BACKGROUND Drug-eluting stents(DES)are used to treat lower extremity arterial disease.During DES treatment,aneurysmal degeneration occasionally occurs,especially with fluoropolymer-based DES.However,the incidence of p...BACKGROUND Drug-eluting stents(DES)are used to treat lower extremity arterial disease.During DES treatment,aneurysmal degeneration occasionally occurs,especially with fluoropolymer-based DES.However,the incidence of pseudoaneurysms after DES placement is rarely reported in the lower extremity region,although there have been several reports on pseudoaneurysm formation after DES placement in the coronary artery region.CASE SUMMARY We report the case of a 64-year-old man who presented with fever and pain in his left hand after dialysis.Bacteremia was diagnosed by blood culture,and after admission,he developed pain on the medial side of the right thigh.A pseudoaneurysm was observed in the right superficial femoral artery(SFA)at the proximal end of a previously placed DES.The bacteremia was thought to have been caused by a pseudoaneurysm of the left superficial brachial artery,and the pseudoaneurysm of the left superficial brachial artery was removed after antibiotic treatment.The pseudoaneurysm of the right SFA rapidly expanded after admission,but the expansion rate was reduced after infection control.Seven months after the first admission,the pseudoaneurysm of the left SFA was re-moved and in situ revascularization performed using a rifampicin-soaked Dacron graft.CONCLUSION Although pseudoaneurysm after DES placement in the lower extremity region is rare,it must be considered in patients with bacteremia.展开更多
目的对1例高频抗体导致的胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)进行检测、鉴定及配血。方法对患儿进行新生儿溶血试验,对母亲进行血清学意外抗体鉴定,并对母亲红细胞进行常见高频抗原鉴定;对检出抗体进行...目的对1例高频抗体导致的胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)进行检测、鉴定及配血。方法对患儿进行新生儿溶血试验,对母亲进行血清学意外抗体鉴定,并对母亲红细胞进行常见高频抗原鉴定;对检出抗体进行IgG分型检测,并用流式细胞术进行单核细胞体外吞噬致敏红细胞试验,以检测抗体相关的吞噬率;对患儿母亲、父亲及舅舅进行相关红细胞血型基因测序;利用稀释的母亲血浆和抗人球卡法,在献血者中进行大规模相合血液的筛选。结果产妇鉴定为Di(b-)稀有血型,产生了抗-Di b(效价512)并导致了严重的HDFN;抗-Di b亚型分型为IgG1和IgG2型,单核细胞体外吞噬效率为88.83%(74.7/84.09);产妇亲属中没有相合献血者,后续从5520名献血者中筛选到2例Di(b-)相合血液,患儿接收输血治疗后康复出院。后续在51334名献血者中筛查到17名Di(b-)献血者,该数据表明Di(b-)在广州地区献血者中的分布频率约为三千分之一(0.033%,17/51334)。结论综合利用血型血清学及分子生物学方法诊断了抗-Di b所致的严重HDFN,建立了1种有效大规模筛查Di(b-)稀有血型的方法并找到相合血液,为建立Di(b-)稀有血型库奠定了基础。展开更多
Background: Sickle cell disease is one of the most common monogenic diseases in the world, affecting approximately 70 million people, 80% in sub-Saharan Africa and 1 in 10 in Senegal. Sickle cell anemia causes functio...Background: Sickle cell disease is one of the most common monogenic diseases in the world, affecting approximately 70 million people, 80% in sub-Saharan Africa and 1 in 10 in Senegal. Sickle cell anemia causes functional asplenia (associated with repeated thrombosis of splenic vessels), resulting in increased susceptibility to infection. However, several studies have reported differences in the spectrum of bacterial infections in malaria-endemic areas. Therefore, we proposed to conduct a study to determine the rate of positive blood cultures and the bacteriological spectrum in sickle cell patients. Materials and Method: This is a descriptive cross-sectional study of blood culture samples from patients who received a request for hemoglobin electrophoresis as part of their treatment at the Principal’s hospital in Dakar. The study took place from January 2008 to December 2021. For each patient, we collect demographic information, including age, gender, and the service from which the analysis request originated. Data were collected in the laboratory’s computer system and entered into Microsoft Excel (2007). Statistical analyzes were performed using Epi-Info 7 software. Results: Our study included 1419 patients. The most common types of hemoglobin profiles were: normal profile (n = 1025), AS profile (n = 283), SS profile (n = 104), SC profile (n = 7). This corresponds to the proportions of 72%, 20%, 0.5% and 7.5% for the profiles Normal, AS, SC and SS. The male proportion was 61.1%, 61.5%, 57.1, respectively %, 55.8% for Normal, SA, SC, and SS profiles. A total of 19,090 individual blood culture bottles were collected from 1419 impatient patients as follows: Normal profile (n = 18,042 bottles), AS profile (n = 677 culture bottles), SS profile (n = 362 bottles). The majority of blood culture orders come from pediatric services, accounting for 70% of the total number of orders. Of 19,090 vials examined in this current study, 19.6% developed a positive blood culture. Overall, the most commonly isolated bacteria were Staphylococci (41.1%), Enterobacteriaceae (36.7%), Bacillaceae (10.2%), unfermented (6.30%), Streptococci (5.01%), and a small proportion of yeast (0.75%). There is no significant difference in bacterial spectrum between the SS profile and the normal profile of individuals (p = 0.104). Coagulase-negative staphylococci accounted for 32%, 24%, and 40% of the species isolated in the normal AS and SS profiles. respectively. Coagulase-negative staphylococci were the most commonly isolated organisms in SS. Group E and sptagged streptococci each account for less than 2% of the organisms isolated in SS. Pneumococci were not found. Bacillus accounts for 25% of isolates in SS subjects compared to 9% in normal and AS subjects, respectively. Pseudomonas aeruginosa and Burkholderia cepacia then make up 10% of the isolates in the subjects of the SS profile as non-fermenters. Conclusion: Our study shows that enterobacteria and staph are prevalent in people with sickle cell disease. There is no significant difference in bacterial spectrum between SS subjects compared to subjects with a normal profile. The rarity of Streptococcus pneumoniae in bacteremia isolates underlines the need for further studies with larger patient numbers to better understand the spectrum of bacterial infections in patients with sickle cell disease in West Africa.展开更多
BACKGROUND Severe infection often results in bacteremia,which significantly increases mortality rate.Different therapeutic strategies are employed depending on whether the blood-borne infection is Gram-negative(G-)or ...BACKGROUND Severe infection often results in bacteremia,which significantly increases mortality rate.Different therapeutic strategies are employed depending on whether the blood-borne infection is Gram-negative(G-)or Gram-positive(G+).However,there is no risk prediction model for assessing whether bacteremia patients are infected with G-or G+pathogens.AIM To establish a clinical prediction model to distinguish G-from G+infection.METHODS A total of 130 patients with positive blood culture admitted to a single intensive care unit were recruited,and Th1 and Th2 cytokine concentrations,routine blood test results,procalcitonin and C-reactive protein concentrations,liver and kidney function test results and coagulation function were compared between G+and Ggroups.Least absolute shrinkage and selection operator(LASSO)regression analysis was employed to optimize the selection of predictive variables by running cyclic coordinate descent and K-fold cross-validation(K=10).The predictive variables selected by LASSO regression analysis were then included in multivariate logistic regression analysis to establish a prediction model.A nomogram was also constructed based on the prediction model.Calibration chart,receiver operating characteristic curve and decision curve analysis were adopted for validating the prediction model.RESULTS Age,plasma interleukin 6(IL-6)concentration and plasma aspartate aminotransferase concentration were identified from 57 measured variables as potential factors distinguishing G+from G-infection by LASSO regression analysis.Inclusion of these three variables in a multivariate logistic regression model identified age and IL-6 as significant predictors.In receiver operating characteristic curve analysis,age and IL-6 yielded an area under the curve of 0.761 and distinguished G+from G-infection with specificity of 0.756 and sensitivity of 0.692.Serum IL-6 and IL-10 levels were upregulated by more than 10-fold from baseline in the G-bacteremia group but by less than ten-fold in the G+bacteremia group.The calibration curve of the model and Hosmer-Lemeshow test indicated good model fit(P>0.05).When the decision curve analysis curve indicated a risk threshold probability between 0%and 68%,a nomogram could be applied in clinical settings.CONCLUSION A simple prediction model distinguishing G-from G+bacteremia can be constructed based on reciprocal association with age and IL-6 level.展开更多
BACKGROUND Achromobacter xylosoxidans is a Gram-negative opportunistic aerobe,usually causing nosocomial infections in immunocompromised patients with manifestations including bacteremia,pneumonia,and catheter-related...BACKGROUND Achromobacter xylosoxidans is a Gram-negative opportunistic aerobe,usually causing nosocomial infections in immunocompromised patients with manifestations including bacteremia,pneumonia,and catheter-related infections.However,A.xylosoxidans have not yet been reported to cause biliary system infections.CASE SUMMARY A 72-year-old woman presented to the outpatient department of our hospital with a chief complaint of jaundice.Computed tomography of her abdomen revealed the presence of a mass of approximately 2.4 cm in the hilar portion of the common hepatic duct,consistent with hilar cholangiocarcinoma.We performed endoscopic retrograde cholangiopancreatography(ERCP)to decompress the obstructed left and right intrahepatic ducts(IHDs)and placed 10 cm and 11 cm biliary stents in the left and right IHDs,respectively.However,the day after the procedure,the patient developed post-ERCP cholangitis as the length of the right IHD stent was insufficient for proper bile drainage.The blood culture of the patient tested positive for A.xylosoxidans.Management measures included the replacement of the right IHD stent(11 cm)with a longer one(12 cm)and administering culturedirected antibiotic therapy,solving the cholangitis-related complications.After the cholangitis had resolved,the patient underwent surgery for hilar cholangiocarcinoma and survived for 912 d without recurrence.CONCLUSION A.xylosoxidans-induced biliary system infections are extremely rare.Clinical awareness of physicians and endoscopists is required as this rare pathogen might cause infection after endoscopic procedures.展开更多
A dispersion interferometer(DI)has been installed and operates on the Experimental Advanced Superconducting Tokamak(EAST).This DI system utilizes a continuous-wave 9.3μm CO_(2)laser source to measure line-averaged el...A dispersion interferometer(DI)has been installed and operates on the Experimental Advanced Superconducting Tokamak(EAST).This DI system utilizes a continuous-wave 9.3μm CO_(2)laser source to measure line-averaged electron densities accurately.In contrast to conventional interferometers,the DI does not require substantial vibration isolations or compensating systems to reduce the impact of vibrations in the optical path.It also employs a ratio of modulation amplitudes,ensuring it remains immune to the variations in detected intensities.Without a variation compensation system,the DI system on EAST reaches a density resolution of less than1.8×10^(-2)πrad and a temporal resolution of 20μs.The measurements made by the POlarimeterINTerferometer(POINT)system and the far-infrared hydrogen cyanide(HCN)interferometer are remarkably consistent with the DI’s results.The possibility of fringe jumps and the impact of refraction in high-density discharge can be significantly decreased using a shorter wavelength laser source.A rapid density change of 3×10^(19)m^(-3)during 0.15 s has been measured accurately in shot No.114755 of EAST.Additionally,the DI system demonstrates dependability and stability under 305 s long-pulse discharges in shot No.122054.展开更多
Huang Di Nei Jing(《黄帝内经》The Yellow Emperor’s Inner Classic) has been the source text of Chinese medicine knowledge and innovation for over two thousand years. Despite this key relevance, many of its ideas and p...Huang Di Nei Jing(《黄帝内经》The Yellow Emperor’s Inner Classic) has been the source text of Chinese medicine knowledge and innovation for over two thousand years. Despite this key relevance, many of its ideas and practices have proven difficult to understand and implement fully into clinical practice. Cultural and language differences can be compounded with these challenges but may also present new opportunities for advancement and insight when studied by researchers outside of the originating culture. This article introduces the method of Classical-Text Archaeology and delves into the author’s two-decade journey of researching this text, with a discussion on cultural differences and issues of medical scholarship.展开更多
China Through My Camera programme provides Namibian influencer a chance to get a multidimensional view of the country.After graduating in Beijing in 2020 during the tumultuous period of COVID-19,I didn’t think that I...China Through My Camera programme provides Namibian influencer a chance to get a multidimensional view of the country.After graduating in Beijing in 2020 during the tumultuous period of COVID-19,I didn’t think that I would be able to return to China anytime soon.The pandemic had disrupted lives globally,and like many international students,I was not sure if I would be able to ever set foot in China again.Travel restrictions were stringent,and the idea of returning seemed like a distant dream.展开更多
文摘BACKGROUND Drug-eluting stents(DES)are used to treat lower extremity arterial disease.During DES treatment,aneurysmal degeneration occasionally occurs,especially with fluoropolymer-based DES.However,the incidence of pseudoaneurysms after DES placement is rarely reported in the lower extremity region,although there have been several reports on pseudoaneurysm formation after DES placement in the coronary artery region.CASE SUMMARY We report the case of a 64-year-old man who presented with fever and pain in his left hand after dialysis.Bacteremia was diagnosed by blood culture,and after admission,he developed pain on the medial side of the right thigh.A pseudoaneurysm was observed in the right superficial femoral artery(SFA)at the proximal end of a previously placed DES.The bacteremia was thought to have been caused by a pseudoaneurysm of the left superficial brachial artery,and the pseudoaneurysm of the left superficial brachial artery was removed after antibiotic treatment.The pseudoaneurysm of the right SFA rapidly expanded after admission,but the expansion rate was reduced after infection control.Seven months after the first admission,the pseudoaneurysm of the left SFA was re-moved and in situ revascularization performed using a rifampicin-soaked Dacron graft.CONCLUSION Although pseudoaneurysm after DES placement in the lower extremity region is rare,it must be considered in patients with bacteremia.
文摘目的对1例高频抗体导致的胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)进行检测、鉴定及配血。方法对患儿进行新生儿溶血试验,对母亲进行血清学意外抗体鉴定,并对母亲红细胞进行常见高频抗原鉴定;对检出抗体进行IgG分型检测,并用流式细胞术进行单核细胞体外吞噬致敏红细胞试验,以检测抗体相关的吞噬率;对患儿母亲、父亲及舅舅进行相关红细胞血型基因测序;利用稀释的母亲血浆和抗人球卡法,在献血者中进行大规模相合血液的筛选。结果产妇鉴定为Di(b-)稀有血型,产生了抗-Di b(效价512)并导致了严重的HDFN;抗-Di b亚型分型为IgG1和IgG2型,单核细胞体外吞噬效率为88.83%(74.7/84.09);产妇亲属中没有相合献血者,后续从5520名献血者中筛选到2例Di(b-)相合血液,患儿接收输血治疗后康复出院。后续在51334名献血者中筛查到17名Di(b-)献血者,该数据表明Di(b-)在广州地区献血者中的分布频率约为三千分之一(0.033%,17/51334)。结论综合利用血型血清学及分子生物学方法诊断了抗-Di b所致的严重HDFN,建立了1种有效大规模筛查Di(b-)稀有血型的方法并找到相合血液,为建立Di(b-)稀有血型库奠定了基础。
文摘Background: Sickle cell disease is one of the most common monogenic diseases in the world, affecting approximately 70 million people, 80% in sub-Saharan Africa and 1 in 10 in Senegal. Sickle cell anemia causes functional asplenia (associated with repeated thrombosis of splenic vessels), resulting in increased susceptibility to infection. However, several studies have reported differences in the spectrum of bacterial infections in malaria-endemic areas. Therefore, we proposed to conduct a study to determine the rate of positive blood cultures and the bacteriological spectrum in sickle cell patients. Materials and Method: This is a descriptive cross-sectional study of blood culture samples from patients who received a request for hemoglobin electrophoresis as part of their treatment at the Principal’s hospital in Dakar. The study took place from January 2008 to December 2021. For each patient, we collect demographic information, including age, gender, and the service from which the analysis request originated. Data were collected in the laboratory’s computer system and entered into Microsoft Excel (2007). Statistical analyzes were performed using Epi-Info 7 software. Results: Our study included 1419 patients. The most common types of hemoglobin profiles were: normal profile (n = 1025), AS profile (n = 283), SS profile (n = 104), SC profile (n = 7). This corresponds to the proportions of 72%, 20%, 0.5% and 7.5% for the profiles Normal, AS, SC and SS. The male proportion was 61.1%, 61.5%, 57.1, respectively %, 55.8% for Normal, SA, SC, and SS profiles. A total of 19,090 individual blood culture bottles were collected from 1419 impatient patients as follows: Normal profile (n = 18,042 bottles), AS profile (n = 677 culture bottles), SS profile (n = 362 bottles). The majority of blood culture orders come from pediatric services, accounting for 70% of the total number of orders. Of 19,090 vials examined in this current study, 19.6% developed a positive blood culture. Overall, the most commonly isolated bacteria were Staphylococci (41.1%), Enterobacteriaceae (36.7%), Bacillaceae (10.2%), unfermented (6.30%), Streptococci (5.01%), and a small proportion of yeast (0.75%). There is no significant difference in bacterial spectrum between the SS profile and the normal profile of individuals (p = 0.104). Coagulase-negative staphylococci accounted for 32%, 24%, and 40% of the species isolated in the normal AS and SS profiles. respectively. Coagulase-negative staphylococci were the most commonly isolated organisms in SS. Group E and sptagged streptococci each account for less than 2% of the organisms isolated in SS. Pneumococci were not found. Bacillus accounts for 25% of isolates in SS subjects compared to 9% in normal and AS subjects, respectively. Pseudomonas aeruginosa and Burkholderia cepacia then make up 10% of the isolates in the subjects of the SS profile as non-fermenters. Conclusion: Our study shows that enterobacteria and staph are prevalent in people with sickle cell disease. There is no significant difference in bacterial spectrum between SS subjects compared to subjects with a normal profile. The rarity of Streptococcus pneumoniae in bacteremia isolates underlines the need for further studies with larger patient numbers to better understand the spectrum of bacterial infections in patients with sickle cell disease in West Africa.
基金Supported by Guizhou Provincial Health Commission Science and Technology Department,No.GZWKJ2023-009Guizhou Science and Technology Department,No.QIANKEHEZHICHEN[2022]YIBAN179Guizhou Science and Technology Department,No.QIANKEHEZHICHEN[2022]YIBAN087.
文摘BACKGROUND Severe infection often results in bacteremia,which significantly increases mortality rate.Different therapeutic strategies are employed depending on whether the blood-borne infection is Gram-negative(G-)or Gram-positive(G+).However,there is no risk prediction model for assessing whether bacteremia patients are infected with G-or G+pathogens.AIM To establish a clinical prediction model to distinguish G-from G+infection.METHODS A total of 130 patients with positive blood culture admitted to a single intensive care unit were recruited,and Th1 and Th2 cytokine concentrations,routine blood test results,procalcitonin and C-reactive protein concentrations,liver and kidney function test results and coagulation function were compared between G+and Ggroups.Least absolute shrinkage and selection operator(LASSO)regression analysis was employed to optimize the selection of predictive variables by running cyclic coordinate descent and K-fold cross-validation(K=10).The predictive variables selected by LASSO regression analysis were then included in multivariate logistic regression analysis to establish a prediction model.A nomogram was also constructed based on the prediction model.Calibration chart,receiver operating characteristic curve and decision curve analysis were adopted for validating the prediction model.RESULTS Age,plasma interleukin 6(IL-6)concentration and plasma aspartate aminotransferase concentration were identified from 57 measured variables as potential factors distinguishing G+from G-infection by LASSO regression analysis.Inclusion of these three variables in a multivariate logistic regression model identified age and IL-6 as significant predictors.In receiver operating characteristic curve analysis,age and IL-6 yielded an area under the curve of 0.761 and distinguished G+from G-infection with specificity of 0.756 and sensitivity of 0.692.Serum IL-6 and IL-10 levels were upregulated by more than 10-fold from baseline in the G-bacteremia group but by less than ten-fold in the G+bacteremia group.The calibration curve of the model and Hosmer-Lemeshow test indicated good model fit(P>0.05).When the decision curve analysis curve indicated a risk threshold probability between 0%and 68%,a nomogram could be applied in clinical settings.CONCLUSION A simple prediction model distinguishing G-from G+bacteremia can be constructed based on reciprocal association with age and IL-6 level.
文摘BACKGROUND Achromobacter xylosoxidans is a Gram-negative opportunistic aerobe,usually causing nosocomial infections in immunocompromised patients with manifestations including bacteremia,pneumonia,and catheter-related infections.However,A.xylosoxidans have not yet been reported to cause biliary system infections.CASE SUMMARY A 72-year-old woman presented to the outpatient department of our hospital with a chief complaint of jaundice.Computed tomography of her abdomen revealed the presence of a mass of approximately 2.4 cm in the hilar portion of the common hepatic duct,consistent with hilar cholangiocarcinoma.We performed endoscopic retrograde cholangiopancreatography(ERCP)to decompress the obstructed left and right intrahepatic ducts(IHDs)and placed 10 cm and 11 cm biliary stents in the left and right IHDs,respectively.However,the day after the procedure,the patient developed post-ERCP cholangitis as the length of the right IHD stent was insufficient for proper bile drainage.The blood culture of the patient tested positive for A.xylosoxidans.Management measures included the replacement of the right IHD stent(11 cm)with a longer one(12 cm)and administering culturedirected antibiotic therapy,solving the cholangitis-related complications.After the cholangitis had resolved,the patient underwent surgery for hilar cholangiocarcinoma and survived for 912 d without recurrence.CONCLUSION A.xylosoxidans-induced biliary system infections are extremely rare.Clinical awareness of physicians and endoscopists is required as this rare pathogen might cause infection after endoscopic procedures.
基金supported by the Comprehensive Research Facility for Fusion Technology Program of China(No.2018-000052-7301-001228)the Major Special Science and Technology Project of Anhui Province(No.912188707023)。
文摘A dispersion interferometer(DI)has been installed and operates on the Experimental Advanced Superconducting Tokamak(EAST).This DI system utilizes a continuous-wave 9.3μm CO_(2)laser source to measure line-averaged electron densities accurately.In contrast to conventional interferometers,the DI does not require substantial vibration isolations or compensating systems to reduce the impact of vibrations in the optical path.It also employs a ratio of modulation amplitudes,ensuring it remains immune to the variations in detected intensities.Without a variation compensation system,the DI system on EAST reaches a density resolution of less than1.8×10^(-2)πrad and a temporal resolution of 20μs.The measurements made by the POlarimeterINTerferometer(POINT)system and the far-infrared hydrogen cyanide(HCN)interferometer are remarkably consistent with the DI’s results.The possibility of fringe jumps and the impact of refraction in high-density discharge can be significantly decreased using a shorter wavelength laser source.A rapid density change of 3×10^(19)m^(-3)during 0.15 s has been measured accurately in shot No.114755 of EAST.Additionally,the DI system demonstrates dependability and stability under 305 s long-pulse discharges in shot No.122054.
文摘Huang Di Nei Jing(《黄帝内经》The Yellow Emperor’s Inner Classic) has been the source text of Chinese medicine knowledge and innovation for over two thousand years. Despite this key relevance, many of its ideas and practices have proven difficult to understand and implement fully into clinical practice. Cultural and language differences can be compounded with these challenges but may also present new opportunities for advancement and insight when studied by researchers outside of the originating culture. This article introduces the method of Classical-Text Archaeology and delves into the author’s two-decade journey of researching this text, with a discussion on cultural differences and issues of medical scholarship.
文摘China Through My Camera programme provides Namibian influencer a chance to get a multidimensional view of the country.After graduating in Beijing in 2020 during the tumultuous period of COVID-19,I didn’t think that I would be able to return to China anytime soon.The pandemic had disrupted lives globally,and like many international students,I was not sure if I would be able to ever set foot in China again.Travel restrictions were stringent,and the idea of returning seemed like a distant dream.
