Objective To summarize the clinical features and prognosis of extensively drug-resistant Acinetobacter baumannii (XDRAB) bacteremia. Methods This retrospective study included patients with Acinetobacter baumannii bacteremia diagnosed and treated in RICU of this hospital during January 1, 2012 and December 31, 2015. Demographic features, clinical data, clinical outcome within 3 days and 14 days after sample collection for blood culture were collected. Results Eight patients were included, with the mean age of (62.4±18.0) years, and including 3 males and 5 females. All patients had underlying diseases, 6 patients were immune suppressed, 7 patients had been exposed to β-lactam/enzyme inhibition or carbapenems for at least 7 days within 2 weeks before blood sample collection, and 6 patients received mechanical ventilation. Lung is the main pathogen source (6 cases). Within 48 hours after blood collection, the mean acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score was 28.3±7.5, the level of serum C-reactive protein (18.2 to 231.0 mg/L) and procalcitonin (0.1 to 25.0 ng/ml) had individual differences. The 3-day mortality rate was 4/8, the death group had APACHEⅡ >25. The 14-day mortality rate was 6/8, all the patients with procalcitionin>0.5 ng/ml died. Conclusions The 14-Day mortality is associated with the severity and increased procalcitionin in XDRAB patients. Preemptive therapy is recommend for patients with multiple risk factors, receiving mechanical ventilation, and with elevated procalcitonin and high APACHEⅡ score ( >25).
ObjectiveBy detecting the expression of the long non-coding RNA metastasis associated lung adenocarcinoma transcript 1 (MALAT1) in myocardial tissue under different hypoxia patterns, to explore the possible mechanism of obstructive sleep apnea (OSA)-induced cardiovascular diseases.MethodsSD rats were randomly and equally divided into 4 groups namely a normal (N) group, a continuous hypoxia (CH) group, an intermittent hypoxia (IH) group and an intermittent hypoxia with hypercapnia (IHH) group, and were treated for 1, 2, and 3 weeks. The expression of MALAT1 and associated immune factors of the myocardial tissue were examined by qRT-PCR.ResultsAn elevation without significance was observed in those three hypoxia groups in contrast with N group after 1 week’s treatment. However, in 2 and 3 weeks’ groups, the mRNA expression of MALAT1 was significantly higher in IHH group than the other three groups (all P<0.01), while there was no significant difference among IH, CH or N groups despite an increasing tendency in IH and CH groups against N group were observed. Additionally, the expressions of hypoxia inducible factor-1α (P<0.05), Toll-like receptor 4 (P<0.01) and interleukin-6 (P<0.05) mRNA were also increased significantly in IHH group compared with IH, CH and IHH groups in 3 weeks’ treatment respectively, which were coordinated with the change of MALAT1 mRNA.ConclusionsThe expression of MALAT1 in myocardial tissue is elevated by intermittent hypoxia with hypercapnia, and the tendency is similar with hypoxia-induced inflammation factors. These findings indicate that MALAT1 is probably a regulatory factor of OSA induced myocardial immune injury.
Objective To evaluate the value of Epworth sleepiness scale ( ESS) in evaluating the severity of obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods A total of 340 cases with suspected OSAHS were enrolled. The ESS scores and polysomnography ( PSG) monitoring data were analyzed. According to the PSG monitoring results the patients were classified into non-OSAHS, mild, moderate and severe OSAHS groups. The average ESS scores and the ratio of patients whose ESS score was ≥9 were compared among the four groups. The diagnostic value of ESS score was evaluated by ROC curve. The correlation of ESS scores with age, apnea hypopnea index ( AHI) , the lowest SpO2( LSpO2 ) and microarousal index was analyzed. Results The ESS scores had an ascending tendency as the severity of OSAHS was increased but only in the severe OSAHS cases the difference was significant statistically compared with the other three groups ( P lt; 0. 05) . The mean ESS scores in the four groups were 9. 96 ± 4. 81,10. 21 ±5. 48, 11. 48 ±5. 28 and 13. 52 ±5. 84, respectively. There was no statistical significance while comparing the ratio of patients whose ESS scores were ≥9 among the four groups. The analysis of ROC curve showed the area under the ROC curve ( AUC) was lesser( 0. 601) and a best cutoff could not be obtained. When ESS score ≥9 was made as the cutoff in screening OSAHS patients the sensitivity was 70. 0% and the misdiagnosis rate was 63. 21% . The ESS scores had positive correlation with the apnea hypopnea index ( AHI)( r =0. 240, P lt; 0. 01) and negative correlation with LSpO2 ( r = - 0. 198, P lt;0. 01) . The ESSscores had no correlation with age or the microarousal index ( P gt; 0. 05) . Conclusions The ESS score has some significance in screening severe OSAHS patients but can not exactly reflect the severity of OSAHS patients among Chinese population, suggesting ESS score has limited value in the evaluation of OSAHS severity. The ESS score ≥9 as a cutoff is not a reliable parameter to estimate the severity of OSAHS. A more effective scoring system need to be established for better screening of OSAHS patients.