Clinical Analysis of 84 Cases of Erythrodermic Psoriasis and 121 Cases of Other Types of Erythroderma from 2010–2015

Erythroderma with complicated etiology is one of the severe skin diseases and has high mortality, of which the incidence was 0.5‰–1.5‰ in skin diseases. Erythrodermic psoriasis（EP） is the commonest type of erythroderma. In addition, there are drug-induced erythroderma, erythroderma secondary to preexisting dermatoses, malignancy-related erythroderma, and idiopathic erythroderma of unknown etiology. Erythroderma of different etiologies has various clinical manifestations, resulting in relevant curative effects and outcomes. In this article, we retrospectively investigated 205 erythroderma patients about clinical symptoms, auxiliary examination and treatments, and evaluated the efficacy and prognosis. There were 84 cases of EP among 205 patients, 10 cases of erythroderma caused by specific drugs, 77 cases of erythroderma secondary to preexisting dermatoses（excluding psoriasis）, 7 cases of erythroderma patients suffering from malignancy and 27 cases with unknown causes. We concluded that the etiology of male patients in different age groups had significant difference. The incidence of EP was the highest among all types. The EP was commonly accompanied with hypoproteinemia, and changed into psoriasis vulgaris after treatment. Drug-induced erythroderma was commonly accompanied with fever, and mostly cured by systematic steroid therapy. For erythroderma secondary to preexisting dermatoses, the original dermatoses must be actively treated to achieve a satisfying prognosis. Erythroderma with malignancy or unknown causes had long-term duration, poor response to the treatment, and high potential to relapse. Therefore, clarifying the etiology, providing an appropiate and individual regimen, and regular follow-up are crucial for the successful treatment of erythroderma with unknown causes.

Clinical Analysis of 42 Patients With Hypertrophic Cardiomyopathy

Objectives To investigate the clinical manifestations of hypertrophic cardiomyopathy (HCM), and to find out the clinical clues to avoid misdiagnosis and provide reference for future clinical diagnosis and treatment. Methods A retrospective analysis of 42 consecutive patients with HCM hospitalized in our hospital between January 1995 and December 2002 was explored. Based on the family history of HCM, clinical manifestations, electrocar-diogram, echocardiogram, coronary angiography and left ventriculography, the clinical characteristics between HCM patients with left ventricular outflow tract obstruction (HOCM) and HCM patients without obstruction (HNOCM) were compared. The causes of misdiagnosis and losing diagnosis were analysis. Results 13 patients were in HOCM group and 29 patients were in HNOCM group. More patients with syncope were in HOCM group than in HNOCM group (6/13 vs. 2/29, P < 0.05). Patients with ejective murmur were in HOCM group only (P < 0.01). Left ventricular outflow tract pressure gradient (LVOTPG) only observed in HOCM group (P < 0.01). Ventricular tachycardia was seen in both groups. 28 out of 42 patients (66.67%) had misdiagnosis, and 4 out of 42 patients (9.53%) had losing diagnosis. Thus, coronary heart disease (CHD) had the highest rate of misdiagnosis. There were 20 CHD patients (71.43%) among 28 patients with misdiagnosis. Hypertension was in 3, congenital heart in 2, cerebro-embolism in 2, and myocarditis in 1. Conclusions For a patient with family history or sudden death history of HCM, unexplained syncope episodes, chest pain (angina), especially in young, an ejection murmur along the left sternum border, the presence of narrow and deep Q waves, or inversion of giant T waves in V3-V6, atrial fibrillation and /or cerebra-embolism echocardiogram should be given. CAG and LVG are necessary only if the result of echo is negative, and the patients with suspected HCM or CHD.

Distribution and antibiotic resistance of pathogens isolated from ventilator-associated pneumonia patients in pediatric intensive care unit

BACKGROUND： With mechanical ventilation widely used in intensive care unit, the ventilator associated pneumonia （VAP） has become a common and serious complication in critically ill patients. Compared with adults, the incidence of VAP and the mortality are higher in children in pediatric intensive care unit （PICU） because of immune deficiency, severe basic diseases, and increased use of artificial airway or mechanical ventilation. Hence it is of significance to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence and mortality of VAP in children.METHODS： From January 2008 to June 2010, 2758 children were treated in PICU of Wuhan Children＇s Hospital. Among them, 171 received mechanical ventilation over 48 hours in PICU, and 46 developed VAP. The distribution and drug-resistance pattern of the pathogenic bacteria isolated from lower respiratory tract aspirations were analyzed. RESULTS：A total of 119 pathogenic microbial strains were isolated. Gram-negative bacilli （G-） were the most （65.55%）, followed by fungi （21.01%） and gram-positive cocci （G~, 13.45%）. Among them, the most common pathogens were Acinetobacter baummannii, Escherichia coli, Klebsiella pneumoniae, candida albicans and coagulase-negative staphylococci. Antibiotic susceptibility tests indicated that the multiple drug-resistances of G- and G＋to antibiotics were serious. Most of G- was sensitive to ciprofloxacin, amikacin, imipenem, meropenem, cefoperazone-sulbactam and piperacillin-tazobactam. The susceptibility of G＋ to vancomycin, teicoplanin and linezolid were 100%. Fungi were almost sensitive to all the antifungal agents. The primary pathogens of VAP were G-, and their multiple drug-resistances were serious. CONCLUSION： In clinical practice we should choose the most sensitive drug for VAP according to pathogenic test.

A retrospective study on professor Gui-Qi Xuan’s experience in traditional Chinese medicine treatment on attention-deficit hyperactivity disorder: based on data mining and network pharmacology

Background:To investigate the clinical medication approach of Professor Guiqi Xuan(Prof.Xuan)in treating pediatric patients with attention-deficit hyperactivity disorder(ADHD)and the potential mechanism of the core herbal prescription.Methods:Following medical record information pretreatment,the Traditional Chinese Medicine(TCM)inheritance computing platform system V3.0 was utilized to analyze the standardized data.The associate rules were summarized to identify the core prescription for treating ADHD.The extracted core herbal prescription’s active compounds and potential targets were used to establish a protein-protein interaction network of active ingredient-disease targets.Cytoscape 3.9.1 software was used to analyze the network’s topological parameters to obtain the key active ingredients and their targets.The Bioconductor data package of R4.0.2 was used to analyze the gene ontology biological functions and Kyoto Encyclopedia of Genes and Genomes pathways of key targets.Results:Two hundred and twenty-seven entries derived from TCM record information were selected.Through data mining,it was found that 62.5%of pediatric patients had short-tempered behavior,nearly half had sleep problems,and 30%-40%had picky eating and polyphagia issues.The highest-frequency syndrome type was kidney deficiency and liver hyperactivity.Deficiency,fire,phlegm,and dyspeptic food were the main pathological factors for ADHD.Prof.Xuan’s treatment of ADHD mainly focused on replenishing kidney essence and subduing Yang(active,external,ascending,warm,bright,functional and excited pertain to Yang).The core herbal prescription for ADHD included Yuan-zhi,Yi-zhi,Gui-jia,Bai-shao,Long-chi,Ci-shi,Shi-chang-pu,Yu-jin,Fu-shen,and Huang-jing.The protein-protein interaction network showed that MAOA,ADRB2,FOS,MAOB,and SLC6A3 were the five key targets essential in treating ADHD with core herbal prescriptions.The gene ontology biological function of crucial targets mainly involved G protein-coupled amine receptor activity,catecholamine binding,and neurotransmitter transmembrane transporter activity.Analysis of Kyoto Encyclopedia of Genes and Genomes pathways showed that the dopaminergic synapse signaling and neuroactive ligand-receptor interaction pathways were significantly enriched and may be the primary routes for the main treatment of ADHD.Conclusion:Prof.Xuan’s treatment of ADHD has achieved satisfactory clinical effects by supplementing the kidney,replenishing the essence,opening the orifices,nourishing the Yin(static,internal,descending,cold,dim,organic,depressed and pertain to Yin),and subduing the Yang.The major prescription predominantly affects catecholamine binding,neuroactive ligand-receptor interaction,G protein-coupled amine receptor function,and signaling pathways for dopaminergic synapses.Our findings showed that the methodology and software used in this research could explore and analyze the mechanism behind Prof.Xuan’s clinical medication rule for treating ADHD in children.

Chinese Medicine Syndromes in Congestive Heart Failure:A Literature Study and Retrospective Analysis of Clinical Cases

Objective： To discuss the characteristics of Chinese medicine （CM） syndrome factors and distribution of congestive heart failure （CHF）, and provide a basis for the diagnosis criteria of essential syndromes. Methods： Based on databases of China National Knowledge infrastructure （CNKI, 1980--2012） and Chinese Journal of Chongqing VlP Database （1989-2012）, the eligible studies in CHF and extracted factors associated with compound syndromes were analyzed. All the syndromes were classified into deficiency, excess, and deficiency-excess in complexity syndrome were classified. Compound syndromes were separated into syndrome factors including single, double, three or four factors, along with the frequency of occurrence. The relation of CHF syndromes with age, gender, primary disease, brain natriuretic peptide （BNP） and cardiac functional grade was studied in 1,451 CHF cases （between December 2010 and September 2012）, and the clinical distribution of common CHF syndromes was summarized. Results： The literature study involved 6,799 CHF cases in 66 literatures after screening. Of the different factors affecting CHF, qi deficiency was the most important one. In deficiency syndrome, Xin （Heart）-qi-deficiency was the most common single factor, and deficiency of both qi and yin was the most common double factor. The retrospective analysis involved 1,451 CHF cases （431 cases with test results of BNP）. The xin blood stasis and obstruction and deficiency of both qi and yin syndrome were mostly seen in female patients, and phlegm-blocking-Xin-vessel and qi-deficiency-blood-stasis syndrome mostly in males. Xin-qi-deficiency and qi-deficiency-blood-stasis syndrome were mostly seen in patients aged 50--60 years. Patients aged over 60 years likely manifest deficiency of both qi and yin and Xin blood stasis and obstruction syndrome. The severity of syndrome is aggravated with increased BNP and cardiac functional grade. Conclusions： The essential syndromes of CHF include qi-deficiency-blood-stasis and deficiency of both qi and yin. The clinical distribution is linked to patients＇ age and gender. BNP and cardiac functional grade is closely related to CHF syndromes, which may indicate the severity of CM syndromes of CHF.

A retrospective clinical study of sixty-three cases with persistent inflammation immunosuppression and catabolism syndrome

Objective To study the clinical characteristics and prognosis of patients with persistent inflammation immunosuppression and catabolism syndrome(PICS)in ICU.Methods A total of 126 patients admitted to ICU(ICU stay of more than 10 days,age≥18 years)between January 2014 and December 2014 were retrospectively studied.Data were collected from electronic medical records including demographics,underlying disease。

Investigation of the 12-month efficacy and safety of low-dose mifepristone in the treatment of painful adenomyosis

Objective:To study the 12-month effects and possible mechanisms of low-dose mifepristone in the treatment of adenomyosis.Methods:Patients included in this retrospective study had painful adenomyosis and previously received 5 mg mifepristone daily(group A,n=45)or 5 mg mifepristone daily with a poor-effect levonorgestrel-releasing intrauterine device(group B,n=13)for 12 months.Uterine size,serum CA125 levels,estradiol levels,Visual Analogue Scale(VAS)score,endometrial thickness,and hemoglobin levels were compared before and after treatment and investigated again at 3 to 6 months after drug withdrawal.Another 8 patients with adenomyosis(group C,n=8)who underwent surgery for severe dysmenorrhea during the same period were only used as a control group for immunohistochemical research.Endometrial biopsy results and expression of nerve growth factor(NGF),cyclooxygenase-2(COX-2),and nuclear-associated antigen Ki-67(Ki-67)in endometrial tissues and adenomyotic lesions were also analyzed.Results:The VAS scores in both experimental groups at all time points during treatment and follow-up were significantly lower(P<0.001)than those before treatment.The uterine size was significantly reduced,and endometrial thickness was distinctly thicker after 12 months of treatment than that before treatment in group A receiving 5 mg/d mifepristone.The immunohistochemical expression of NGF and COX-2 decreased in both eutopic and ectopic endometrium after treatment,whereas that of Ki-67 slightly increased in eutopic endometrium after treatment and rapidly recovered to the baseline value after stopping mifepristone.There were no signs of hyperplasia,atypical hyperplasia,or malignancy in the endometrial biopsies.Conclusions:The results suggested that a daily dose of 5 mg mifepristone for 12 months down-regulated the expression of NGF and COX-2 and was effective in treating painful adenomyosis with few side effects.