Subglottic Secretion Drainage for Preventing Ventilator Associated Pneumonia: A Meta-analysis

Objective： Ventilator associated pneumonia （VAP） has been shown to be associated with significant morbidity and mortality（ Chastre and Fagon, 2002; klompas, 2007） among mechanically venti- lated patients in the intensive care unit （ICU）, with the incidence ranging from 9% to 27% ; crude mortality ranges from 25% to 50%.1-3 A meta-analysis of published studies was undertaken to combine information regarding the effect of subglottic secretion drainage （SSD） on the incidence of ventilated associated pneumonia in adult ICU patients. Methods： Reports of studies on SSD were identified by searching the PUBMED, EMBASE, and COCHRANCE LIBRARY databases （December 30, 2010）. Randomized trials of SSD compared to usual care in adult mechanically ventilated ICU patients were included in this meta-analysis. Results： Ten RCTs with 2,314 patients were identified. SSD significantly reduced the incidence of VAP [ relative risk （RR） =0.52, 95% confidence interval （C/）： 0.42-0.64, P〈0.000 01]. When SSD was compared with the control groups, the overall RR for ICU mortality was 1.00 （95% CI, 0.84-1.19） and for hospital mortality was 0.95 （95% CI, 0. 80-1.13）. Overall, the subglottic drainage effect on the days of mechanical ventilation was -1.52 days （95% CI, -2.94 to -0.11） and on the ICU length of stay （LOS） was -0.81days （95% CI, -2.33 to -0.7）. Conclusions： In this meta-analysis, when an endotracheal tube （ETT） with SSD was compared with an ETT without SSD, there was a highly significant reduction in the VAP rate of approxi- mately 50%. Time on mechanical ventilation （MV） and the ICU LOS may be reduced, but no reduction in ICU or hospital mortality has been observed in published trials,

Risk factors for ventilator-associated pneumonia in trauma patients:A descriptive analysis

BACKGROUND:We sought to evaluate the risk factors for developing ventilator-associated pneumonia(VAP)and whether the location of intubation posed a risk in trauma patients.METHODS:Data were retrospectively reviewed for adult trauma patients requiring intubation for>48 hours,admitted between 2010 and 2013.Patients’demographics,clinical presentations and outcomes were compared according to intubation location(prehospital intubation[PHI]vs.trauma room[TRI])and presence vs.absence of VAP.Multivariate regression analysis was performed to identify predictors of VAP.RESULTS:Of 471 intubated patients,332 patients met the inclusion criteria(124 had PHI and208 had TRI)with a mean age of 30.7±14.8 years.PHI group had lower GCS(P=0.001),respiratory rate(P=0.001),and higher frequency of head(P=0.02)and chest injuries(P=0.04).The rate of VAP in PHI group was comparable to the TRI group(P=0.60).Patients who developed VAP were 6 years older,had significantly lower GCS and higher ISS,head AIS,and higher rates of polytrauma.The overall mortality was 7.5%,and was not associated with intubation location or pneumonia rates.In the early-VAP group,gram-positive pathogens were more common,while gram-negative microorganisms were more frequently encountered in the late VAP group.Logistic regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the models.CONCLUSION:In trauma,the risk of developing VAP is multifactorial.However,the location of intubation and presence of chest injury could play an important role.

Pseudomonas aeruginosa ventilator associated pneumonia: improved outcomes with earlier follow-up

It is not clear what is the appropriate timing to follow-up patients with ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infe- ction Score >6 between days 3-5 of an appro- priate antibiotic treatment. We studied 122 patients with Pseudomonas aeruginosa VAP. A follow-up respiratory sample was collected on days three or five ( “day-three” and “day-five” group ) and treatment was modified 48h later. Molecular typing identified super-infections or persistence. For serial data another respiratory sample was collected, on day three from the “day-five” group and on day five from the “day-three” group. Sixty patients, in the “day- three” group compared to 62 in the “day-five” group, had reduced fourteen-day mortality ( 18.3% and 38.7%;p=0.01 ) and fewer days in intensive care unit (17.2 ± 4.3 compared to 27.3 ± 4.7, p6, improved fourteen-day mortality and shorter duration of stay in health-care facilities were observed with earlier follow-up.

Natural History, Outcomes and Antibiotic Treatment for Ventilator-Associated Tracheobronchitis in Critical Ill Patients

We assessed incidence and outcomes of patients with ventilator-associated respiratory infections (VARI) due to tracheobronchitis (VAT) and pneumonia (VAP), including length of intensive care unit (ICU) stay and ventilator days. We also examined pathogens, rate of progression from VAT to VAP, and impact of antibiotic therapy for VAT. Data analysis included 234 patients, 100 patients (43%) had at least moderate (+++) bacterial growth in their semi-quantitative endotracheal aspirate (SQ-ETA) cultures. VAT and VAP were each diagnosed in 34 (15%) patients. Staphylococcus aureus was the most common pathogen isolated and had the highest rate of progression from VAT to VAP. Seven (21%) of the 34 patients were diagnosed with VAT that later progressed to VAP in averaged 3 days. Patients diagnosed with VAT had significantly more ventilator days (9 vs 6, p p < 0.001) and hospital days (22 vs 17, p < 0.001). No significant difference was observed in the clinical outcomes of the 25 VAT patients with timely, appropriate antibiotics compared to the 9 VAT patients who did not receive timely appropriate antibiotics. VAT was a risk factor for increased ventilator days, longer length of ICU and hospital stay. The time window from VAT to VAP allowed physicians to identify the pathogens and sensitivity profile needed to treat VAT with appropriate antibiotics. Data from well-designed studies were needed to assess the impact of early, appropriate antibiotic therapy for VAT, the choice of antibiotics, as well as the duration and route of administration.

Factors Associated with Acute Respiratory Infections in Children Aged 0 - 5 Years in the Yénawa District of Cotonou (Benin) in 2023

Introduction: Acute respiratory infections remain one of the main causes of mortality in children aged 0 to 5. This work aimed to study the associated factors with the occurrence of acute respiratory infections in children 0 to 5 years old in Yénawa, Cotonou in 2023. Subjects and Method: It was an analytical cross-sectional study of children aged 0 - 5 years and their mothers in Yénawa, selected by four-degree random sampling. The sampling size, calculated using the Schwartz formula, was 126 children and 126 mothers. The dependent variable was the occurrence of acute respiratory infections. The independent variables were classified into four groups: socio-demographic and economic characteristics, behavioral factors, child-related factors, and environmental factors. Data collected by observation and questionnaire survey were analyzed using STATA version 15 software. Associated factors were investigated by bivariate analysis and multiple logistic regression, at the 5% significance level. Results: A total of 126 children aged 0 - 5 years and 126 mothers were surveyed, aged 23.5 (11 - 36) months and 30 (18 - 48) years respectively. The prevalence of acute respiratory infections was 74.60% (CI95% = 66.89 to 82.30). The associated factors were the mother’s age between 18 and 28 (OR = 10.77;CI95% = 1.89 to 61.27;p = 0.007), the use of charcoal/wood for cooking (OR = 7.36;IC = 1.99 to 27.10;p = 0.003)), children's poor personal hygiene (OR = 8.87;IC = 2.92 to 26.97;p 0.001)), and cohabitation with domestic animals (OR = 7.27;IC = 1.67 to 31.71;p = 0.015). Conclusion: Communicating with mothers about the factors identified will help reduce the prevalence of acute respiratory infections in children aged 0 to 5.

Ventilator associated pneumonia following liver transplantation:Etiology,risk factors and outcome

AIM: To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia(VAP) in patients undergoing orthotopic liver transplantation(OLT).METHODS: This retrospective study considered 242 patients undergoing deceased donor OLT. VAP was diagnosed according to clinical and microbiological criteria. RESULTS: VAP occurred in 18(7.4%) patients, with an incidence of 10 per 1000 d of mechanical ventilation(MV). Isolated bacterial etiologic agents were mainly Enterobacteriaceae(79%). Univariate logistic analysis showed that model for end-stage liver disease(MELD) score, pre-operative hospitalization, treatment with terlipressin, Child-Turcotte-Pugh score, days of MV and red cell transfusion were risk factors for VAP. Multivariateanalysis, considering significant risk factors in univariate analysis, demonstrated that pneumonia was strongly associated with terlipressin usage, pre-operative hospitalization, days of MV and red cell transfusion. Mortality rate was 22% in the VAP group vs 4% in the group without VAP. CONCLUSION: Our data suggest that VAP is an important cause of nosocomial infection during postoperative period in OLT patients. MELD score was a significant risk factor in univariate analysis. Multiple transfusions, treatment with terlipressin, preoperative hospitalization rather than called to the hospital while at home and days of MV constitute important risk factors for VAP development.

The Diagnostic and Prognostic Value of Serum Procalcitonin among Ventilator Associated Pneumonia Patients

Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results: There was a highly statistically significant difference (p value 0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p 0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p = 0.449), CRIP (R = 0.403) and SOFA (R = 0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings.

Ventilator Associated Pneumonia in an Intensive Care Unit

The aim of this prospective study was to evaluate the incidence, etiologic agents and mortality rate of ventilator-associated pneumonia (VAP). In a six-month period, cases who were 18 years or older, dependent on mechanical ventilator for more than 3 days and without pulmonary infection on first admission were included in this study. In all cases, body temperature recordings, blood and urine culture, microbiological analyses of endotracheal aspirates, and chest X-rays were obtained and used to identify VAP. Apache II scores on admission, duration of mechanical ventilation, length of intensive care unit (ICU) stay and mortality were recorded. This study included 45 cases and 22 developed VAP (48%). The incidence of VAP was 25.34 per 1000 ventilator days. Univariate analyses showed that duration of mechanical ventilation, length of ICU stay, coma and tracheotomy were associated with the development of VAP. The mortality rate of cases with VAP (72.7%) was significantly higher than cases without VAP (39.1%). The most frequent microorganisms were Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella pneumoniae. In our study, VAP was a very common and important complication of mechanical ventilation and mortality was very high. To reduce mortality, minimize morbidity, shorten the length of stay, and reduce costs, defined risk factors for VAP should be recognized and an effective infection control program for the prevention of VAP should be implemented. Surveillance results should be evaluated regularly and necessary precautions should be taken.

Molecular Epidemiology of Coxsackievirus B1-5 Associated with HFMD in Fujian Province, China, 2011-2016

Hand,foot and mouth disease(HFMD)is a common infectious disease that usually affects children less than 5 years of age.HFMD is caused by human enteroviruses(HEVs).HEVs,members of the Enterovirus genus of the Picornaviridae(small RNA virus)family.

EXPRESSION OF MULTIDRUG RESISTANCE-ASSOCIATED PROTEIN IN HUMAN GASTRIC AND RENAL CARCINOMAS

Objective The clinical signilicance of exPression of multidrug resistance- associated protein (MRP) in gastric and renal carcinoma was investigated. Methods LSAB immunohistochemistry was performed to detect eopression of MRP in the carcinoma tissues of 52 patients with gastric carcinoma and 20 cases with renal cell carcinoma. Results The positive expression rate of MRP was 38.5% (20/52) in gastric carcinoma tissues, and 60% (12/20) in renal carcinoma tissues. The expression of MRP both on cellular membrane and in cytoplasm was observed, but the expression in cytoplasm (thick granule) was more obvious. The positive expression rates of MRP in advanced gastric and renal carcinoma (Ⅲ orⅣ stage) were 60% (15/25) and 88.90% (8/9) reSPectively, which were higher than those in early lesion (Ⅰ or Ⅱ stage, 18.5% and 36.4% respectively). Furthermore, the patients with positive expression of MRP in gastric carcinoma tissues had shorter mean survival time and lower 5-year survival rate than that with negative eopression of MRP. Conclusion MRP plays an important role in the infiltration and metastasis of gastric and renal carcinoma and might contribute to the intrinsic drug - resistance in both carcinomas.

Simulation on dissolute and dust dispersion in comprehensive mechanized heading face with forced-exhaust ventilation

According to the characteristics of comprehensive mechanized heading face, established the mathematical model of single-phase air flow with κ-ε two equations model, and have established κ-ε-θ-κp mathematic model to solve two-phase flow of gas and particles in dust space with eulerian-eulerian method and eulerian-lagrangian method. Numerical solution of gas-particle two-phase flow was put forward based on collocated grid SIMPLE algorithm. Moreover, numerical simulation of dust concentration in fully mechanized caving face was carded out by using Fluent software. Finally, when in forced-exhaust ventilation circumstance, drawer type fan drum have less dust absorption, and most of dust spread to the other site; the dust concentration is inversely proportional to the distance from tunneling head, and the dust concentration has already diffused to decrease below 102 mg/m3 at the position ofx=12 m. Dust are more focused on relative side（in the range about y from 0 to 2 meter） of roadway space of press-ventilated fan drum, especially between tunneling place and drawer type fan drum; the roadway with road header have a higher dust concentration. These conclusions provide reliable theory basis for the dust prevention in comprehensive mechanized heading face.

CONVERGENCERATESIN THESTRONG LAWSOFASYMPTOTICALLY NEGATIVELY ASSOCIATEDRANDOM FIELDS

In this paper, a notion of negative side ρ \|mixing ( ρ\+- \|mixing) which can be regarded as asymptotic negative association is defined, and some Rosenthal type inequalities for ρ\+- \|mixing random fields are established. The complete convergence and almost sure summability on the convergence rates with respect to the strong law of large numbers are also discussed for ρ\+-\| mixing random fields. The results obtained extend those for negatively associated sequences and ρ\+*\| mixing random fields.

Designing coal panels in the conditions of associated methane and spontaneous fire hazards

An increase in methane,spontaneous fire and bumping hazards in Polish hard coal mines,observed in the last two decades,led to the need to elaborate the tools allowing proper selection of a range of preventive measures to fight them at the stage of designing coal extraction.Designing the production of a coal seams in the conditions of associated methane and spontaneous fires hazards in Polish hard coal mines requires elaboration of the design standards for coal panels in gassy coal seams.This paper presents the guidelines on how to design production in the conditions of associated methane and spontaneous fire hazards.Presented tools and methodology since the very first research were many times verified by daily mining operations in the conditions of associated methane and spontaneous fire hazards,which confirms their significant contribution to the development of safe and economical mining operations.

Analysis of the joint detection capability of the SMILE satellite and EISCAT-3D radar

The Solar wind Magnetosphere Ionosphere Link Explorer(SMILE)satellite is a small magnetosphere–ionosphere link explorer developed cooperatively between China and Europe.It pioneers the use of X-ray imaging technology to perform large-scale imaging of the Earth’s magnetosheath and polar cusp regions.It uses a high-precision ultraviolet imager to image the overall configuration of the aurora and monitor changes in the source of solar wind in real time,using in situ detection instruments to improve human understanding of the relationship between solar activity and changes in the Earth’s magnetic field.The SMILE satellite is scheduled to launch in 2025.The European Incoherent Scatter Sciences Association(EISCAT)-3D radar is a new generation of European incoherent scatter radar constructed by EISCAT and is the most advanced ground-based ionospheric experimental device in the high-latitude polar region.It has multibeam and multidirectional quasi-real-time three-dimensional(3D)imaging capabilities,continuous monitoring and operation capabilities,and multiple-baseline interferometry capabilities.Joint detection by the SMILE satellite and the EISCAT-3D radar is of great significance for revealing the coupling process of the solar wind–magnetosphere–ionosphere.Therefore,we performed an analysis of the joint detection capability of the SMILE satellite and EISCAT-3D,analyzed the period during which the two can perform joint detection,and defined the key scientific problems that can be solved by joint detection.In addition,we developed Web-based software to search for and visualize the joint detection period of the SMILE satellite and EISCAT-3D radar,which lays the foundation for subsequent joint detection experiments and scientific research.

纤维支气管镜肺泡灌洗液中sTREM-1、IL-32及PCT水平对呼吸机相关性肺炎病情及预后判断的价值

目的:探讨纤支镜支气管肺泡灌洗液中可溶性髓系细胞触发受体-1(sTREM-1)、白细胞介素32(IL-32)及降钙素原(PCT)水平与呼吸机相关肺炎(VAP)患者病情及预后判断的价值。方法:选取确诊的53例VAP患者作为VAP组;另选取同期实施机械通气但是未发生VAP的56例患者作为对照组。记录两组患者肺泡灌洗液中sTREM-1、IL-32、PCT水平、CPIS评分、APACHEⅡ评分,并探究其与患者病情和预后的相关性。结果:VAP组患者肺泡灌洗液sTREM-1、IL-32、PCT水平及CPIS评分、APACHEⅡ评分均高于对照组(P<0.05);VAP组患者肺泡灌洗液的sTREM-1、IL-32、PCT水平与CPIS评分正相关(r=0.614、0.603、0.621,P<0.05);VAP组患者肺泡灌洗液的sTREM-1、IL-32、PCT水平与APACHEⅡ评分正相关(r=0.414、0.463、0.409,P<0.05);53例VAP患者,经过28 d治疗,死亡17例、存活36例,死亡的VAP患者肺泡灌洗液sTREM-1、IL-32、PCT水平及CPIS评分、APACHEⅡ评分均高于存活组(P<0.05);肺泡灌洗液sTREM-1、IL-32、PCT水平预测VAP患者不良预后结局的受试者工作曲线下面积(AUC)分别为0.900、0.862、0.917。结论:VAP患者肺泡灌洗液中sTREM-1、IL-32、PCT水平升高,并且与患者肺部感染程度、病情危重程度正相关,对于预测患者不良结局具有较高的价值。

MiR-150-5p inhibits cell proliferation and metastasis by targeting FTO in osteosarcoma

Background:Osteosarcoma(OS),recognized as the predominant malignant tumor originating from bones,necessitates an in-depth comprehension of its intrinsic mechanisms to pinpoint novel therapeutic targets and enhance treatment methodologies.The role of fat mass and obesity-associated(FTO)in OS,particularly its correlation with malignant traits,and the fundamental mechanism,remains to be elucidated.Materials and Methods:1.The FTO expression and survival rate in tumors were analyzed.2.FTO in OS cell lines was quantified utilizing western blot and PCR.3.FTO was upregulated and downregulated separately in MG63.4.The impact of FTO on the proliferation and migration of OS cells was evaluated using CCK-8,colony formation,wound healing,and Transwell assays.5.The expression of miR-150-5p in OS cells-derived exosomes was identified.6.The binding of miR-150-5p to FTO was predicted by TargetScan and confirmed by luciferase reporter assay.7.The impact of exosome miR-150-5p on the proliferation and migration of OS cells was investigated.Results:The expression of FTO was higher in OS tissues compared to normal tissues correlating with a worse survival rate.Furthermore,the downregulation of FTO significantly impeded the growth and metastasis of OS cells.Additionally,miR-150-5p,which was downregulated in both OS cells and their derived exosomes,was found to bind to the 3′-UTR of FTO through dual luciferase experiments.Exosomal miR-150-5p was found to decrease the expression of FTO and inhibit cell viability.Conclusions:We identified elevated levels of FTO in OS,which may be attributed to insufficient miR-150-5p levels in both the cells and exosomes.It suggests that the dysregulation of miR-150-5p and its interaction with FTO could potentially promote the development of OS.

FOCUS-PDCA模式对ICU重症患者呼吸机相关性肺炎的影响

目的分析发现-组织领导-明确情况-分析了解-改进方案(find organize clarify understand select,FOCUS)-计划-执行-检查-行动(plan do check act,PDCA)模式对重症监护室(intensive care unit,ICU)重症患者呼吸机相关性肺炎(ventilator associated pneumonia,VAP)的影响。方法选取2022年10月—2023年9月菏泽市牡丹人民医院ICU接受机械通气治疗的重症患者120例,根据干预时间将其分为2组,即2022年10月—2023年3月60例患者作为对照组,2023年4—9月60例患者作为研究组。对照组接受常规干预措施预防VAP,研究组在此基础上,采用FOCUS-PDCA模式预防VAP。比较2组患者机械通气时间、住院时间、住院费用、一次性脱机成功率与VAP发生率。结果与对照组相比,研究组机械通气时间、住院时间更短(P<0.05),住院费用更低(P<0.05)。研究组一次性脱机成功率为96.67%,高于对照组的85.00%(χ^(2)=4.904,P<0.05);VAP发生率为1.67%,低于对照组的13.33%(χ^(2)=4.324,P<0.05)。结论FOCUS-PDCA模式能够有效降低ICU重症患者VAP的发生率,缩短机械通气时间与住院时间,节省住院费用,提高一次性脱机成功率,具有临床应用价值。

呼吸机相关肺炎患者病原菌分布及血清miR-101-3p、斯钙素1的检测分析

目的 探究呼吸机相关肺炎(ventilator-associated pneumonia,VAP)患者病原菌分布及血清微小RNA-101-3p(microRNA-101-3p,miR-101-3p)、斯钙素1(stanniocalcin 1,STC1)表达水平在VAP诊断中的临床意义。方法 选取2020年1月至2023年4月在安徽医科大学附属六安医院进行机械通气治疗,发生VAP的患者121例作为VAP组,未发生VAP的患者87例为非VAP组,同期健康体检者83例为对照组。采集VAP组患者下呼吸道分泌物进行病原菌鉴定;测定所有研究对象的血清STC1、降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、miR-101-3p水平。采用Pearson法分析血清miR-101-3p、STC1与炎症因子PCT、CRP、TNF-α的相关性;采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析血清miR-101-3p、STC1对VAP的诊断价值。结果 121例VAP患者共检测分离出病原菌218株,其中革兰氏阴性菌124株(56.88%),革兰氏阳性菌86株(39.45%),真菌8株(3.67%);VAP组的血清miR-101-3p、PCT、CRP、TNF-α水平均显著高于非VAP组和对照组(P<0.05),STC1水平显著低于非VAP组和对照组(P<0.05);VAP患者的血清miR-101-3p水平与PCT、CRP、TNF-α呈正相关(P<0.05),STC1水平与PCT、CRP、TNF-α呈负相关(P<0.05);ROC曲线显示血清miR-101-3p、STC1单独及联合诊断VAP患者的曲线下面积(area under curve,AUC)分别为0.766、0.750、0.841,联合诊断价值高于二者单独诊断(Z二者联合-miR-101-3p=2.275、P=0.023,Z二者联合-STC1=2.856、P=0.004)。结论 VAP患者以革兰氏阴性菌感染为主,血清miR-101-3p呈高表达、STC1呈低表达,血清miR-101-3p、STC1联合诊断对于VAP的发生具有一定的诊断价值。

血清ChE、Syndecan-1水平对AECOPD合并呼吸机相关性肺炎患者病情及预后的评估价值

目的 分析血清胆碱酯酶(ChE)、多配体蛋白聚糖-1(Syndecan-1)水平对慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸机相关性肺炎(VAP)患者病情及预后的评估价值。方法 选取2022年1月至2024年1月淮安市第五人民医院收治的AECOPD合并VAP患者132例(设为AECOPD合并VAP组),另选择同期COPD稳定期患者70例(设为COPD稳定期组)和同期体检健康者70例(设为对照组),比较3组血清ChE、Syndecan-1水平。根据急性生理和慢性健康评分系统Ⅱ(APACHEⅡ)评分将AECOPD合并VAP患者分为低危VAP组(42例)、中危VAP组(44例)、高危VAP组(46例),分析血清ChE、Syndecan-1水平与AECOPD合并VAP患者APACHEⅡ评分的相关性。根据28 d预后分为死亡组(52例)和存活组(80例),比较3组ChE、Syndecan-1水平,并收集AECOPD合并VAP患者基线资料,绘制受试者工作特征(ROC)曲线,分析CHE、Syndecan-1水平评估AECOPD合并VAP患者不良预后的价值。结果 血清ChE水平AECOPD合并VAP组低于COPD稳定期组低于对照组,血清Syndecan-1水平AECOPD合并VAP组高于COPD稳定期组高于对照组(P <0.05),低、中、高危VAP组血清ChE水平依次降低,Syndecan-1水平依次降低(P <0.05)。AECOPD合并VAP患者APACHEⅡ评分与血清ChE水平呈负相关,与血清Syndecan-1水平呈正相关(P <0.05)。APACHEⅡ评分增加、降钙素原升高、Syndecan-1升高为AECOPD合并VAP患者不良预后的独立危险因素,第1秒用力呼气容积占预计值百分比升高、ChE升高为独立保护因素(P <0.05)。血清ChE联合Syndecan-1水平评估AECOPD合并VAP患者不良预后的曲线下面积为0.882,大于血清ChE、Syndecan-1水平单独评估的0.800、0.794(P <0.05)。结论 血清ChE水平降低和Syndecan-1升高与AECOPD合并VAP患者病情加重和预后不良有关,血清ChE联合Syndecan-1水平评估AECOPD合并VAP患者预后的价值较高。

Epidemio-Clinical Profile and Factors Associated with Performance Indicators of Integrated Management of Severe Acute Malnutrition in Children Aged 6 - 59 Months Hospitalized at the Kalaban Coro Reference Health Center

Introduction: Malnutrition is an important reason for consultation in Mali’s health facilities and remains a major public health problem. The aim of this study was to describe the epidemioclinical profile and associated factors with performance indicators of integrated management of severe acute malnutrition in children aged 06 to 59 months. Methodology: this was a cross-sectional study with retrospective data collection (January 2021 to December 2022). All children hospitalized for severe acute malnutrition in the pediatric department and whose medical records were usable were included. Data collected using a standardized questionnaire was analyzed with SPSS Version 20 software. Results: A total of 534 children were included. The 12 to 23 months age group (49.1%) and the female sex (53.18%) were the most affected. Fully vaccinated children by age represented 49.4%. The predominant form of malnutrition was marasmus (77.7%). Diarrhea/vomiting (30.3%), fever (18.4%) and cough (15.5%) were the main reasons for consultations. Cure, discontinuation and death rates were 78.5%, 2.1% and 9.2%, respectively. On univariate analysis, the factors statistically associated with performance indicators (cure, drop-out, death) were gastroenteritis (P-value Conclusion: This study reveals that the frequency of severe acute malnutrition remains high at the Kalaban Coro reference health center. Better prevention of illnesses such as malaria, gastroenteritis, and respiratory infections, as well as timely referral, could help facilitate its management.