ObjectiveTo understand the prognosis of infantile spasm through long-term follow-up. MethodsChildren with infantile spasm diagnosed and treated in Children’s Hospital from January 2010 to December 2015 were retrospectively analyzed. Clinical data were collected and telephone follow-up was conducted. ResultsA total of 169 cases were collected, and only 59 cases were successfully followed up, of which 13 patients were allowed to attend school. 38 patients were not allowed to go to school, 8 patients were dead. In the group that did not go to school, 17 of them could not walk, accounting for 44.74% of the non-school attendance group, 27 of them could not run, accounting for 71.05% of the non-school attendance group. There are 33 caese who could only depend on family care instead of themselves, accounting for 86.84% of the non-school group.There were 36 children who could not speak simple sentences, accounting for about 94.74%. In addition, in terms of seizures, there were 15 patients seizure-free for more than 5 years, accounting for 29.41% of the survival group. ConclusionThe long-term prognosis of infantile spasm was poor, the mortality rate was 13.56%, the school attendance rate was 25.5% in the survival group, and the self-care ability of the non-school attendance group was poor. The normal development at the onset of the disease and the early control of epilepsy without seizures are the important prognostic factors of the disease.
Objective To analyze the clinical features of patients with acute pulmonary embolism ( APE) with normal blood pressure and right ventricular dysfunction. Methods 130 hospitalized patients with normotensive APE between January 2009 and January 2012 were retrospectively analyzed. The patients underwent transthoracic echocardiography to determine if they were complicated with RVD. The clinical features, risk factors, diagnosis, and treatment were analyzed and compared between the normotensive APE patients with or without RVD. Results 41 normotensive APE patients with RVD were as RVD group, and other 89 patients without RVD were as non-RVD group. The incidences of syncope ( 34.1% vs. 7.8% ) , tachycardia( 41.4% vs. 21.3% ) , P2 hyperthyroidism( 46.3% vs. 25.8% ) , jugular vein filling ( 12.1% vs. 1.1% ) , and cyanosis ( 26.8% vs. 8.9% ) were all significantly higher in the RVD group than those in the non-RVD group ( P lt; 0.05) . Computed tomography pulmonary angiography ( CTPA) revealed that the incidences of thromboembolism involving proximal pulmonary artery ( 58. 3% vs. 8. 3% ) and thromboembolism involving lobar pulmonary ( 77.8% vs.51.2% ) were also higher in the RVD group ( P lt; 0.001, P = 0.025 ) . In the RVD group, the patients were assigned to received thrombolysis plus anticoagulation therapy, or anticoagulation therapy alone. The clinical indicators ( heart rate, PaCO2 , AaDO2 , SPAP, TRPG) were all statistically improved after thrombolysis or anticoagulation treatment ( P lt;0.001) . But compared with the patients who underwent anticoagulation therapy alone, the cost of treatment and the incidence of minor bleeding were significantly higher, and the levels of AaDO2 , SPAP and TRPG were statistically lower in the patients with thrombolysis plus anticoagulation therapy. Conclusions For APE patients with central pulmonary embolism demonstrated by CTPA, syncope, and tachycardia, transthoracic echocardiograph should be performed as early as possible to confirm RVD diagnosis. For normotensive APE patients with RVD, anticoagulant treatment can achieve higher efficacy of costeffectiveness ratio.
ObjectiveTo investigate the difference in fibrinogen and D-dimer (D-D) level among pulmonary embolism patients with different risk stratification. MethodsSixty pulmonary embolism patients admitted during January 2013 and January 2014 in our hospital were retrospectively analyzed.The general clinical data were gathered, and the patients were divided into a high-risk group (n=19), a moderate-risk group (n=21), and a low-risk group (n=20) according to the 2008 ESC Guidelines on the diagnosis and management of acute pulmonary embolism.Fourteen patients admitted simultaneously with dyspnea and chest pain without pulmonary embolism were randomly recruited as a control group.The plasma levels of fibrinogen and D-D were detected and compared between these groups. ResultsIn the pulmonary embolism patients, there were no significant statistical differences in general data between the patients with different risk degree.With the risk degree increased, the level of fibrinogen decreased and the level of D-D increased (P < 0.05).Compared with the pulmonary embolism patients, the level of fibrinogen was higher and the level of D-D was lower in the control group(P < 0.05).The level of fibrinogen was negatively correlated with the level of D-D with a correlation coefficient of-0.805. ConclusionsElevated fibrinogen is one of high risk factors of the pulmonary embolism. With the occurrence of pulmonary embolism, the level of fibrinogen becomes lower, suggesting the potential of fibrinogen as a indicator for pulmonary embolism diagnosis and risk stratification.
Objective To investigate the value of procalcitonin (PCT) at admission for severity stratificaton and prognosis prediction of community-acquired pneumonia (CAP), and assess the ability of the combination of PCT and the validated pneumonia risk scores (PSI and CURB-65) for predicting 30-day mortality. Methods A retrospective study was performed in 150 hospitalized CAP patients admitted in the Department of Respiratory Medicine of General Hospital of Tianjin Medical University between March 2015 and March 2016. The primary end point for this study was mortality within 30 days. Sensitivity (SEN), specificity (SPE), positive and negative predictive value (PPV, NPV) of PCT for assessing mortality was calculated and compared to validated pneumonia risk scores. Results In the 150 CAP patients enrolled, there were 77 males and 73 females with an average age of 58.4±16.3 years. Twelve (8%) patients died within 30 days. The non-survivors had significantly higher median PCT level (4.25 ng/mlvs. 0.24 ng/ml) and C-reactive protein (CRP) level (14.60 mg/dlvs. 5.10 mg/dl) compared with the survivors. The median PCT level was significantly higher in the patients with more severe disease assessed by two risk scoring systems. Combination of PCT with risk scores can improve prognostic value for predicting 30-day mortality of CAP. Conclusions The level of PCT at admission is more useful than the traditional biomarkers for the severity stratification and prognosis prediction of CAP. It can well determine patients at low risk of mortality from CAP. There is no advantage of PCT compared to PSI or CURB-65, so we recommend combination of PCT to risk sores to predict 30-day mortality of CAP.
Objective To discuss the correlation between immune status and clinical characteristics in pulmonary cryptococcosis. Methods The clinical data of 32 non-AIDS patients with pulmonary cryptococcosis, diagnosed from August 2001 to October 2017 in Tianjin Medical University General Hospital, were retrospectively analyzed. The enrolled patients were divided into an immune-competent group with 13 cases and an immune-suppressed group with 19 cases. The clinical characteristics were compared between the two groups with different immune status. Results All 32 patients were treated for clinical symptoms. The main symptoms were cough, expectoration, fever, chest tightness, chest pain, and hemoptysis. There were no statistical differences between the two groups. The computed tomography of chest showed that there were 2 patients (6.3%) involving upper lung in the immune-competent group, and 5 patients (15.6%) in the immune-suppressed group. There were 9 patients (28.1%) involving lower lung in the immune-competent group, and 12 patients (37.5%) in the immune-suppressed group. There were 10 patients (31.3%) with nodular masses of lesions in the immune-competent group and none in the immune-suppressed group. There was 1 patient with infiltrating in the immune-competent group and 8 patients in the immune-suppressed group. There were 2 patients with mixed types of lesions in the immune-competent group and 11 patients in the immune-suppressed group. Five patients were complicated with cryptococcal meningitis, and 2 patients with eosinophilia. Conclusions The clinical characteristics of the patients with pulmonary cryptococcosis are not specific in difference immune status. The chest CT shows that the lesions of immune-competent patients are mainly nodular masses type, while lesions of immune-suppressed patients are mainly infiltrating shadow and mixed shadow. The treatment should be chose according to immune status.
Objective To develope a novel rabbit carotid body and carotid common artery model in vivo for the simulation of various intermittent hypoxia ( IH) intensities, IH durations, IH reoxygenation ( ROX) durations and continuous hypoxia ( CH) modes. Methods Forty-five adult New Zealand rabbits ( 2. 5-3. 0 kg) were anesthetized while spontaneous breathing kept intact. The tissue surrounding the right carotid common artery and carotid sinus nerve ( CSN) were cleared and " single" chemoreceptor bundle of the CSN was revealed. Then suction electrodes were placed and CSN afferent activity was monitored and recorded carefully. The right common carotid artery was exposed, cannulated to distal part and its proximal part was ligated. Preparations were challenged by changing the PO2 of the gas mixture equilibrating the perfusate. Alternatively perfusion ( 2 mL/min) of equilibrated perfusate bubbled with normoxia or hypoxia gas mixtures formed IH/ROX cycles in carotid common artery, simulating the pattern of hypoxic episodes seen in obstructive sleep apnea syndrome ( OSAS) , or with continuously perfusing hypoxia perfusate to form CH modes. All the perfusing procedures were regulated by a customized computer-controlled set and monitored using O2 gas analyzer. After the systematic exposures, carotid body, carotid common artery part distal to cannula, and carotid bifurcation were harvested as samples. Results The frequencies and average amplitudes of CSN chemoreceptor bundles afferent activities with normoxia perfusion were ( 0. 17 ±0. 03) impulse/ s and ( 46. 2 ±4. 4) μV, and with hypoxia perfusion were ( 0. 64 ±0. 09) impulse/ s and ( 87. 4 ±6. 6) μV, respectively. PO2 was ( 139 ±1. 5) mm Hg in normoxia perfusate and ( 35. 2 ±1. 3) mm Hg in hypoxia perfusate. Conclusion This new carotid body and carotid common arterymodel is a valuable tool to study neurological and biochemical changes in various IH and CH modes.
Objective To summarize research progress of the mechanism of natural killer cells (NK cells) acted in regulating the T cell immunity in chronic infectious disease. Method Literatures about recent studies concerning how NK cells act as a regulator for T cells in chronic infectious disease were reviewed according to the results obtained from PubMed, Embase, CNKI, CBM, and Wanfang databases. Results NK cells that acted as regulators of T cell immunity could affect T cell immune responses through influencing antigen presentation, secreting cytokine, and presenting lytic activities, thus playing an important role in the immunological therapy of chronic infectious diseases. Conclusion NK cells are critical for T cell immune regulation, which could provide noval strategies for immunological therapy of chronic infectious disease, transplantation-related immune rejection, and autoimmune disease.
Objective To detect expression of miR-483-5p in surem of patients with hepatocellular carcinoma (HCC) and investigate it’s clinical significance for diagnosis of HCC. Methods The rerum samples of 112 patients with HCC (HCC group), 85 patients with chronic viral hepatitis B (CHB group), and 56 healthy people for physical examination (healthy control group) were collected from January 2010 to January 2012 in the First Hospital of Lanzhou University. According to the results of preliminary chip detection of miRCURY LNATM miRNA, the real-time fluorescent quantitative PCR was adopted to quantitate the serum levels of miR-483-5p and miR-500a and the routine electrochemical method was used to detect the serum alpha fetoprotein (AFP) in every group. The receiver operating characteristic (ROC) curve was utilized to analyze the diagnostic values of serum miR-483-5p, miR-500a, and AFP for the HCC. Results The serum levels of miR-483-5p and miR-500a in the HCC group were significantly higher than those of the CHB and healthy control groups (both P<0.000 1), which had no significant differences between the CHB group and the healthy control group (P>0.05). The serum miR-483-5p level of the HCC patient decreased markedly at the postoperative 30 d (P<0.000 1) as compared with the preoperative level. The area under the ROC curve (AUC) of miR-483-5p, miR-500a, AFP, or miR-483-5p in combination with AFP for the diagnosis of the HCC was 0.74 (cutoff value=2.842, sensitivity=74% and specificity=66%), 0.66 (cutoff value=1.830, sensitivity=74% and specificity=51%), 0.81 (cutoff value=20 μg/L, sensitivity=78% and specificity=70%), and 0.92 (cutoff value=3.78, sensitivity=81% and specificity=83%), respectively. The AUC values of miR-483-5p in the diagnosis of the HCC patients with positive AFP (AFP>20 μg/L) and negative AFP (0–20 μg/L) were 0.78 and 0.83, respectively. Conclusions Serum miR-483-5p highly expresses in HCC, which has a certain accuracy in diagnosis of HCC, it combined with AFP could further increase its diagnostic value. Serum miR-483-5p might play an important supplemental role in diagnosis of HCC patient with negative AFP.