Risk factors of infected pancreatic necrosis secondary to severe acute pancreatitis

BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution secondary to SAP, is obliged for a more preferable prognosis. Thus, the present study was conducted to identify the risk factors of IPN secondary to SAP. METHODS： The clinical data of patients with SAP were retrospectively analyzed. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and the development of IPN secondary to SAP. A receiver operating characteristic（ROC） curve was created for each of the qualified independent risk factors. RESULTS： Of the 115 eligible patients, 39（33.9%） progressed to IPN, and the overall in-hospital mortality was 11.3%（13/115）.The early enteral nutrition（EEN）（P=0.0092, OR=0.264）, maximum intra-abdominal pressure（IAP）（P=0.0398, OR=1.131）and maximum D-dimer level（P=0.0001, OR=1.006） in the first three consecutive days were independent risk factors associated with IPN secondary to SAP. The area under ROC curve（AUC） was 0.774 for the maximum D-dimer level in the first three consecutive days and the sensitivity was 90% and the specificity was 58% at a cut-off value of 933.5 μg/L; the AUC was 0.831 for the maximum IAP in the first three consecutive days and the sensitivity was 95% and specificity was 58%at a cut-off value of 13.5 mm Hg. CONCLUSIONS： The present study suggested that the maximum D-dimer level and/or maximum IAP in the first three consecutive days after admission were risk factors of IPN secondary to SAP; an EEN might be helpful to prevent the progression of IPN secondary to SAP.

Clinical features and risk factors of acute hepatitis E with severe jaundice

AIM:To compares the clinical features of patients infected with hepatitis E virus(HEV) with or without severe jaundice.In addition,the risk factors for HEV infection with severe jaundice were investigated.METHODS:We enrolled 235 patients with HEV into a cross-sectional study using multi-stage sampling to select the study group.Patients with possible acute hepatitis E showing elevated liver enzyme levels were screened for HEV infection using serologic and molecular tools.HEV infection was documented by HEV antibodies and by the detection of HEV-RNA in serum.We used χ2 analysis,Fisher's exact test,and Student's t test where appropriate in this study.Significant predictors in the univariate analysis were then included in a forward,stepwise multiple logistic regression model.RESULTS:No significant differences in symptoms,alanine aminotransferase,aspartate aminotransferase,al-kaline phosphatase,or hepatitis B virus surface antigen between the two groups were observed.HEV infected patients with severe jaundice had significantly lower peak serum levels of γ-glutamyl-transpeptidase(GGT)(median:170.31 U/L vs 237.96 U/L,P = 0.007),significantly lower ALB levels(33.84 g/L vs 36.89 g/L,P = 0.000),significantly lower acetylcholine esterase(CHE) levels(4500.93 U/L vs 5815.28 U/L,P = 0.000) and significantly higher total bile acid(TBA) levels(275.56 μmol/L vs 147.03 μmol/L,P = 0.000) than those without severe jaundice.The median of the lowest point time tended to be lower in patients with severe jaundice(81.64% vs 96.12%,P = 0.000).HEV infected patients with severe jaundice had a significantly higher viral load(median:134 vs 112,P = 0.025) than those without severe jaundice.HEV infected patients with severe jaundice showed a trend toward longer median hospital stay(38.17 d vs 18.36 d,P = 0.073).Multivariate logistic regression indicated that there were significant differences in age,sex,viral load,GGT,albumin,TBA,CHE,prothrombin index,alcohol overconsumption,and duration of admission between patients infected with acute hepatitis E with and without severe jaundice.CONCLUSION:Acute hepatitis E patients may naturally present with severe jaundice.

Risk factors of posttraumatic cerebral infarction in patients with severe and extremely severe head injury

Objective To explore pathogenesis and risk factors for posttraumatic cerebral infarction (PTCI) in patients with severe and extremely severe head injuries for the purpose of providing clues for reducing occurrence of PTCI and case-fatality. Methods Gender,age,Glasgow coma scale (GCS) ,the presence or absence of basicranial fracture,cerebral hernia or infection,surgical modality,hypotension,and the use of diuretics

Rotor broken bar fault diagnosis for induction motors based on double PQ transformation

A new rotor broken bar fault diagnosis method for induction motors based on the double PQ transformation is pre-sented. By distinguishing the different patterns of the PQ components in the PQ plane,the rotor broken bar fault can be detected. The magnitude of power component directly resulted from rotor fault is used as the fault indicator and the distance between the point of no-load condition and the center of the ellipse as its normalization value. Based on these,the fault severity factor which is completely independent of the inertia and load level is defined. Moreover,a method to reliably discriminate between rotor faults and periodic load fluctuation is presented. Experimental results from a 4 kW induction motor demonstrated the validity of the proposed method.

Severe male factor in in vitro fertilization:definition,prevalence,and treatment.An update

Infertility affects 10%–15%of couples worldwide.Of all infertility cases,20%–70%are due to male factors.In the past,men with severe male factor(SMF)were considered sterile.Nevertheless,the development of intracytoplasmic sperm injection(ICSI)drastically modified this scenario.The advances in assisted reproductive technology(ART),specifically regarding surgical sperm retrieval procedures,allowed the efficacious treatment of these conditions.Yet,before undergoing ICSI,male factor infertility requires careful evaluation of clinical and lifestyle behavior together with medical treatment.Epidemiologically speaking,women whose male partner is azoospermic tend to be younger and with a better ovarian reserve.These couples,in fact,are proposed ART earlier in their life,and for this reason,their ovarian response after stimulation is generally good.Furthermore,in younger couples,azoospermia can be partially compensated by the efficient ovarian response,resulting in an acceptable fertility rate following in vitro fertilization(IVF)techniques.Conversely,when azoospermia is associated with a reduced ovarian reserve and/or advanced maternal age,the treatment becomes more challenging,with a consequent reduction in IVF outcomes.Nonetheless,azoospermia seems to impair neither the euploidy rate at the blastocyst stage nor the implantation of euploid blastocysts.Based on the current knowledge,the assessment of male infertility factors should involve:(1)evaluation–to diagnose and quantify seminologic alterations;(2)potentiality–to determine the real possibilities to improve sperm parameters and/or retrieve spermatozoa;(3)time–to consider the available“treatment window”,based on maternal age and ovarian reserve.This review represents an update of the definition,prevalence,causes,and treatment of SMF in a modern ART clinic.

Investigation on occupant injury severity in rear-end crashes involving trucks as the front vehicle in Beijing area, China

Purpose： Rear-end crashes attribute to a large portion of total crashes in China, which lead to many casualties and property damage, especially when involving commercial vehicles. This paper aims to investigate the critical factors for occupant injury severity in the specific rear-end crash type involving trucks as the front vehicle （W）. Methods： This paper investigated crashes occurred from 2011 to 2013 in Beijing area, China and selected 100 qualified cases i.e., rear-end crashes involving trucks as the FV. The crash data were supplemented with interviews from police officers and vehicle inspection. A binary logistic regression model was used to build the relationship between occupant injury severity and corresponding affecting factors. More- over, a multinomial logistic model was used to predict the likelihood of fatal or severe injury or no injury in a rear-end crash. Results： The results provided insights on the characteristics of driver, vehicle and environment, and the corresponding influences on the likelihood of a rear-end crash. The binary logistic model showed that drivers＇ age, weight difference between vehicles, visibility condition and lane number of road signifi- cantly increased the likelihood for severe injury of rear-end crash. The multinomial logistic model and the average direct pseudo-elasticity of variables showed that night time, weekdays, drivers from other provinces and passenger vehicles as rear vehicles significantly increased the likelihood of rear drivers being fatal. Conclusion： All the abovementioned significant factors should be improved, such as the conditions of lighting and the layout of lanes on roads. Two of the most common driver factors are drivers＇ age and drivers＇ original residence. Young drivers and outsiders have a higher injury severity. Therefore it is imperative to enhance the safety education and management on the young drivers who steer heavy duty truck from other cities to Beiiing on weekdays.

Dynamic changes in blood cytokine levels as clinical indicators in severe acute respiratory syndrome

Objective To investigate the dynamic changes observed in serum levels of interleukins (ILs), tumor necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1 ) in severe acute respiratory syndrome (SARS) patients.Methods Sixty-one cases of SARS with positive antibodies to SARS coronavirus (SARS-CoV) were classified into the following categories: initial stage (3-7 days), peak stage (8-14 days), and remission and recovery stage (15 -27 days). Forty-four healthy individuals were used as controls. Serum levels of ILs, TNF-a and TGF-p, were measured in all subjects. Serum antibodies to SARS-CoV were detected only in SARS cases.Results The mean concentration of serum IL - 6 in SARS patients did not differ from that in the control group in initial and peak stages, but became significantly higher in remission and recovery stage compared with the control group, initial and peak stages ( P<0. 01). The mean concentration of serum IL-8 in SARS patients did not differ from that of the control group in initial stage, but was significantly higher than control group in peak stage and remission and recovery stage ( P < 0. 05). And it was more significantly higher in remission and recovery stage than in peak stage ( P<0. 01). The mean concentrations of IL-16 and TNF-αin SARS patients were higher than those of the control group for every length of the clinical courses investigated, and were especially high in remission and recovery stage (P<0. 01). SARS patients experienced higher concentration of serum IL-13 compared with the controls in initial stage ( P < 0. 01), but returned to normal levels in peak stage and in remission and recovery stage. The mean concentration of serum IL-18 in SARS patients was significantly lower than that of the control group during all clinical courses ( P < 0. 05). The mean concentration of serum TGF-β1, in SARS patients was higher than that of the control group during all clinical courses. Although TGF-bbbbb1 in serum decreased in remission and recovery stage in SARS patients, the average was still higher than that of the control group (P<0. 01). Conclusions Most proinflammatory cytokines and TGF-β1, were elevated during the early phase of SARS, which may be associated with lung infiltration and proliferation. Concurrently, the mean concentration of serum IL-13 decreased gradually, and the mean concentration of serum IL-18 level in SARS patients was lower than that of the control group during all the courses of SARS, suggesting that the immune state of the patients with SARS was obviously abnormal. Observing the dynamic changes in blood cytokine levels can provide a scientific basis to assess pathogenesis and efficacy of clinical treatment of SARS.