Objective To investigate the fungal species distribution, liability factors, therapy and prevention of fungal septicemia.Methods A time-matched case-control study was conducted in 30 patients fromApril 2011 to November 2012 with fungal septicemia. Results Of the pathogens in 30 cases with fungal septicemia, 43.3% was Candida albicans, 23.3% was Candida tropicalis, and 10% was Candida parapsilosis. All 30 cases with fungal septicemia were hospital acquired. Malignant hematological system disease( 33.3% ) , COPD( 23.3% ) , and diabetes ( 20.0% ) were the main predisposing diseases. Broadspectrumantibiotic use( 86.7% ) , endovascular prosthesis( 60.0% ) , parenteral alimentation( 53.3% ) were the major risk factors. All 30 cases received systemic anti-fugal therapy. The efficacy rate of amphotericin B therapy was higher than that of fluconazol ( P =0.002) and voriconazole( P = 0.006) . 13 cases( 43.3% ) were cured or significantly improved, and 17 cases( 56.7% ) were dead. Conclusions The most frequently fungi was Candida albicans in fungal septicemia. Malignant hematological system disease and COPD were main predisposing diseases. Broad-spectrumantibiotic use and parenteral alimentation were independent risk factors. Anti-fugal therapy with amphotericin B can achieve better prognosis. Early diagnosis, controlling risk factors, and earlier empirical antifungal therapy are keys to reduce mortality of fungal septicemia.
Objective To investigate the differences in bacteria distribution and drug resistance of pathogens in patients with lower respiratory tract infection between respiratory general wards and respiratory intensive care unit ( RICU) .Methods All the clinical isolates fromsputumor secretion of lower respiratory tract from2007. 1-2010. 10 were analyzed retrospectively. Antibiotic susceptibility was tested by Kirby-Bauer method. Results The total number of isolated strains was 3202. Among 1254 strains isolated from respiratory general wards, Gram-positive bacteria accounted for 2. 63% , Gram-positive bacteria accounted for 42. 42% , and fungi accounted for 54. 95% . Streptococcus pneumoniae ranked first place among Gram-positive bacteria, accounting for 51. 52% . Haemophilus parainfluenzae bacillus ranked first place among Gramnegative bacteria, accounting for 21. 99% . Both were sensitive to the most commonly used antibiotics. Among 1948 strains isolated from RICU ward, Gram-positive bacteria accounted for 4. 52% , Gram-positive bacteria accounted for 37.73% , and fungi accounted for 57. 75% . Staphylococcus aureus ranked first place among Gram-positive bacteria, accounting for 52. 27% . Acinetobacter baumannii ranked first place in Gramnegative bacteria, accounting for 27. 35% . Both were resistant to most commonly used antibiotics. Pseudomonas aeruginosa had a higher rate of infection both in the general wards and RICU, and was resistant to most commonly used antibiotics.Conclusions In lower respiratory tract infection of respiratory general ward, Gram-positive bacteria with Streptococcus pneumoniae mainly and Gram-negative bacteria with Haemophilus parainfluenzae mainly are both sensitive to the most commonly used antibiotics. While in the RICU ward, Gram-positive bacteria infections with Staphylococcus aureus mainly and Gram-negative bacteria infections with Acinetobacter baumannii mainly are both resistant to most commonly used antibiotics.
Objective To investigate nosocomial non-fermented bacterial infection in lower respiratory tract and the risk factors for multi-drug resistant bacterial infection. Methods 229 patients with nosocomial nonfermented bacterial infection in lower respiratory tract from January to December in 2007 in Xiangya Hospital were analyzed retrospectively. The distribution and drug sensitivity of pathogens were recorded. Of those 229 patients,183 cases were infected by non-fermented multi-drug resistant bacteria( MDRB) . The risk factors for non-fermented MDRB infection in lower respiratory tract were analyzed by multi-factor logistic multiple regression analysis.Results The top four non-fermented bacteria isolated were Pseudomonas aeruginosa( 47.6%) , Acinetobacter baumannii( 36. 3% ) , Acinetobacter spp( 8. 6% ) , and Stenotrophomonas maltophilia( 5. 1%) . Higher isolatated rate was found in neurosurgery ( 25. 7% ) and central ICU( 22. 9% ) . The isolated non-fermented bacteria except Stenotrophomonas maltophilia were resistant to all antibiotics except cefoperazone-sulbactam and meropenem. ICU stay( P lt; 0. 001) , tracheotomy or tracheal intubation( P = 0. 001) , and previous use of carbapenemantibiotics( P =0. 032) were independent risk factors for non-fermented MDRB infection. Conclusion Non-fermented bacillus were important pathogens of nosocomial infection in lower respiratory tract with high rates of antibiotic resistance. It is important to prevent non-fermented MDRB infection by strict limitation on the indication of ICU stay,tracheotomy and use of carbapenem.
ObjectiveTo improve the diagnosis and treatment of the disease, the clinical symptoms, pathological features, diagnosis and differential diagnosis, treatment and prognosis of massive lung inflammatory myofibroblastic tumor (IMT) were analyzed.MethodsA case, admitted to the Department of Respiratory and Critical Care Medicine of Xiangya Hospital, Central South University, diagnosed as massive lung IMT, was retrospectively analyzed. His clinical and chest radiological data were collected and literature which searched through CNKI, WanFang Med online and PubMed on this subject were reviewed.ResultsThe patient, middle-age male, was presented with cough, dyspnea and weight loss, whose chest radiology was characterized by a large thoracic cavity occupation. He was confirmed with massive lung IMT by several lung biopsy. From above databases, 8 cases were retrieved, including 6 articles in English and 2 articles in Chinese. In 9 cases of massive lung IMT, there were 4 males and 5 females. The age was from 1.5 to 75 years old and the average age was 28 years old. The clinical symptoms were non-specific, and chest imaging was characterized by a large thoracic occupation. One case had distant metastases with bone, adrenal gland and lymph node, and one case had distant metastasis with brain after complete surgery.ConclusionsLung massive IMT has no characteristic clinical and radiological features. And a definite diagnosis depends on pathological biopsy and immunohistochemical analysis. It needs to be differentiated from other thoracic giant tumors. The preferred treatment is complete surgical resection. The prognosis after complete resection is usually good, and probably affected by size.
Objective Using nerve growth factor ( NGF) and anti-NGF microspheres injected directly into the asthmatic rat adrenal gland, to explore the possible role of anti-NGF microsphere treatment in asthma.Methods 32 male SD rats were randomly divided into a normal control group, an asthma group, a NGF microspheres group, and an anti-NGF microspheres group. The behavior of rats, lung function testing, light microscopy of lung biopsy, electron microscopy of adrenal medulla cell ultrastructure changes, NGF and phenylethanolamine N-methyltransferase ( PNMT) expressions in the adrenal gland were assayed by immunohistochemistry method, and serum NGF, cortisol, corticosterone, epinephrine and norepinephrine concentrations were detected by ELISA. Results Behavior in the asthma rats showed varying degrees of sneezing, runny nose, wheezing, scratching the head and face, irritability holes, incontinence, increased aggression and other acts, while in the anti-NGF rats showed relatively slighter symptoms. The rats in the asthma, anti-NGF and NGF groups showed significant airway hyperresponsiveness, while RL value reduced and Cdyn value increased in the anti-NGF group compared with the asthma group. HE staining of lung tissue revealed obvious bronchoconstriction, inflammatory cell infiltration around small vessels and alveolar spaces and in interstitum, bronchial epithelial cells desquamation in the asthma group. In anti-NGF group, tracheal epithelium was relatively complete, inflammatory exudation, bronchoconstriction and inflammatory cell infiltration were milder compared to the asthma group. Electron microscopy showed vacuolated changes of adrenal medulla cells, uneven distribution of chromaffin granules in the asthma group and the NGFgroup, and the quantity and concentration of chromaffin granules were significantly lower than normal. There were villous clubbing processes on the adrenal medulla cell membrane in the NGF group. While the anti-NGF group had no significant vacuolar changes in chromaffin granules and the concentration was close to normal. Image analysis showed that mean gray values of PNMT and NGF in the anti-NGF group were significantly different fromthe asthma group. The ELISA results showed that: ( 1) The average concentrations of epinephrine in each group were as follows, ie. the control group gt; anti-NGF group gt; asthma group gt; NGF group. ( 2) The average concentrations of norepinephrine in each group were as follows, ie. the NGF group gt; asthma group gt; anti-NGF group gt; control group. ( 3) There was no significant difference among the groups in the average concentration of cortisol. ( 4) The average concentrations of norepinephrine in each group were as follows, ie. , the control group gt; anti-NGF group gt; asthma group gt; NGF group. Conclusions Local embedding of anti-NGF microspheres can alleviate inflammatory infiltration in lung tissue and improve lung function of rat model with asthma. The mechanismmay be the anti-NGF antagonists the NGF receptor and reverse adrenal medulla cell transdifferentiation process primined by NGF.
ObjectiveTo analyze the clinical and epidemiological characteristics of hospitalized avian influenza A (H7N9) virus infections in Hunan province from 2013 to 2017, and provide evidences for control, diagnosis and treatment of this disease.MethodsNinety-one hospitalized patients were confirmed with H7N9 infection in Hunan. Excluding 2 patients less than 18 years old and 10 with missing data, 79 patients with H7N9 infection were analyzed.ResultsMost confirmed cases were affected in the second and fifth epidemic wave and number of patients in the fifth wave was more than the sum in prior 4 waves. Epidemiological characteristics, clinical symptoms and case fatality did not change significantly. Administration of antiviral drugs was more active in the fifth wave [from illness onset to antiviral drug: (6.3±2.4)d vs. (7.6±2.4)d, P=0.047]. Multiple logistic regression analysis showed that shock (OR=4.683, 95%CI 1.136–19.301, P=0.033) was the independent risk factor of H7N9 infections. There were no significant differences in case fatality among group oseltamivir, group oseltamivir+peramivir, and group peramivir.ConclusionsPatients with avian influenza A (H7N9) increased in the fifth wave but clinical characteristics changed little. Antiviral treatment should be more active. Shock is an independent risk factor of H7N9 infections. Oseltamivir-peramivir biotherapy can not reduce case fatality compared with oseltamivir or peramivir monotherapy.
ObjectiveTo investigate the disease severity and comorbidities in outpatient with asthma from urban area in China.MethodsA face-to-face, questionnaire-based survey was carried out in outpatient department in 30 general hospitals from 30 provinces in China mainland except for Tibet during October 2015 to May 2016, and asthma patients who meet the including criteria were enrolled. Data of demographic characteristics, smoking status, disease severity, and comorbidities were collected.ResultsA total of 3 875 cases were included. According to GINA criteria, the proportion of diseases severity was as following: intermittent status 52.5% (2 033/3 875), mild persistent 24.5% (951/3 875), moderate persistent 16.9% (656/3 875), and severe persistent 6.1% (235/3 875). The overweight rate was 32.9% (1 274/3 875), the rate of obesity was 10.3% (401/3 875), and the smoking rate was 20.1% (777/3 875). Obesity and smoking were related to poor asthma control. 75.9% (2 941/3 875) of the patients had comorbidities: allergic rhinitis 43.4% (1682/3 875), hypertension 16.4% (634/3 875), nasosinusitis 8.7% (338/3 875), chronic obstructive pulmonary disease 7.3% (283/3 875), bronchiectasis 3.0% (118/3 875), and rhinopolypus 2.9% (114/3 875).ConclusionsThe majority of asthma patients from outpatient department are mild asthma patients. The proportion of allergic rhinitis and bronchiectasis in asthma patients is higher than mean level. Asthma patients with comorbidities of obesity and smoking is related to poor asthma control.
ObjectiveTo analyze the relationship between medication compliance of patients with uncontrolled asthma and lung function,airway inflammation level, asthma control level and quality of life so as to obtain important references for improving patient compliance and asthma control level in the future. MethodsQuestionnaires were performed in asthma patients who did not achieve asthma control and had poor compliance in 32 third-class hospitals in 28 provinces of China mainland. All patients were tested for lung function and airway inflammation levels. So the relevant data of asthma compliance was investigated and analyzed. ResultsA total of 923 patients were investigated and the questionnaire recovery rate was 100%. Two hundred and forty-three (26.33%) answered cognitive related questions about asthma completely correctly. Treatment compliance in asthma patients was positively correlated with lung function and significantly negatively correlated with exhaled nitric oxide. Better treatment compliance in asthma has higher level of asthma control and quality of life. Poor compliance in asthma patients will lead to decreased lung function and elevated levels of airway inflammation, resulting in decreased asthma control and quality of life. ConclusionAsthma treatment compliance is related to lung function, airway inflammation, asthma control level and quality of life.