the attention of physicians.

Humans ; Bacteremia ; Cross Infection ; Methicillin-Resistant Staphylococcus aureus ; Retrospective Studies ; Sepsis ; Staphylococcal Infections/epidemiology* ; Staphylococcus aureus ; Tertiary Care Centers ; China

Objective:To evaluate the relationship between long-term learning and memory impairment induced by sevoflurane anesthesia and postsynaptic density protein-95 (PSD-95)/Kalirin-7/Ras-related C3 botulinum toxin substrate 1 (Rac1) signaling pathway in neonatal rats.Methods:Sixty SPF male Wistar rats, aged 7 days, weighing 12-18 g, were divided into 5 groups ( n=12 each) using a random number table method: control group (group C), 1% sevoflurane anesthesia for 2 h group (group S 1), 1% sevoflurane anesthesia for 4 h group (group S 2), 2% sevoflurane anesthesia for 2 h group (group S 3) and 2% sevoflurane anesthesia for 4 h group (group S 4). Morris water maze test was performed at 4, 8 and 12 weeks after anesthesia.The rats were sacrificed after the last Morris water maze test, and the hippocampal tissues were obtained for microscopic examination of the pathological changes (using HE staining), neuron apoptosis (by TUNEL staining), and expression of PSD-95, Kalirin-7 and Rac1 protein and mRNA (by Western blot and quantitative real-time polymerase chain reaction). The apoptosis rate was calculated. Results:Compared with group C, the escape latency was significantly prolonged, the number of crossing the original platform was reduced, the time of stay in the target quadrant was shortened, and the apoptosis rate of hippocampal neurons was increased at 4th, 8th and 12th weeks after anesthesia, phosphorylated Rac1/Rac1 ratio was decreased, and the expression of PSD-95 and Kalirin-7 protein and mRNA was down-regulated in S 1, S 2, S 3 and S 4 groups ( P<0.05). Compared with group S 4, the escape latency was significantly shortened, the number of crossing the original platform was increased, the time of stay in the target quadrant was prolonged, and the apoptosis rate of hippocampal neurons was decreased, phosphorylated Rac1/Rac1 ratio was increased, the expression of PSD-95 and Kalirin-7 protein and mRNA was up-regulated, and the histopathological changes of hippocampal tissues were attenuated in S 1, S 2 and S 3 groups ( P<0.05). Conclusions:The mechanism by which sevoflurane anesthesia induces long-term learning and memory impairment may be related to inhibition of activity of PSD-95/Kalirin-7/Rac1 signaling pathway in hippocampi of neonatal rats.

Objective:To evaluate the prognostic value of extravascular lung water index (EVLWI) , soluble intercellular adhesion molecule-1(sICAM-1) and Krebs yon den lungen-6 (KL-6) in severe pneumonia patients with Severe Acute Respiratory Syndrome (ARDS).Methods:A prospective study was conducted in Respiratory Intensive Care Unit of the Affiliated Zhengzhou Central Hospital of Zhengzhou University from October 2017 to February 2020. The study included 65 severe pneumonia patients with ARDS, who was performed by measurement of pulse index continuous cardiac output and survived more than 3days after admission. The Extravascular Lung Water Index (EVLWI) , sICAM-1, KL-6 and Oxygenation Index(OI) on 1st, 3rd and 5th day were detected. APACHEⅡ score, patient survival events (days) and survival outcome were recorded. Correlation analysis between EVLWI, sICAM-1, KL-6 and OI was performed on the 1st, 3rd and 5th day after admission. Independent risk factors of mortality in severe pneumonia patients with ARDS were analyzed by multiple logistic regression. Receiver operating characteristic curve was drawn, and the prognostic value of each parameter was assessed finally.Results:The PCT, EVLWI, sICAM-1, KL-6 and APACHEⅡ score in the death group were significantly higher than those in the survival group ( P<0.05) at RICU admission, and the length of RICU stay was significantly shorter than that in the survival group ( P<0.05), while differences in other clinical characteristics between two groups were not statistically significant ( P>0.05) . These parameters including levels of EVLWI, sICAM-1, KL-6, Procalcitonin and APACHE Ⅱscore in the death group were significantly higher than those in the survival group on the 1st, 3rd and 5th day ( P<0.05), whereas the OI was significantly lower than that of the survival group on the 3rd and 5th day ( P<0.05). Logistic regression analysis showed that EVLWI, sICAM-1, KL-6 level were significantly related with the mortality of these patients. The levels of sICAM-1, kl-6 and EVLWI on 1st, 3rd and 5th day after RICU admission showed a significant negative correlation with OI ( P<0.001). Whereas, The levels of sICAM-1, kL-6 on 1st, 3rd and 5th day showed a significant positive correlation with EVLWI ( P<0.001). The sensitivity and specificity of sICAM-1, KL-6 combined with EVLWI in prognosis evaluation on 1st, 3rd and 5th day were 75.0%, 84.4%, 85.0%, 66.7%, 80.0%, 86.7%, respectively. The AUC was 0.864, 0.881, 0.892 on 1st, 3rd and 5th day, respectively ( P<0.001), which had a better prognostic value than each of them. Conclusions:EVLWI, sICAM-1 and KL-6 were independent risk factors for the prognosis of severe pneumonia patients with ARDS. The combination of EVLWI, sICAM-1 and KL-6 might be important in early predicting the prognosis of the 28d mortality.

Objective:Intensive physicians have relatively insufficient knowledge and experience in treating patients with decompensated schistosomiasis cirrhosis (DSC) admitted in intensive care unit (ICU), but are relatively familiar with patients with decompensated alcoholic cirrhosis (DAC). For this purpose, the clinical characteristics and prognosis of these patients were compared and analyzed.Methods:A retrospective analysis was performed from January 2013 to May 2019 in our hospital and Quzhou People’s hospital. The demographic data, laboratory examination, liver function, Child-Pugh classification, complications of cirrhosis, ultrasonic imaging gastroscopy manifestations were recorded and analyzed. In addition, the treatments and prognosis were also compared.Results:A total of 30 patients (12 males and 18 females) with DSC (aged 57-88) and 31 patients with DAC (aged 41-75) were collected. Compared with patients with DAC, DSC patients were more likely to have coronary heart disease, lower proportion of hyponatremia and lower need of ventilator support. Although the incidences of jaundice and hepatic encephalopathy were significantly reduced ( P<0.05), but parameters of liver function and coagulation were no significant differences in both groups ( P>0.05). B-mode ultrasound of liver in patients with DSC displayed more proportion of patchy and diffuse echo changes and liver volume reduction ( P<0.05), whereas the manifestations of gastroscope in both groups were similar. No significant difference in main treatment measures like uses of somatostatin and three-chamber and two-capsule tube was observed. After treatment, the stop time of gastrointestinal bleeding was similar between groups of DAC and DSC [1.25 (0.5-4.125) days vs. 1.75 (1-2.375) days] ( P>0.05). In addition, the length of ICU stay in DAC group was similar to DSC group [(4.96±3.58) days vs. (3.82±1.99) days], so did the 28-day mortality [14.29% (2/14) vs. 18.18% (2/11)] (both P>0.05). Conclusions:In genenal, patients with decompensated schistosomiasis cirrhosis have the similar clinical characteristics, major biochemical indicators and accessory examination results like ultrasound and gastroscopic examinations to patients with decompensated alcoholic cirrhosis. After timely treatments, both of these patients could achieve a good prognosis.

The lower extremity exoskeleton robot is a wearable device designed to help people suffering from a walking disorder to regain the power of the legs and joints to achieve standing and walking functions. Compared with traditional robots that include rigid mechanisms, lower extremity exoskeleton robots with compliant characteristics can store and release energy in passive elastic elements while minimizing the reaction force due to impact, so it can improve the safety of human-robot interaction. This paper reviews the compliant characteristics of lower extremity exoskeleton robots from the aspects of compliant drive and compliant joint, and introduces the augmentation, assistive, rehabilitation lower extremity exoskeleton robots. It also prospect the future development trend of lower extremity exoskeleton robots.

Objective To evaluate the prognosis value of plasma soluble vascular endothelial growth factor receptor (sFlt-1) combined with extravascular lung water index (EVLWI) in acute respiratory distress syndrome (ARDS) complicated with septic shock caused by severe pneumonia. Methods A retrospective analysis was conducted in Respiratory Intensive Care Unit of the Affiliated Zhengzhou Central Hospital of Zhengzhou University from January 2015 to July 2017. The study included 52 severe pneumonia patients with ARDS complicated with septic shock, who was performed by measurement of pulse index continuous cardiac output (PICCO) and survived more than 3 days after admission. According to the 28-day mortality, these patients were divided into the survival group (31 cases) and the death group (21 cases). PICCO was used to record the EVLWI level. The plasma level of sFlt-1 was measured by enzyme-linked immunosorbent assay (ELISA). Acute physiology and chronic health evaluation II (APACHE II) score and sequential organ failure assessment (SOFA) score were calculated. Independent risk factors were analyzed by multiple logistic regression. Correlation analysis between plasma sFlt-1 and EVLWI and APACHE II values was performed on the 1st, 2nd and 3rd day after admission. Receiver operating characteristic curve (ROC) was calculated, and the prognostic value of each parameter was assessed. Results The blood lactate, APACHE II score and SOFA score in the death group were significantly higher than those in the survival group at RICU admission (P<0.05), and the length of RICU stay was significantly shorter than that in the survival group (P<0.05), while differences in other clinical characteristics between the two groups were not statistically significant. The levels of EVLWI, sFlt-1 and blood lactate, APACHE II score and SOFA score in the death group were significantly higher than those in the survival group on the 1st, 2nd and 3rd day (all P<0.05), whereas the PaO2/FiO2 was significantly lower than that of the survival group on the 2nd and 3rd day (all P<0.05). Logistic regression analysis showed that sflt-1 level and EVLWI were significantly related with the patient mortality. The levels of sFlt-1 on day 1, 2 and 3 after RICU admission were positively related to EVLWI and APACHE II score (all P<0.01). The sensitivity and specificity of sFlt-1 combined with EVLWI in prognosis evaluation were 89.7％, 78.2％ and 86.3％, 75.7％, respectively. The AUC of sFlt-1 combined with EVLWI was 0.875 and 0.856 on the 1st and 3rd day, respectively (all P<0.01), which had a better prognostic value than each of them. Conclusions SFlt-1 could be used as a biomarker of mortality for severe pneumonia patients with ARDS complicated with septic shock. The combination of sFlt-1 and EVLWI might be important in early prediction of the prognosis of the 28-day mortality in patients with ARDS complicated with septic shock caused by severe pneumonia.

Objective To explore the clinical value of pulse indicates continuous cardiac output (PICCO) in fluid resuscitation of patients with ARDS complicated with septic shock caused by severe pneumonia. Methods Thirty-nine ARDS patients complicated with septic shock caused by severe pneumonia were divided into two groups, namely PICCO group and control group. The data of demographics and clinical findings of both groups were collected. At the same time, the data of serum lactic acid, Pa02/Fi02, MAP, the volume of fluid input, the amount of vasoactive agent, APACHE Ⅱ Scores of both groups at 6 hours and 24 hours after admission were collected, and the data of EVLWI, PVPI, CI, SVRI, GEDVI in PICCO group were documented at admission and 24 hours later, as well as the duration of mechanical ventilation, length of stay in the respiratory ICU and 30-day mortality were recorded. SPSS software of version 21.0 was used to statistically analyze the data. Results ① There were no statistically significant differences in in age, gender, APACHEII score and other relevant physiological parameters between two groups.② Compared with control group at 6 h and 24 h, the PICCO-guided treatment significantly reduced the level of Lac, elevated the MAP value and decreased the volume of fluid input (all P＜0.05) At the same time, this approach improved 24 h-Pa02/ Fi02(P=0.001).More importantly, the PICCO-guided treatment significantly reduced the duration of mechanical ventilation[(8.83 ± 3.57) vs (13.54 ± 4.06)d, P=0.000],shortened the stay in the respiratory ICU[(10.12 ± 4.46) vs (14.10 ± 5.65)d,P=0.020]and decreased the 30d mortality 15.79％ vs 50％,p=0.041. ③ In PICCO group, EVLWI and PVPI were significantly decreased[(12.27 ± 4.42) vs (16.11 ± 5.99) mL/ kg,P=0.028; (3.66 ± 1.71) vs (6.88 ± 2.93) mL/m2, P=0.000]; respectively and SVRI and GEDVI were significantly increased[(1212.70 ± 304.10) vs (958.50 ± 192.40)kPa·s/(min·m2),P=0.004; (676.57 ± 77.86) vs (616.33 ± 57.49)mL/(min · M2),P=0.010]; respectively at 24h compared those at admission. Conclusions Compared with conventional fluid resuscitation, PICCO-oriented treatment can quickly improve the relevant physiological parameters, direct the fluid resuscitation more accurately, shorten the duration of mechanical ventilation as well as the stay in ICU, and decrease the 30d mortality in patients with ARDS complicated with septic shock caused by severe pneumonia. Therefore, PICCO-oriented fluid resuscitation has noticeable clinical value, and be worthy of further clinical application especially in this kind of patients.

Objective To investigate the clinical characteristics and prognosis of patients with high level of plasma procalcitonin (PCT > 100 μg/L), and to improve the clinician's understanding, diagnosis and treatment of this kind of patients. Methods A retrospective study was conducted. The clinical data of patients with plasma PCT over 100 μg/L within 48 hours of admission admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from February 2013 to December 2016 were collected, and the clinical characteristics were analyzed. The patients were divided into survival and death groups according to 28-day prognosis. The general data and laboratory parameters including vital signs, 24-hour urine output, routine blood test, blood biochemical tests, coagulation parameters, myocardial enzymes and arterial blood gas analysis were collected. The risk factors of mortality were analyzed using multi-logistic regression analysis. Results 188 patients with high level of plasma PCT were enrolled. There were 128 male patients (68.1%) with the average age of 62 (49, 75) years. Most patients were admitted in intensive care unit (ICU, 70.7%, 133/188). Major diagnosis was sepsis (91.0%), followed by multiple organ dysfunction syndrome (MODS, 57.4%), post large operation of thorax and abdomen (20.7%), trauma/burns (13.8%) and post-cardiopulmonary resuscitation (CPR, 6.4%). Of all the 188 patients, 115 patients survived and 73 died with a mortality of 38.8%. The parameters in the death group, including the percentages of MODS (84.9% vs. 40.0%), trauma/burns (26.0% vs. 6.1%), post-CPR (13.7% vs. 1.7%), ventilator support (82.2% vs. 40.9%) and shock (100.0% vs. 60.0%), the numbers of principal diagnosis [2.0 (2.0, 3.0) vs. 2.0 (1.0, 2.0)], acute physiology and chronic health evaluation Ⅱ score [APACHE Ⅱscore: 24 (19, 28) vs. 14 (10, 16)] and sequential organ failure assessment (SOFA) score [16.0 (12.5, 18.0) vs. 9.0 (6.0, 12.0)], as well as liver function, coagulation parameters, myocardial enzymes and lactic acid (Lac) levels were significantly higher than those in the survival group, but the platelet (PLT) count in the death group was significantly lower than that in the survival group [×109/L: 62.00 (21.50, 111.00) vs. 93.00 (53.00, 136.00), all P < 0.05]. The parameters with statistical significance in the univariate analysis were enrolled in the multiple factor logistic regression analysis, which showed that patient with a high score of APACHE Ⅱ [odds ratio (OR) = 1.290, 95% confidence interval (95%CI) = 1.121-1.484, P = 0.000] or the occurrence of MODS (OR = 7.264, 95%CI = 1.762-29.941, P = 0.006) at admission had a poor prognosis. Conclusions The primary patients with high levels of plasma PCT (> 100 μg/L) were diagnosed with sepsis, MODS, trauma and post-CPR, complicated with respiratory and circulatory insufficiency. These factors of trauma, MODS and cardiac arrest, and some laboratory parameters including PLT, Lac, liver function, coagulation spectrum, and cardiac enzymes were correlated with the prognosis of the patients with high levels of plasma PCT. High APACHE Ⅱ score and the incidence of MODS might be independent predictors of poor prognosis in the patients with high levels of plasma PCT.

OBJECTIVE: To investigate the role and significance of CD45RO in occurance and development in laryngeal squamous carcinoma, and to provide some valuable clues for searching new approaches to assess prognosis and theoretical basis for tumor biotherapy. METHOD: The expression of CD45RO protein in 50 cases of laryngeal squamous carcinoma and 10 cases normal mucos was detected by immunohistochemical S-P method. RESULT: The positive rate of CD45RO was 30% and 86% respectively in normal tissue and laryngeal squamous cell carcinoma tissue. The expresion of CD45RO was significantly and negatively associated with local metastatic of lymph nodes 0.713, P < 0.05) and tumor sites (r = -0.750, P < 0.05), but it have no notable difference with pathology differentiation, age, infiltrating depth and clinical stages in 50 cases of laryngeal squamous cell cancer. CONCLUSION (1) The expresion of CD45RO in laryngeal squamous cell cancer is more than that in normal tissue. (2) It is possible that overexpresion of CD45RO in laryngeal squamous cell carcinoma cut local metastatic lymph nodes. (3) It is probable that overexpresion of CD45RO in laryngeal squamous cell cancer made for prognosis of patients. (4) Other than UICC-TNM stage, pathology differentiation, it provide valuable clues for searching new approaches to assess prognosis of laryngeal squamous cell carcinoma.
Carcinoma, Squamous Cell ; blood ; pathology ; secondary ; Female ; Humans ; Laryngeal Neoplasms ; blood ; pathology ; Leukocyte Common Antigens ; blood ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Prognosis