Table of Content

05 May 2018, Volume 33 Issue 5

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Epidemiology and risk factors of  Clostridium difficile  infection

Luo Yuxin, Han Fei, Zhang Ruimiao, Yin Fengrong

2018, 33(5):  369-372.  doi:10.3969/j.issn.1004-583X.2018.05.001

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Clostridium difficile (CD), parasitic on the intestine, belongs to grampositive bacteria. With the widespread use of antibiotics, the incidence and severity of Clostridium difficile infection  (CDI)  have been on the rise worldwide.  Of  particular note, the emergence and outbreak of virulent ribotype 027 strain (BI/NAP 1/027/toxinⅢ)  has made CD one of the most important healthcare related pathogens.  Researches on CDI epidemiology are undergoing continuous renewal at home and abroad.  The epidemiological situation and risk factors of CDI are reviewed  in order to strengthen the understanding of CDI among clinical medical workers．

Progress of laboratory diagnosis of Clostridioides difficile infection

Yang Jing, Zhao Jianhong

2018, 33(5):  373-376.  doi:10.3969/j.issn.1004-583X.2018.05.002

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Clostridioides difficile  is a grampositive,  anaerobic sporeforming bacillus commonly found in the environment and human gut.  Over use of antibiotics, immunosuppressive agents and chemotherapy drugs all may lead to the overgrowth of the toxic strain of C. difficile with high resistance, which is the main factor responsible for  C. difficile infection (CDI). The globally increasing incidence of CDI, especially the outbreak of nosocomial infection caused by the hypervirulent strain in North America, has aroused worldwide attention. To provide new insights into the early diagnosis and treatment of diarrhea associated with C. difficile,  this review summarizes the latest development on pathogenesis and laboratory diagnosis of C. difficile.

Research development on drug resistance and mechanisms of Clostridium difficile

Fan Xin1, Chen Xinfei2, Xiao Meng2, Xu Yingchun2

2018, 33(5):  377-380.  doi:10.3969/j.issn.1004-583X.2018.05.003

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Clostridium difficile is the major cause of antibiotic associated diarrhea and hospital acquired infectious diarrhea. In developed countries and regions,  C. difficile  infections have high morbidity and mortality and have received broad attention. In comparison,  China's data on C. difficile,  especially on its resistance to commonly used antibiotics, is limited. Hence, this paper reviews the latest research progress on resistant status of  C. difficile  and its resistant mechanism.

Progress of clinical characteristics and treatment of Clostrudium difficile  infection

Jin Meng, Yang Hong

2018, 33(5):  381-384.  doi:10.3969/j.issn.1004-583X.2018.05.004

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Clostrudium difficile (CD) is a major cause of hospital acquired infection. It can cause antibioticassociated diarrhea and even induce toxic megacolon and shock. Symptoms of CD infection (CDI) range from mild diarrhea to lifethreatening pseudomembranous colitis, toxic megacolon, even death. The testing of CD  usually requires a multistep algorithm (ie, glutamate dehydrogenase plus toxin A and B enzyme immunoassays). The first therapeutic step of CDI is to discontinue the administration of the inciting antibiotic agents as soon as possible. And vancomycin, fidaxomicin and metronidazole are recommended as the most effective  therapies of CDI.  As to patients suffering from CDI recurrence,  fecal microbiota transplantation is recommended.

Application of fecal microbiota transplantation in treatment of Clostridium difficile infection

Xiang Liyuan1, Zhang Faming1, 2

2018, 33(5):  385-389.  doi:10.3969/j.issn.1004-583X.2018.05.00

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Fecal microbiota transplantation (FMT) has been recommended by American Medical Guideline and European Expert Consensus to treat recurrent Clostridium difficile infection (CDI). This article aims to review the research advancement of  indications, clinical workflow, safety, and ethics of and supervision on FMT in the treatment of CDI and the concerned  treatment options of Chinese doctors.

Advances in  the  prevention and vaccine research of Clostridium difficile infection

2018, 33(5):  390-393.  doi:10.3969/j.issn.1004-583X.2018.05.006

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Clostridium difficile infection (CDI) is recognized as a major cause of nosocomial diseases ranging from antibioticassociated diarrhea to fulminant colitis. The past two decades saw C. difficile hyper virulent BI/NAP1/027 strain being associated with increased incidence and severity of CDI, which involved considerable human resourches, financial and material loss. Thus,  the development of novel therapeutics is imperative for the prevention and treatment of CDI. Vaccination can represent a valuable strategy to prevent CDI and the study on experimental vaccines against C. difficile has undergone for almost 20 years. This review summarizes recent achievements and remaining challenges in the field of C. difficile vaccines in a bid to provide references for clinical work and scientific research.

Study advances  of  inflammatory bowel disease complicated with  Clostridium difficile  infection

Li Yue, Qian Jiaming

2018, 33(5):  394-397.  doi:10.3969/j.issn.1004-583X.2018.05.007

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Studies have demonstrated an increasing incidence of  Clostridium difficile  infection (CDI) in patients with inflammatory bowel disease (IBD). CDI can both precipitate and worsen flares of IBD,  contributing to emergent colectomies and mortality.  Host microbiome, immune response and  genetics jointly decide whether patients with IBD will suffer from CDI. Further studies may help define pathogenesis of CDI as well as identify high risk subgroups that may benefit from prophylactic intervention.

Current  status and preventive measures of  Clostridium difficile infection in children

Guo Cheng, Zhang Lin

2018, 33(5):  398-401.  doi:10.3969/j.issn.1004-583X.2018.05.008

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Clostridium difficile (CD) is the most important cause of hospitalacquired and antibioticassociated diarrhea. Due to the extensive use of broadspectrum antibiotics, the incidence of  Clostridium difficile infection (CDI) is on the rise worldwide, and has become a serious public health problem. Although epidemiological data of CDI concerning Chinese children is unavaliable, the abusive use of antibiotics in their diagnosis and treatment is undeniable; and concerned clinical knowledge awaits improvement.  These factors added together may contribute to domestic incidence of CDI higher than that of foreign countries. This article introduces the pathogenic mechanism, epidemiology, risk factors and preventive measures of CD to  provide basis for prevention and control of CDI.

Clinical study on correlation between anti PPD antibody and cerebrospinal fluid cytology in patients with tuberculous meningitis

Li Shumin, Li Yao, Lin Jianwen, Ren Yanwei, Song Qisheng, Hao Guohua, Wang Suping

2018, 33(5):  402-404,408.  doi:10.3969/j.issn.1004-583X.2018.05.009

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Objective  To investigate the cytological changes of cerebrospinal fluid in tuberculous meningitis patients with different positive rates of antipurified protein derivative of tuberculin (PPD) antibody, and further to evaluate their correlation and diagnostic value. Methods  The antiPPD antibody IgG and cytology of cerebrospinal fluid in 26 tuberculous meningitis patients and 30 cases of viral meningitis in the control group were detected at the 1st, 2nd, 3rd and 4th week of onset. Results   At the early stage of onset, tuberculous meningitis patients of the positive rate of antiPPD antibody IgG and the plasmacyte ratio of cerebrospinal fluid cytology were low within the 1st week, while these rates increased during the 2nd to 3rd week. After effective treatment, although the positive rate of antiPPD antibody IgG was still high, the plasmacyte ratio decreased and even disappeared. Cerebrospinal fluid (CSF) anti PPD antibody IgG was negative at the 1st ,2nd, 3rd and 4th week of onset in CSF group. Lymphocyte reactivity was dominant in CSF cytology, and the rate of plasma cell was low. Conclusion  There is better correlation between antiPPD antibody IgG and plasmacyte ratio in cerebrospinal fluid, which represents as low positive rate of antiPPD antibody IgG accompanies with low or no plasmacyte ratio, while high positive rate of antiPPD antibody IgG accompanies with high plasmacyte ratio, the combination of both examinations could improve the early diagnosis rate of tuberculous meningitis.

Clinical observation of GuillainBarré syndrome following trauma and operation

Yang Yongxuan1, Liu Gonglu2, Du Jian3, Zhang Xiaofang1

2018, 33(5):  405-408.  doi:10.3969/j.issn.1004-583X.2018.05.010

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Objective  To observe the clinical manifestation and the therapeutic efficacy of intravenous immunoglobulin(IVIg) for patients with GuillainBarré syndrome following trauma and operation. Methods  A retrospective analysis was conducted on 16 patients with GuillainBarré syndrome following trauma and operation. Then, these patients were compared with nontrauma and nonoperation patients in aspect of clinical features and IVIg therapeutic efficacy. Results  The patients complicated with GuillainBarré syndrome within 3 weeks after trauma and operation may have pharyngalgia and diarrhea before GuillainBarré syndrome. The major clinical manifestations were weakness and numbness of limbs and some severe cases had symptom of dyspnea. The physical signs were low muscular tension and deep tendon reflex or disappeared with or without paresthesia. The clinical pictures of the patients were more severe than nontraumatic and nonoperatic cases. In CSF of most patients, dissociation of protein from cell can be found. The electromyography examination showed demyelization and axonal degeneration. After IVIg  therapy,  the efficacy of  patients following trauma and operation was poor as compared with that of  nontrauma and nonoperation patients(P＜0.01). Conclusion  The efficacy of  IVIg  in patients following  trauma and operation is poor.  Doctors should treat secondary GuillainBarré syndrome patients after trauma and operation to improve the prognosis of patients through intime diagnosis and treatment.

Safety and efficacy of urokinase plus tirofiban in  treatment of acute ischemic stroke patients

Jing Hongfei， Wang Yanfang， Wang Long

2018, 33(5):  409-412.  doi:10.3969/j.issn.1004-583X.2018.05.011

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Objective  To investigate the safety and efficacy of  urokinase  plus  tirofiban in the treatment of acute ischemic stroke patients. Methods  Fifty patients with acute ischemic stroke were infused intravenously urokinase  1 500 000   U and then were randomized into two groups.  25 patients in tirofiban group were infused tirofiban （0.4  μg/［kg·min］   for  30 min， and then 0.1 μg/［kg·min］  for  72 h）     immediately  after urokinase,while  25 patients in the control  group received no tirofiban. The incidences of intracranial hemorrhage, systematic bleedings and death during the first 14 days were recorded. The National Institutes of Health Stroke  Score at day 14 and modified Rankin scale at 3 months were assessed.Results  There were no statistical differences in the incidences of symptomatic intracranial hemorrhage， intracranial hemorrhage, systematic bleedings and death during the first 14 days (P>0.05)  between the two groups. At day 14 the average National Institutes of Health Stroke Score in tirofiban group was significantly lower than that of  control group(7.46 versus 9.48，P=0.032)，and at 3 months more patients had favorable outcomes of modified Rankin scale 0 to 2 (2.6 versus 1， P=0.038).Conclusion  Intravenous tirofiban immediately after urokinase can improve outcomes of acute ischemic stroke patients without increasing the events of bleedings. It is safe and potentially more effective when compared with urokinase alone for acute stroke patients.

Transcranial sonography in diagnosis of Parkinson’s disease

Zhu Jianwena， Zhao Cana， Zhang Weib， Wang Shaoyinga， Liu Shanshana

2018, 33(5):  413-415.  doi:10.3969/j.issn.1004-583X.2018.05.012

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Objective  To figure out whether patients with Parkinson’s disease in the mainland of China have substantia nigra (SN) echo enhancement through the transcranial sonography (TCS) examination of patients with Parkinson’s disease and the control group, and Parkinson’s HoehnYahr(HY) grading and Parkinson’s disease rating score results.Methods  The selected subjects were examined by TCS， and the test results were evaluated. Results  The incidence of SN in Parkinson’s disease patients was significantly higher than that in normal control group (P<0.05). The HY staging of abnormal Parkinson’s group was significantly higher than that of Parkinson’s normal group (P<0.05)， indicating that the area of SN hyperechoic in Parkinson’s disease was associated with HY staging. The sensitivity of TCS examination to Parkinson’s disease was  80.5%, and specificity 79.9%. Conclusion  The detection rate of strong echogenicity of SN in Parkinson’s disease patients in our country is significantly higher than that of control group, indicating that the situation of enhanced SN echo in Parkinson’s patients also exists  in our country,  which accords with the reports at home and abroad. Considering its high  sensitivity and specificity, TCS examination  is of great significance to the diagnosis of Parkinson’s diseases.

Impact of blood pressure on ventricular remodeling in patients with acute myocardial infarction and primary hypertension

Cui Xuelian， Nie Yuhua， Wang Tongyang

2018, 33(5):  416-419.  doi:10.3969/j.issn.1004-583X.2018.05.013

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Objective  To investigate the impact of blood pressure after percutaneous coronary intervention (PCI) on ventricular remodeling in patients with acute myocardial infarction (AMI) and primary hypertension. Methods  A total of 265 patients with AMI and  primary hypertension receiving PCI from June 2014 to June 2016 were enrolled. And followups were conducted on them  1 week, 1 month, 3 months and 12 months after PCI. The blood pressure of the patients was measured at each followup，and the echocardiography was performed at 1 month and 12 months after the operation. The risk factors of heart dilatation and the impact of blood pressure on ventricular remodelingin patients with AMI after PCI were analyzed.Results  The risk factors of heart dilatation  in patients with AMI after PCI included heart dilatation in baseline， delayed blood flow perfusion, more  abnormal segments of the ventricular wall movement showed by echocardiography  1 weeks after PCI， poor cardiac functionin 1 weeks after PCI， poor control of blood pressure   after PCI， and low dosage of ACEI/ARB after PCI.  Twelve months after PCI， the left ventricular volume(LVEDV: 109±9 vs 120±9， P=0.014，t=-2.711; LVESV: 80±11 vs 97±8， P=0.001， t=-3.765)  and left ventricular mass(LVMI: 105±12 vs 115±15， P=0.017，t=-2.617)   of  patients with good control of blood pressure were less than that of patients with bad control of blood pressure. Conclusion  The poor control of blood pressure after PCI in patients with AMI is one of the risk factors of heart dilatation. The blood pressure after PCI could impact ventricular remodeling， and higher blood pressure will promote ventricular remodeling.

Effects of liraglutide on renal function in patients with microalbuminuria of diabetic nephropathy

Dong Lia, Zhao Jihaib

2018, 33(5):  420-423.  doi:10.3969/j.issn.1004-583X.2018.05.014

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Objective  To observe the efficacy and safety of liraglutide on renal function in patients with microalbuminuria of diabetic nephropathy(DN). Methods  A total of  86  DN patients with microalbuminuria were randomly divided into two groups. The control group was given conventional therapy, while the observation group got liraglutide combined with conventional therapy. After six months of treatment,  comparison in two groups was made  in body mass index (BMI), fasting blood glucose (FBG), 2 h postprandial blood glucose (PBG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS) and insulin resistance index (HOMAIR), urinary albumin excretion rate (UMAER), serum creatinine (SCr), the calculation of urine protein creatinine ratio (ACR) and glomerular filtration rate (eGFR). Results  Before the treatment, there was no significant difference in blood glucose and renal function indexes between two groups (P>0.05).  After the  treatment, both groups saw decreases in BMI, FBG, PBG, HbA1c, HOMAIR, BUN, SCr, UMAER and ACR , while FINS and eGFR levels  increased (P<0.05),  the improvement in observation group was more significant (P<0.01). The incidence of hypoglycemia in observation group was lower than that of control group. Conclusion   Liraglutide can protect the kidney by bringing down the blood glucose to an approapriate level, and improve renal function, and the probability of hypoglycemia is low.

Analysis on the ability of impulse oscillometry and lung plethysmography to detect airway resistance--a comparative study

Zhang Xuhua， Zhou Ping， Li Xin， Li Yawen， Zhang Wen， Li Yan， Lu Xinming

2018, 33(5):  424-426.  doi:10.3969/j.issn.1004-583X.2018.05.015

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Objective  To explore the relationship between impulse oscillometry and lung plethysmography, both of which can detect airway resistance(Raw),  for more evidence in clinic application and standardization. Methods  A total of 217 subjects were enrolled and conducted on Raw tests through impulse oscillometry and lung plethysmography respectively and the results were compared. Results  The correlation analysis showed that the Raw measured by impulse oscillometry was positively correlated with that of lung plethysmography (P<0.01). The Raw results (R20) were not statistically different between impulse oscillometry measurement and lung plethysmography measurement(P>0.05). Then, Raw(R5) displayed statistical difference between the two groups(P<0.01). Conclusion  The Raw measured by impulse oscillometry was consistent with that measured by lung plethysmography. Being easy to operate and read, and economic, the impulse  oscillometry providing allround information is necessary and useful supplement to traditional lung function test worth widespread use.

Experssion  and significance of VEGF， bFGF， endostatin in hepatic sclerosis

Duan Jiayuea， Shi Qingfenga， Wang Mingguanga， Qi Chengb， Yan Changqinga

2018, 33(5):  427-430.  doi:10.3969/j.issn.1004-583X.2018.05.016

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Objective  To explore the expressions of vascular endothelial growth factor (VEGF)， basic fibroblast growth factor (bFGF) and endostatin in hepatic sclerosis. Methods  The data of 22 patients with hepatic sclerosis who admitted to our hospital from January 2015 to June 2016 were analyzed and named as experience group;, while 10 cases of normal liver tissues were selected as the normal group. HE and Masson trichrome staining were used to observe the two groups of specimens. The expression of VEGF， bFGF and Endostatin in the experimental group and the normal group were detected by  immunohistochemistry  and ELISA. Results  ① HE staining and Masson staining showed that   the experimental group, compared with normal group，witnesses the significant increase of the fiber bands， the formation of false lobule，the expansion of  a large number of inflammatory cells and the disappearence of  the structure of the portal area in the liver tissue. ② As to the immunohistochemistry, the relative gray level values of VEGF， bFGF and endostatin in normal group were 0.06±0.03，0.08±0.05 and 0.07±0.02 respectively;while the relative gray level values of VEGF， bFGF and endostatin in experimental group were 0.16±0.02， 0.14±0.03 and 0.14±0.01 respectively. Compared with the normal group， the expression of VEGF， bFGF and endostatin were significantly upregulated in the experimental group (P<0.05).  ③ In ELISA experiment, the absorbance (OD) of VEGF, bFGF and endostatin in normal group were 283.05±14.32，30.03±2.11 and 4 350.63±636.66 respectively; The absorbance (OD) of VEGF， bFGF and endostatin in experimental group were 539.63±160.28， 63.99±33.28 and 8 194.75±1 319.28, respectively. Compared with the normal group, the expression of VEGF， bFGF and endostatin were significantly upregulated in the experimental group. Conclusion  The expression of VEGF,  bFGF and endostatin protein are upregulated in patients with hepatic sclerosis. The expression of these proteins is closely related to the occurrence and development of the disease.

Efficacy of  anti  tumor necrosis factor α  preparation  in achilles tendon enthesitis

Xie Jianli, Chen Haiying, Wang Junxiang, Zhang Ying, Xu Jinrong

2018, 33(5):  431-433,439.  doi:10.3969/j.issn.1004-583X.2018.05.017

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Objective  To explore the value of anti tumor necrosis factor α (TNFα)  preparation in achilles  tendon  enthesitis  in ankylosing spodylitis(AS) by ultrasonics. Methods  We chose 32 AS patients who received anti TNFα preparation as experiment group and 29 AS patients who got conventional therapy as control group. The ultrasound images, erythrocyte sedimentation rate(ESR) and C reactive protein(CRP) were compared  after six weeks of treatment  between two groups. Results  Compared with the control group, the ultrasound scores and clinic scores of achilles tendon enthesitis in experiment group witnessed  significant reduction（both  P<0.01). The changes of ESR and CRP in experiment group were more significant than those in control group(both P<0.01). Conclusion  Anti  TNFα  preparation can improve the achilles tendon enthesitis in AS patients, which has been proved by ultrasonics.

Systematic review of thalidomide and thalidomide analogues for treatment of inflammatory bowel disease

Song Yan1， Yang Hu2， Jiang Kui1， Wang Bangmao1

2018, 33(5):  434-439.  doi:10.3969/j.issn.1004-583X.2018.05.018

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Objective  To evaluate the efficacy and safety of thalidomide and thalidomide analogues for treatment of inflammatory bowel disease. Methods   To review the efficacy and safety of  thalidomide and thalidomide analogues for the treatment of IBD systematically, a systematic research was performed　on PubMed, Cochrane Center Register of Controlled Trails, Embase, Web of Science, CNKI, Wan Fang, CQVIP and other data bases. And analysis was made on its induced remission rate, sustaining remission rate and adverse events. Results  Sixteen studies (3 RCTs and 13 case series) met the inclusion criteria and 333 patients were included. Two RCTs showed that thalidomide can effectively increase induced remission rate in patients  with CD and UC(46.4%  vs  11.5%, P=0.010; 83.3%  vs  18.8%,P=0.005). And a series of case studies revealed that the thalidomide was conducive to the remission of CD, with the induced remission rate was 50.0% (95%CI=36.0%65.0%).  Neurologic disturbances accounted for 65.5% of the adverse events(207/316), being the most common adverse event. Peripheral neuropathy was the most frequent cause of drug withdrawal.Conclusion  Thalidomide is effective for treating IBD,  especially for inducing remission in CD patients.