Table of Content

05 January 2016, Volume 31 Issue 1

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Acarbose and growth of China diabetes management

Yang Wenying

2016, 31(1):  1-6.  doi:10.3969/j.issn.1004-583X.2016.01.001

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Over the past 20 years, diabetes management philosophy continually has updated with the progress. Meanwhile, acarbose (Glucobay) came on market, and entered into clinical applications of China, its treatment philosophy fits the development of diabetes management concept, such as “pay attention to postprandial blood glucose, reduce blood sugar fluctuations”, “prevention of diabetes, as soon as possible intervention” and so on. This paper focuses on the diabetes management philosophy and acarbose application history in China.

Atrial fibrillation treatment: present state and future directions

Guo Xueyuan, Ma Changsheng

2016, 31(1):  7-9.  doi:10.3969/j.issn.1004-583X.2016.01.002

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Atrial fibrillation (AF) is an emerging epidemic of cardiovascular disease in the 21st century, and the disease burden is worsening. Warfarin is used for stroke prevention in AF as an effective drug, but its use in patients with AF of our country is still inadequate. With the continuous increase of new oral anticoagulants and left atrial appendage closure technology applications, antithrombotic treatment of AF is facing more choices. Catheter ablation has become the first-line treatment for paroxysmal AF. However,the best strategy for ablation persistent AF is still controversial. In recent years, more and more focuses have been put on life style intervention in the prevention and treatment of AF. The management of AF will expect a new stage in the future.

Role of percutaneous left atrial appendage occlusion in stroke prevention for nonvalvular atrial fibrillation

Qi Shuyuan,Tian Ying

2016, 31(1):  10-13.  doi:10.3969/j.issn.1004-583X.2016.01.003

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Thromboembolism is the most serious complication in patients with atrial fibrillation(AF).It is crucial to predict and reduce the thromboembolic risk as soon as possible.Chronic anticoagulaion therapy has certain limitations in the prevention of thromboembolic events.Left atrial appendage(LAA) was confirmed as the main part of thrombus formation in patients with nonvalvular AF.As a result,percutaneous LAA occlusion has been advocated as a strategy for the prevention of thromboembolic event.LAA occlusion can effectively reduce the incidence of thromboembolic events in patients with nonvalvular AF and was also considered for patients with contraindications to oral anticoagulation.The WATCHMAN and ACP device have been authorized to enter the European Union market.LARIAT ligation device was also approved by US Food and Drug Administration because of its efficacy and safety.Due to its wide indications and high safety,percutaneous LAA occlusion or suture ligation is expected to become a reasonable alternative to prevent thromboembolic events for most patients with AF.

Anticoagulation advance in atrial fibrillation

Xue Li, Cai Heng

2016, 31(1):  14-18.  doi:10.3969/j.issn.1004-583X.2016.01.004

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Atrial fibrillation (AF) is one of the most common tachyarrhythmias in clinical practice. AF increases the risk of stroke. Warfarin has been proven effective. However, the high risk of bleeding, narrow therapeutic window, long term INR monitoring for proper adjustment of medication are the major drawbacks of this medicine. The novel oral anticoagulants (NOACs) such as dabigatran, rivaroxaban, and apixaban are effective and safe alternative to warfarin for the prevention of stroke and systemic emboli in patients with AF. Percutaneous left atrial appendage occlusion may be an effective alternative treatment for prevention of thromboembolic events in AF patients.

The status and advances of radiofrequency catheter ablation for atrial fibrillation

Xie Ruiqin, Yin Guangli, Yang Yingtao

2016, 31(1):  19-21.  doi:10.3969/j.issn.1004-583X.2016.01.005

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Atrial fibrillation is one of the most common arrhythmias in clinic. The biggest risk of atrial fibrillation is thromboembolism, the most common complication is stroke. With the aging of population, more and more people suffer from atrial fibrillation, so the treatment of atrial fibrillation has gradually become the focus problem. Radiofrequency catheter ablation for atrial fibrillation is one of the important treatment methods, it can obviously improve the prognosis of patients with atrial fibrillation. And with the development of technology, ablation method has been mature, the status of radiofrequency catheter ablation for atrial fibrillation is gradually improved. However, there is no fixed operation method up to now. The mechanism of atrial fibrillation is not thoroughly explicit, especially for persistent atrial fibrillation. There are still some problems with radiofrequency catheter ablation for atrial fibrillation to further investigate.

Treatment of acute atrial fibrillation

Liu Hongbin, Wang Xiaoyan, Zhang Zhigang, Ji Zhenguo

2016, 31(1):  22-26.  doi:10.3969/j.issn.1004-583X.2016.01.006

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Acute atrial fibrillation defines the patients with atrial fibrillation which continue less than 48 hours, and the patients present obvious symptom or hemodynamic instability. The feature of acute atrial fibrillation is rapid ventricular rate, which may result in dangerous complications such as heart failure, stroke, sudden death and so on. Therefore, we should give urgent treatment for the patients. The treatment of acute atrial fibrillation should base on factors of original diseases, inducement, hemodynamic stability or not and the duration of fibrillation, which are helpful for individualized treatment plan.

Drug therapy of atrial fibrillation with organic heart disease

Qi Shuying, Yuan Xiaohong

2016, 31(1):  27-29.  doi:10.3969/j.issn.1004-583X.2016.01.007

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Atrial fibrillation (AF) is one of the most common types of arrhythmia with high disability rate and mortality rate in clinical practice. Treatment strategies of AF include anticoagulation to prevent thromboembolism, conversion and sinus rhythm maintenance and ventricular rate control. However, the process of atrial fibrillation with organic heart disease has its particularity. This article reviews the medication treatment for AF with organic heart disease.

Progress of treatment strategy in atrial fibrillation with non-structural heart disease

Ding Chao

2016, 31(1):  30-33.  doi:10.3969/j.issn.1004-583X.2016.01.008

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Atrial fibrillation (AF) is one of the most common cardiac arrhythmias. Based on the symptom and duration, AF can be clinically classified into five types: first detected, paroxysmal, persistent, long-standing persistent and permanent AF. According to the haemodynamic condition and duration, rhythm-control strategy (conversion and maintenance of sinus rhythm), rate-control strategy and continuous anticoagulation strategy are optional. Non-vitamin K antagonist oral anticoagulants (NOACs) have been proposed as alternatives to vitamin K antagonists (VKAs). The status of catheter ablation improves gradually, especially for the paroxysmal AF with non-structural heart disease, and now catheter ablation has been considered as a first line treatment and may be prior to anti-arrhythmic drug therapy in symptomatic paroxysmal AF with non-structural heart disease.

Association study between single nucleotide polymorphisms of interleukin 23 receptor and rheumatoid arthritis

Xie Qingyun, Wei Meng, Fu Peiliang, Sun Jiuyi, Qian Qirong

2016, 31(1):  40-44.  doi:10.3969/j.issn.1004-583X.2016.01.010

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Objective To analyze the association between single nucleotide polymorphisms (SNPs) of interleukin 23 receptor (IL23R) and rheumatoid arthritis (RA).Methods Case-control study was performed on 228 RA cases and 228 controls. Tag-SNPs in IL23R gene were selected from the HapMap database Chinese population. A total of 14 tag-SNPs was examined by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS).Results Significant differences were detected for three SNPs (rs10489628, rs10889675 and rs10889677) in genotype analysis between RA patients and healthy controls. No significant differences in the distribution of the haplotype were found.Conclusion This study suggests that IL23R is the susceptible gene for RA.

Follow-up of treatment of anti-tumor necrosis factor alpha blocker in 35 patients with refractory SAPHO syndrome

Li Chen, Wang Jing, Shi Xiaohu, Liu Jinhe, Hao Weixin, Dong Zhenhua, Zhang Wen

2016, 31(1):  45-47.  doi:10.3969/j.issn.1004-583X.2016.01.011

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Objective To investigate the efficacy and safety of anti-tumor necrosis factor alpha (TNF-α) antagonist in the treatment of refractory SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis).Methods A total of 35 patients with refractory SAPHO syndrome treated by TNF-α antagonist was retrospectively studied and the response of patients was recorded.Results The treatment time for 35 patients with TNF-α antagonist was 2 weeks to 240 weeks, and the average time was (24.4±48.8) weeks. The ostalgia in 32 cases (91.4%) significantly improved in the early time: the ostalgia in 22 cases (68.8%) has been improved after receiving once therapy; the ostalgia in 8 cases (32.0%) improved after receiving twice therapy; the ostalgia in 2 cases (6.2%) improved after receiving therapy three times. For rash, 15 cases were effective in early stage, but in the maintenance treatment, 6 cases had a relapse or aggravation of skin rash and 12 cases had no improvement. A total of 9 cases had adverse reactions: 6 cases had new rash, 1 case had submaxillaritis, 1 case had buttock abscess and 1 case had pneumonia.Conclusion Among the patients with refractory SAPHO syndrome receiving TNF-α antagonist treatment, 91.4% of patients with ostalgia significantly improved in the early time and the improvement was more effective in the first three therapy; but in the maintenance medication, only 11 cases (31.4%) were effective. The improvement of the rash was not wholly satisfied, only 9 cases (27.2%) were effective and it was possible to induce a new or aggravated rash, and also there was potential risk to be infected.

Relationship between RacGAP1 expression in gastric cancer and Helicobacter pylori L-type infection

Lu Ming,Liu Hengchang,Wang Quan

2016, 31(1):  48-52.  doi:10.3969/j.issn.1004-583X.2016.01.012

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Objective To explore the expression of RacGAP1 in gastric cancer tissue and its relationship with Helicobacter pylori L-type (Hp-L) infection.Methods A total of 125 cases of patients with gastric cancer were divided into Hp-L infection positive group (infection group) and Hp-L infection negative group (non-infection group), another 30 cases who had normal gastric mucosa and Hp-L non-infection were selected as control group. Immunohistochemical method was used to check the expression of Racgap1 protein in gastric cancer tissue. The Racgap1 mRNA expression was detected using RT-PCR method. All the patients were taken a period of five years of follow-up.Results RacGAP1 protein was expressed in nucleus mainly, and the positive rate of RacGAP1 expression in infection group and non-infection group were significantly higher than that of control group(P＜0.01), and the positive rate of RacGAP1 expression was significantly higher in infection group than in non-infection group(P＜0.05). RacGAP1 protein expression in gastric cancer tissues was associated with tumor size, invasion depth, lymph node metastasis, TNM staging and Hp infection. The survival rate of the non-infected group was significantly higher than that of the infected group (P<0.05).Conclusion RacGAP1 expression was significantly increased in gastric cancer tissues, Hp infection may be the reason leading to the increase of RacGAP1 expression, and the prognosis in patients with high expression of RacGAP1 was poor.

Expression and clinical significance of apolipoprotein M in inflammatory bowel disease

Wang Tingting, Wang Liangzhi

2016, 31(1):  53-55.  doi:10.3969/j.issn.1004-583X.2016.01.013

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Objective To investigate the expression and clinical value of serum apolipoprotein M (apoM) in patients with inflammatory bowel disease (IBD).Methods The levels of serum apoM and TNF-α in 101 IBD patients and 69 healthy individuals were measured by ELISA.Results The serum concentration of apoM was respectively (13.5±8.8) mg/L, (10.2±5.8) mg/L and (2.0±1.3) mg/L in ulcerative colitis (UC) patients, Crohn disease (CD) patients and healthy controls, and the level of serum apoM in UC patients was significantly higher than that of CD patients (P<0.05). Serum apoM concentrations in both UC and CD patients were significantly elevated with increased disease activity(P<0.05). In addition, serum apoM concentration and TNF-α concentration were positively correlated in IBD group (r=0.314,P=0.001), especially in CD subgroup (r=0.365,P=0.010).Conclusion The levels of serum apoM in UC and CD patients were correlated with disease activity and have potential application value in evaluating disease activity of IBD.

Analysis of Helicobacter pylori infection in 558 children with gastrointestinal symptoms

Zhao Zhiqing, Gao Jingyun, Li Guangmin

2016, 31(1):  56-58.  doi:10.3969/j.issn.1004-583X.2016.01.014

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Objective To investigate Helicobacter pylori (Hp) infection in children with gastrointestinal symptoms in Tangshan.Methods From January 2013 to January 2015, ¹³C-urea breath test was done in 558 children with gastrointestinal symptoms.Results The rate of Hp positive in 558 patients was 41.4%(231/558), including the infection rates of 47.1% in male (152/323) and 33.6% in female (79/235)(P＜0.01); The infection rate of 3 years to 6 years and from 7 years to 14 years was respectively 28.8% (40/139) and 45.6% (191/419)(P＜0.01).Conclusion In Tangshan, the rate of Hp infection in children with gastrointestinal symptoms was related with gender, the rate of Hp infection was significantly higher in male than in female, and the positive rate was directly proportional to age.

Clinical prognostic analysis on 69 cases of adult Hodgkin lymphoma

Zhao Weihua, Xu Haiping, Peng Zhigang, Yao Yibing, Jiang Yanfeng, Ma Jie

2016, 31(1):  59-62.  doi:10.3969/j.issn.1004-583X.2016.01.015

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Objective To explore the clinical characteristics and prognosis of Hodgkin lymphoma(HL).Methods The clinical data of 69 adult patients with HL treated at our hospital from Jan. 2004 to Dec. 2014 were analyzed retrospectively,analyzing the clinical characteristics with prognosis.Results ①50 patients (72.5%) had cervical lymph nodes involvement in the pre-treatment evaluation.Pathological study revealed that mixed cellularity was most common.②The response rate was 76.8%(53/69). The rates of 5-years overall survival rate and failure free survival were 80.0% and 72.0%.③Kaplan-Meier single-factor analysis showed that age,clinical staging,extra nodal tissues involvement, splenomegaly,International Prognostic Index(IPI) grouping, hemoglobin, first-line chemotherapy regimens,chemotherapy course, remission were the main factors influencing the survival (P<0.05).④Cox model multivariate analysis indicated that remission was the main factor affecting the survival (P<0.05).Conclusion Cervical lymph node was the most common involvement site with HL. Remission was the independent prognosis risk factor for HL.

Change of Tregs cells percentage, interferon-γ, interleukin-4 and CD25 level in sepsis patients of intensive care unit

Dong Hong, Zhang Huizhi,Qian Qinjuan

2016, 31(1):  63-67.  doi:10.3969/j.issn.1004-583X.2016.01.016

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Objective To observe the change of CD4⁺CD25⁺regulatory T cells(Tregs) in early-stage sepsis patients of intensive care unit(ICU).Methods The subjects were 74 early-stage sepsis patients in ICU of Tianjin People's Hospital from June 2012 to December 2013,30 patients with systemic inflammatory response syndrome (SIRS) and 44 healthy controls. The percentage of Tregs cells in the blood, the level of plasma interferon-γ(IFN-γ),interleukin-4(IL-4) and soluble CD25 of the early-stage sepsis patients were tested.Results Compared with the control group, the level of plasma IFN-γ and IL-4 in the early-stage sepsis patients increased significantly(P<0.01). The value of IFN-γ/IL-4 was significantly higher in patients with sepsis and SIRS(P<0.01).There were no difference about the indicators between SIRS patients and early-stage sepsis patients (P>0.05). The percentage of Tregs in early-stage sepsis patients was significantly higher than that of SIRS and health control cases(P<0.01). Using the percentage of Tregs could distinguish early-stage sepsis and SRIS. The plasma soluble CD25 levels in patients with early-stage sepsis also improved significantly, and the level was positively correlated with the percentage of Tregs(r=0.391,P=0.004).Conclusion The results suggest that Tregs can be used as an index of early diagnosis of sepsis, and using the percentage of Tregs could distinguish early-stage sepsis and SRIS. The ratio can be used for evaluating immune status in patients and help doctors formulate the best immune adjustment therapy.

Effectiveness research of PICCO on the control of circulation system complications during mild hypothermia in patients with craniocerebral injury

Sun Zhihui, Liu Qinqin, Wan Min, Qi Yingjie, Li Hui

2016, 31(1):  68-70.  doi:10.3969/j.issn.1004-583X.2016.01.017

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Objective To explore the effectiveness of pulse-indicated continuous cardiac output (PICCO) technology on the control of circulation system complications during mild hypothermia in patients with craniocerebral injury.Methods A total of 70 patients with severe craniocerebral injury receiving mild hypothermia therapy in intensive care unit (ICU) from September, 2012 to March, 2015 were retrospectively analyzed. All patients were divided into control group with heart rate (P) and invasive arterial pressure (MAP) monitor and PICCO group with PICCO monitor.Results The circulatory complications during mild hypothermia therapy mainly occurred in cooling stage and low temperature stage, the incidence of low blood pressure of PICCO group was significantly lower than that of control group (P<0.05); and the liquid intake of PICCO group was significantly lower than that of control group (P<0.01); After 21 days of treatment, the Glasgow Coma Scale (GCS) scores of PICCO group was significantly higher than that of control group (P<0.01) and the length of hospital stay was significantly shorter than that of control group (P<0.05). Conclusion As for patients with severe craniocerebral injury receiving mild hypothermia therapy, PICCO monitoring technology can monitor the hemodynamic indexes in real-time manner, reasonably regulate fluid management and the dosage of hibernation drugs, effectively exert control on complications such as arrhythmia, hypotension and neurogenic pulmonary edema caused by mild hypothermia therapy to reduce the incidence rate of complications, so as to improve the survival rate of patients and reduce morbidity as well as lowering the burden on society.

Clinical significance of neuron-specific enolase and brain active peptide protein in patients with acute carbon monoxide poisoning

Jin Pingyan, Lin Ming

2016, 31(1):  71-73.  doi:10.3969/j.issn.1004-583X.2016.01.018

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Objective To investigate the clinical significance of neuron-specific enolase (NSE) and brain active peptide 100-β (S-100 β) protein in patients with acute carbon monoxide poisoning (ACOP).Methods All patients with ACOP was divided into mild, moderate and severe groups according to Glasgow Coma Scale (GCS) score. Healthy cases were selected as control group. The NSE and S-100β protein levels were measured by chemiluminescence immune assay.Results Compared with the control group, the levels of NSE and S-100β in patients with ACOP were significantly higher (P<0.01). The levels of NSE and S-100β were significantly higher in moderate and severe groups than in mild group (P<0.01). The levels of NSE and S-100β in dead patients were significantly higher, however, the number of cases was limited to be excluded from the statistical analysis.Conclusion The levels of NSE and S-100β could reflect the degree of brain injury in patients with ACOP and has great significance in treatment and prognosis.

Relationship between blood glucose variability and prognosis in patients with acute organophosphorus pesticide poisoning

Qiu Bin,Xu Jianru, Ge Zhihua

2016, 31(1):  74-76.  doi:10.3969/j.issn.1004-583X.2016.01.019

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Objective To investigate the relationship between blood glucose variability and prognosis in patients with acute organophosphorus pesticide poisoning (AOPP).Methods A retrospective study involving 59 patients with AOPP from January 2010 to August 2015 was performed. All cases were divided into survival group (n=40) and death group (n=19) according to the prognosis. Blood glucose (GLU), the mean and standard deviation of GLU (GLUave and GLUsd), variation of GLU (GLUcv), GLU lability index (GLI) and APACHEⅡ score were monitored and calculated. The value of prognosis of each index was evaluated by receiver operating characteristic (ROC) curve.Results There was no statistically difference in the GLU admission and GLUave between two groups (P>0.05). The levels of GLUsd,GLUcv and GLI in death group were significantly higher than those of survival group (P<0.05). ROC curve indicated that GLI was most sensitive in predicting prognosis and was similar to APACHⅡ score.Conclusion Glucose variability is firmly associated with mortality in patients with AOPP, lowering blood glucose variability is helpful in improving outcomes in AOPP patients.

Risk factors for ischemic cerebral infarction in large-artery atherosclerotic stenosis

Zhang Guangbo,Yu Kai, Ji Ruijun,Wang Yongjun, Gao Suying,Yan Yinglin

2016, 31(1):  77-80.  doi:10.3969/j.issn.1004-583X.2016.01.020

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Objective To investigate the risk factors between ischemic cerebral infarction in large-artery atherosclerotic stenosis and small artery occlusive cerebral infarction.Methods The subjects were based on the standard extract of 736 patients with cerebral infarction. According to the presence of artery stenosis, the patients were divided into two groups: stenosis group(303 cases),non-stenosis group(433 cases). The risk factors between ischemic cerebral infarction with large-artery atherosclerotic stenosis and small artery occlusive cerebral infarction were analyzed.Results After adjusting potential confounders, age (adjusted OR=1.024; 95% CI=1.010-1.039; P<0.01), diabetes (adjusted OR=1.572; 95% CI=1.113-2.219; P=0.010) were shown to be significant associates in schemic cerebral infarction with large-artery atherosclerotic stenosis. High density lipoprotein cholesterol(adjusted OR=0.650; 95% CI=0.432-0.977; P<0.05) was the protection factor of ischemic cerebral infarction in large-artery atherosclerotic stenosis.Conclusion Age, diabetes are independent risk factors for ischemic cerebral infarction in large-artery atherosclerotic stenosis. High density lipoprotein cholesterol is the protection factor.

Effect of Bobath ball training on motor function in hemiparetic stroke patients

Ji Jing,Wang Ningxia

2016, 31(1):  81-84.  doi:10.3969/j.issn.1004-583X.2016.01.021

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Objective To explore the effect of Bobath training on motor function in stroke patients with hemiplegia.Methods A total of 40 cases of stroke patients with hemiplegia were randomly divided into A group (20 cases) and B group (20 cases), both groups were treated with conventional rehabilitation therapy. Moreover, additional external Bobath ball training was given on A group with 20 min each time for 6 times a week for 4 weeks. Before and after treatment, motor function, balance ability and daily life ability were assessed using Fugl-Meyer Locomotor Rating Scale (FMA), Berg Balance Scale (BBS) and Modified Barthel Index Assessment Scale (BI).Results Before treatment, there was no significant difference between two groups. After 4 weeks of treatment, the levels of FMA, BBS and BI were significantly improved in both groups, and the improvement of group A was superior to that of group B (P<0.05).Conclusion Bobath ball training can better improve motor function, balance and daily life ability.

Clinical effect of pernasal catheter in adhesive intestinal obstruction

Guo Wenbin,Sun Ximing

2016, 31(1):  85-87.  doi:10.3969/j.issn.1004-583X.2016.01.022

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Objective To explore clinical effect of pernasal intubation intervention in adhesive intestinal obstruction.Methods A total of 200 patients with adhesion intestinal obstruction were selected from our hospital, and the patients were divided into two groups: control group and experimental group, 100 patients in a group. The patients of control group underwent conventional treatment (nasogastric tube gastrointestinal decompression), those of experimental group got intervention combined with conventional treatment. Comparison was made in the drainage flow in three days after treatment, exhaust time, remission time of abdominal distension and pain, the clinical therapeutic effect and complications (perforation, bleeding, narrow, transit operation) between two groups.Results The drainage flow and exhaust time, abdominal distension, abdominal pain relief time in treatment group were better than those in control group (P<0.05).The clinical cure rate of experimental group was significantly higher than that of control group (89% vs 58%,P<0.05).The incidence of complications in experimental group were less than those of control group (9% vs 21%,P<0.05).Conclusion Pernasal intubation intervention for adhesive intestinal obstruction showed obvious clinical effect, quick remission of symptoms, higher cure rate,but fewer complications, so the method may be used widely in clinic.

Change of antimicrobial resistance in Escherichia coli isolated from urine in 2012-2014

Cai Yongran,Dong Aiying,Li Xiaochao,Han Xiaoyan,Li Ning

2016, 31(1):  88-91.  doi:10.3969/j.issn.1004-583X.2016.01.023

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Objective To provide evidence for clinical treatment of urinary tract infections by analyzing the distribution and drug resistance of Escherichia coli from patients with urinary tract infection.Methods Escherichia coli was collected from the samples of urinary tract infections in Jan. 2014 to Dec. 2014 and the strains were identified using BD Phoenix-100 automatic bacterial analyzer. The drug sensitivity test was carried out by MIC method and K-B method.Results The distribution of Escherichia coli was most common in Department Urology, three years accounted for an average of 22.5%, followed by 12.9% of Nephrology, ICU accounted for 11.3%,Geriatrics accounted for 9.6%, Neurology 8.8%, Neurological Intensive Ward 7.9%. The bacteria for clinical experience of first-line drugs ampicillin, cefazolin, sulfamethoxazole, ampicillin/sulbactam resistance rates were relatively high, the three year average resistance rate 93.0%,77.2%,74.1%,81.5%. Levofloxacin of quinolones showed three years the average resistance rate more than 75%, and in three years increased year by year, 2014 compared with 2012 and 2013,the difference was statistically significant(P<0.05).To cefoperazone / sulbactam (15.9%), piperacillin/tazobactam (21.6%), imipenem(3.3%), meropenem (3.3%), the bacteria were more sensitive; low resistance rate on amikacin was 13.2%, but the relatively high rate of gentamicin resistant belonged to aminoglycosides (65.0%).Conclusion The infection distribution and sensitivity of Escherichia coli are constantly changing, so clinicians should choose antibiotics accordingly.

Meta analysis on diagnostic value of multiple urine detection methods for urinary tract infection

Wang Peng, Luo Chunhua, Chen Tong, Wang Juan

2016, 31(1):  92-99.  doi:10.3969/j.issn.1004-583X.2016.01.024

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Objective To compare the value of multiple urine detection methods in urinary tract infection by Meta analysis, including bacterial culture, urinary sediment microscopic examination, urine analyzer and routine urine dry chemical method for bacteria, white blood cell and red blood cell.Methods The papers were retrieved from PubMed, EMbase, Cochrane library, Springerlink, CNKI and Wanfang database, with the time limit of retrieval from the establishment of database to December, 2014. Two system evaluators performed independent screening for the quality of references according to the inclusion and exclusion criteria in references. RevMan 5.3 and Meta-DiSc were adopted for reference analysis. The combination sensitivity (Sen), specificity (Spe), positive likelihood ratio (LR⁺), negative likelihood ratio (LR^-) and diagnosis odds ratio (DOR) were calculated, and SROC curve was drawn.Results ① 14 references were included finally (the information of 9 518 patients in total) according to the inclusion and exclusion criteria ; ② urine while blood cell were detected by urinary sediment microscopic examination as the golden standard; according to the detection by the routine urine dry chemical method, the AUC (area under the curve) of SROC is 0.9656, the comprehensive sensitivity was 0.845 (0.805,0.879), and the comprehensive specificity 0.944(0.929,0.957); according to the detection by the urine analyzer, the AUC of SROC was 0.8983, the comprehensive sensitivity 0.631 (0.591,0.669), and the comprehensive specificity 0.929 (0.911,0.944); ③ urine red blood cell was detected by urinary sediment microscopic examination as the golden standard; according to the detection by the routine urine dry chemical method, the AUC of SROC was 0.9306, the comprehensive sensitivity 0.590 (0.572,0.608), and the comprehensive specificity 0.948 (0.938,0.956); according to the detection by the urine analyzer, the AUC of SROC was 0.7319, the comprehensive sensitivity 0.473 (0.433,0.513), and the comprehensive specificity 0.971 (0.958,0.980); ④ Urine bacteria were detectedby bacterial culture as the golden standard; according to the urine analyzer, the AUC of SROC curve fitting was 0.9048, the comprehensive sensitivity 0.842 (0.811,0.870), and the comprehensive specificity 0.881 (0.865,0.896).Conclusion In the examination of white blood cell and red blood cell under urinary tract infection, the routine urine dry chemical method was superior to urine analyzer in terms of AUC, sensitivity and specificity. In the urine bacterial examination, urine analyzer had higher diagnostic values and a shorter period of bacterial culture. Therefore, urine analyzer was recommended for screening of urine bacteria. However, in order to make a definite diagnosis, it was necessary for the combination of bacterial culture.

Seven case of fulminant type 1 diabetes and review of literature

Zhong Yuhua,Liao Weiling, Su Huixuan,Qiu Junlin,Peng Lihua

2016, 31(1):  100-102.  doi:10.3969/j.issn.1004-583X.2016.01.025

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Objective To study the clinical characteristics of Chinese fulminant type 1 diabetes and understand China fulminant type 1 diabetes clinical characteristics with Japanese, Korean whether there is a difference between the two countries.Methods Analysis of clinical data of 52 patients with fulminant type 1 diabetes in China,and to study the difference between Chinese and Japanese patients.Results ①Patients with fulminant type 1 diabetes in China the average age was (32.2±12.6) years old, at least 18 years of age accounted for about 96% of the total number of patients, and the maximum number of 18 to 30 years old, about 52% of the total. ②Compared with those of Japanese patients with fulminant type 1 diabetes in our country the onset age of the lower (32.4±12.6 years vs 39.14±15.7 years,P<0.05), shorter duration (3.4±2.3 days vs 4.44±3.1 days,P<0.05), the low blood sugar (38.5±15.3 mmol/L vs 44.2±20.0 mmol/L,P<0.05); Electrolyte metabolism disorder is more serious, characterized by high potassium, low serum sodium (6.3±1.2 mmol/L vs 5.5±1.2 mmol/L,128.9±6.2 vs 131.0±9.0 mmol/L,P<0.05).③Compared with south Korean patients, the onset age of China is lower (32.4±12.6 years vs 37.4±12.4 years), and the onset of potassium is higher (6.3±1.2 mmol/L vs 5.6±1.5 mmol/L,P<0.05).Conclusion ① Fulminant type 1 diabetes is not rare in our country, and patients with adult onset. ② Compared with Japan,South Korea,the Chinese patients have the lower age of onset and higher serum potassium.

Clinical features in aged patients with aspiration pneumonia: a meta-analysis

Gao Kun, Wu Beibei

2016, 31(1):  103-106.  doi:10.3969/j.issn.1004-583X.2016.01.026

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Objective To analyze the clinical and etiologic features in elderly patients with aspiration pneumonia and to provide a fundamentism for empirical therapy.Methods A total of 36 literatures with complete and precise data about aged patients with aspiration pneumonia were searched in CNKI database from 2000 to 2014, then analyzed and summarized.Results All 2 851 cases of aspiration pneumonia in aged patients had atypical clinical signs and symptoms,and the patients all associated with a variety of underlying diseases, especially with the central nervous system diseases. The main infectious pathogens were gram-negative bacteria with high resistant rate.Conclusion Understanding of clinical features and early diagnostic rate in aged patients with aspiration pneumonia should be elevated, reasonable and effective empirical anti-infection treatment should be performed to reduce the mortality.