Objective: To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children. Methods: A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher's exact test, while non-normal distrituction numeric variables were compared with nonparametric test. Results: Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia, Escherichia coli, and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs. 17.3% (142/820), 13.0% (103/790) vs. 9.1% (75/820), 4.6% (36/790) vs. 2.7% (22/820), χ²=18.71, 6.20, 4.07, all P<0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P>0.05). Conclusions: The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae, and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.
Adolescent ; Brain Abscess ; Child ; Child, Preschool ; Escherichia coli ; Female ; Humans ; Hydrocephalus ; Infant ; Infant, Newborn ; Male ; Meningitis, Bacterial/epidemiology* ; Retrospective Studies ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Subdural Effusion ; beta-Lactamases

Exosomes are subtypes of extracellur vesicles containing a variety of cell-specific proteins, lipids and nucleic acids released during cell activation or apoptosis, and play the role of intercellur communication mediators in different physiological and pathological processes. With the development of research in recent years, the role of platelet-derived exosomes in cardiovascular diseases has attracted extensive attention. This paper reviews the role of platelet-derived exosomes in atherosclerotic thrombosis and the potential role of platelet-derived exosomes as biomarkers for the diagnosis and treatment of atherosclerotic thrombotic disease and the problems to be solved.
Apoptosis ; Atherosclerosis/pathology* ; Blood Platelets/pathology* ; Exosomes/pathology* ; Humans ; Thrombosis

OBJECTIVE: To investigate the current status of antibiotic use for very and extremely low birth weight (VLBW/ELBW) infants in neonatal intensive care units (NICUs) of Hunan Province. METHODS: The use of antibiotics was investigated in multiple level 3 NICUs of Hunan Province for VLBW and ELBW infants born between January, 2017 and December, 2017. RESULTS: The clinical data of 1 442 VLBW/ELBW infants were collected from 24 NICUs in 2017. The median antibiotic use duration was 17 days (range: 0-86 days), accounting for 53.0% of the total length of hospital stay. The highest duration of antibiotic use was up to 91.4% of the total length of hospital stay, with the lowest at 14.6%. In 16 out of 24 NICUs, the antibiotic use duration was accounted for more than 50.0% of the hospitalization days. There were 113 cases with positive bacterial culture grown in blood or cerebrospinal fluid, making the positive rate of overall bacterial culture as 7.84%. The positive rate of bacterial culture in different NICUs was significantly different from 0% to 14.9%. The common isolated bacterial pathogens Klebsiella pneumoniae was 29 cases (25.7%); Escherichia coli 12 cases (10.6%); Staphylococcus aureus 3 cases (2.7%). The most commonly used antibiotics were third-generation of cephalosporins, accounting for 41.00% of the total antibiotics, followed by penicillins, accounting for 32.10%, and followed by carbapenems, accounting for 13.15%. The proportion of antibiotic use time was negatively correlated with birth weight Z-score and the change in weight Z-score between birth and hospital discharge (r=-0.095, -0.151 respectively, P<0.01), positively correlated with death/withdrawal of care (r=0.196, P<0.01). CONCLUSIONS Antibiotics used for VLBW/ELBW infants in NICUs of Hunan Province are obviously prolonged in many NICUs. The proportion of routine use of third-generation of cephalosporins and carbapenems antibiotics is high among the NICUs.
Anti-Bacterial Agents ; Birth Weight ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Intensive Care Units, Neonatal ; Surveys and Questionnaires

Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.
Abdomen ; surgery ; China ; Drainage ; methods ; Evidence-Based Medicine ; Humans ; Practice Guidelines as Topic ; Societies, Medical ; organization & administration ; Surgical Wound Infection ; prevention & control ; Traumatology ; organization & administration ; Vacuum

Pulsed glow discharge mass spectrometric(Pulsed-GDMS) method for the measurement of 7 kinds of key elements(Mg,Fe,Cu,La,Ce,Pr and Nd) in rare earth alloys was established. The influence factors of measurement repeatability, such as pulse time, sample homogeneity, anode cap, flow tube, corn, and sample tablet density were systematically studied. The results showed that,for elements with mass fraction of more than mg/g, the parts (anode cap, flow tube and corn) had the largest influence on measurement repeatability. When the new graphitic parts were used and no parts were changed during the whole measurement,the relative standard deviation (RSD) was less than 3%. However, the RSD were 2%-11%and 3%-21% when the new graphitic parts and the reusable parts were used and changed,respectively. The second influence factor of measurement repeatability was the tablet density. The results showed that,the lower the density,the worse the measurement repeatability, and for the dense tablet, the RSD was less than 3%. Key elements in 1# rare earth alloy were measured by high resolution inductively coupled plasma-mass spectrometry (HR-ICP-MS), and the analytical results were used as reference values for the calibration of Pulsed-GDMS. The relative sensitivity factors (RSF) were obtained, and the key elements in 2# rare earth alloy were measured by Pulsed-GDMS after calibration. The analytical results of key elements in 2#sample by Pulsed-GDMS and HR-ICP-MS were compared, and the results showed that for the dense sample, the analytical results showed good agreement. Under the optimal conditions, the expanded uncertainty of measurement by Pulsed-GDMS reduced to 3%-10%.

Objectives: This study aimed to observe the change of arachidonic acid-induced platelet aggregation rate (AA-Ag) and short-term adverse reactions after taking 50 or 100 mg/d aspirin(enteric-coated sustained-release formulation) or 100 mg/d aspirin (enteric-coated aspirin tablet)in the elderly Chinese population (aged 60 years or older). Methods: A total of 1 194 participants aged 60 or older, who should be recommended to take aspirin therapy due to medical reasons, were recruited and randomly assigned into three groups to receive enteric-coated sustained-release aspirin tablet (50 mg, once daily, group A), or 100 mg, once daily (group B) or enteric-coated aspirin tablet 100 mg once daily (group C), respectively. AA-Ag was measured after (14±3)days of aspirin treatment. Adverse events and bleeding events were recorded during the (28±3)days of follow-up. Results: The AA-Ag in group A (n=347), B (n=338) and C (n=332) post 14-day aspirin therapy were 6.65 (4.03,10.84)%, 5.89(3.22,10.03) % and 6.00(3.68,10.09) %, respectively (P>0.05). During the 28 days follow-up, the adverse events rate of group A (n=388), B (n=387) and C (n=385) was 3.87%,3.36%, and 7.95%, and the mild bleeding events rate was 3.09%, 2.33%, and 6.23%, respectively. Adverse events rate and mild bleeding events rate were significantly higher in group C than in group A and B (P<0.05). Conclusions: Compared with 100 mg-dose aspirin, 50 mg-dose aspirin achieves similar anti-platelet aggregation effect in this elderly Chinese population. The short-term adverse events and mild bleeding risk of aspirin with enteric-coated sustained-release formulation were fewer than that of enteric-coated formulation.

Objective To explore the influence of Xihuang Pill on the levels of hormones and receptors in hypothalamus -pituitary-ovary axis and the index of ovary and uterus organs in rats .Methods Wistar female non-pregnant rats were randomly divided into 5 groups ( n =10 in each group):blank group,control group and medium,high and low dose experi-mental groups.Each rat in the control group was given 1.8 mg· kg-1· d-1 tamoxifen;and each rat in the high , middle and low dose experimental groups was given 2.16,1.08 and 0.54 g· kg -1· d-1Xihuang Pill for gastric perfusion,and the blank group was given distilled water with equal volume.The serum levels of gonadotropin -releasing hormone ( GnRH), follicle stimulating hormone (FSH) and luteinzing hormone (LH),estra-diol(E2),progesterone were detected by enzyme linked immunosorbent assay.The expression of follicle stimulating hormone receptor (FSHR) and luteinizing hormone receptor (LHR) in ova-ries were detected by Western blot.Results GnRH in blank group,control group and high,middle and low dose ex-perimental groups were ( 14.99 ±2.33 ), ( 14.63 ±3.39 ), ( 11.90 ±1.11 ), ( 5.55 ±1.05 ), ( 14.82 ±1.47 ) ng· L-1,respectively;comparison between high ,middle dose experimental groups and blank group ,the difference was significant ( all P ＜0.01 ) .E2in the 5 groups were ( 16.84 ±4.20 ), ( 9.10 ±4.76 ), ( 13.38 ±2.12 ), (13.45 ±4.14),(16.32 ±4.23) ng· L-1,respectively;comparison between control group and blank group ,the di-fference was significant ( P ＜0.01 ) .Progesterone in the 5 groups were ( 164.46 ±14.90 ), ( 189.99 ±23.35 ), (187.12 ±17.23),(196.25 ±15.87),(173.26 ±14.07) pmol· L-1,respectively;comparison between control group and high,middle dose experimental groups with blank group ,the difference was significant ( P＜0.05 or P＜0.01 ). Conclusion Xihuang Pill can reduce the contents of GnRH and E 2in serum of rats and increase the content of progesterone,which indicates that Xihuang Pill can have an influence on hypothalamic -pituitary-ovarian axis related hormones.

Objective To study the efficacy and possible molecular mechanisms of celecoxib on the prevention and treatment of traumatic myositis ossificans (TMO) in rats.Methods TMO SD rats were prepared,and 40 rats were randomly divided into control group and test group,20 rats in each group.The test group was given 10 mg · kg-1 · d-1 celecoxib by intragastric administration,qd,and the control group was given an amount of 0.9％ NaCl by intragastric administration,qd.Two groups of rats were given 10 weeks.New bone formation of two groups was detected by X ray examination.Enzyme-linked immunosorbent assay (ELISA) was used to detect the expressions level of tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6) and bone morphogenetic protein-4 (BMP-4).Results At the fifth week after operatiorn,the new bone formation in the test group and the control group were 35.00％ (7 cases/ 20 cases) and 70.00％ (14 cases/20 cases),TNF-α levels were (73.6±15.9) and (101.5 ±17.3) ng· L-1,and IL-6 levels were (33.6 ± 5.8) and (52.8 ± 7.2)ng · L-1,the differences were statistically significant (all P ＜ 0.05).At the tenth week after operation,the new bone formation in the test group and the control group were 65.00％ (13 cases/20 cases) and 95.00％ (19 cases/20 cases),TNF-α levels were (55.8-12.7) and (81.7 ± 15.6) ng· L-1,and BMP-4 levels were (4.5 ± 0.3) and (5.3 ± 0.2) ng · L-1,the differences were statistically significant(all P ＜ 0.05).Conclusion Celecoxib has a good preventive and therapeutic effect on TMO,and its mechanism may be related to the inhibition of the level of inflammation and down-regulation of BMP-4 expression.

OBJECTIVETo investigate the first switched time of PML/RARα fusion gene in patients with acute promyelocytic leukemia (APL) and its clinical significance.

METHODSsixty cases of newly diagnosed APL were enrolled in this study. They received standard remission induction, consolidation and maintenance treatments according to the clinical pathway for APL, and were followed up. During the same time the PML/RARα fusion gene mRNA expression of all cases was detected by multi-nested PCR.

RESULTSexcept for 3 death cases and 1 case failed to follow-up, the PML/RARα fusion genes in the remaining 56 cases were firstly found to be negative from 24 to 381 days respectively, the mean value of the first switched time was 131 ± 90 days. There was no statistically significant difference in age, sex and risk stratification between different groups. However, the cases with L-type PML/RARα gene had shorter time compared with the patients with S-type PML/RARα gene (P = 0.032); then, for the above-mentimed 56 cases, the follow-up duration ranged from 25-1979 days (median 946 days), long-term molecular remissions had been observed in most cases, but 1 case with the first switched time of 133 days unfortunately recurred to be positive and followed by clinical relapse.

CONCLUSIONThe PML/RARα fusion gene in newly diagnosed APL patients was first switched to be negative in about 4 months after treatment. The first switched time of PML/RARα fusion gene can objectively reflect the reduction of leukemia cells, and the differences among different subtypes of PML/RARα fusion gene may have some suggestions for the treatment, but without important significance for the evaluation of prognosis and recurrence for APL patients. In addition, minimal residual disease (MRD) can be dynamically monitored by detecting PML/RARα fusion gene, thus having an important clinical significance for analysis of APL recurrence.

Humans ; Leukemia, Promyelocytic, Acute ; Neoplasm, Residual ; Oncogene Proteins, Fusion ; Polymerase Chain Reaction ; Prognosis ; Recurrence ; Remission Induction

OBJECTIVETo evaluate the surgical outcomes for patients with locally recurrent rectal cancer (LRRC) and to analyze the prognostic factors.

METHODSClinical data of 187 patients with LRRC undergoing surgery at the First Hospital of peking University from January 1985 to December 2009 were retrospectively reviewed.

RESULTSProcedures performed included local resection(n=34), abdominoperineal resection (n=35), posterior pelvic exenteration (n=17), total pelvic exenteration(TPE, n=98), TPE with sacrectomy (n=2), and TPE with internal hemipelvectomy (n=1). The operation was R0 in 87 patients, R1 in 60, and R2 in 40. The degree of radical resection was associated with the initial surgery and the degree of pelvic fixation (P<0.05). The pelvic recurrence rate was 44.4%(64/144). The operative morbidity and mortality were 47.5%(89/187) and 2.7%(5/187), respectively. The overall 3- and 5-year survival rates were 42.2% and 30.7%, respectively. The degree of radical resection and lymph node metastasis were independent risk factors associated with prognosis. The 5-year survival rates of R0, R1 and R2 were 42.6%, 17.2% and 0, respectively(P<0.01). The 5-year survival rates of patients with and without lymph node metastasis were 5.6% and 40.5%(P<0.01) respectively.

CONCLUSIONAccurate evaluation of extent of pelvic fixation and achievement of R0 resection are critical to improve the surgical outcomes for LRRC.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; surgery ; Pelvic Exenteration ; methods ; Prognosis ; Rectal Neoplasms ; mortality ; pathology ; surgery ; Retrospective Studies ; Survival Rate