ObjectiveTo understand the role of metformin on reducing incidence of type 2 diabetes mellitus (T2MD) patients complicated with liver cancer. MethodThe related literatures of metformin treated patients with T2MD complicated with liver cancer at home and abroad in recent years were reviewed. ResultsA large number of epidemiological and clinical data showed that the metformin might prevent the occurrence of the T2MD patients complicated with liver cancer, its mechanism was mainly inhibited the proliferation of hepatoma cells through the ATM-LKB1-AMPK-mTOR pathway, PI3K/Akt/mTOR pathway, or miRNA. The current controversy was the authenticity of the data, the influencing factors included the aging problem and characteristics of metformin user. The prospective study design rigorous remained to be clarified. ConclusionMetformin could reduce the incidence of T2MD patients complicated with liver cancer, and could inhibit the growth of liver cancer cells, which provides a new way of thinking for the comprehensive treatment of liver cancer.
ObjectiveTo investigate the effect of non-heated silver needle decompression under the guidance of pathogenic principle of muscle shortening on patients with cervical vertebra disease of the nerve root type. MethodsSixty patients diagnosed with cervical vertebra disease of the nerve root type between April 2007 and June 2009 were divided randomly into therapy group (n=30), treated with non-heated silver needle decompression, and control group (n=30), treated with physical therapy. Then, we observed the total effective rate, positive physical signs and electrophysiological indexes of the patients 3, 6, 12, and 24 months after treatment. ResultsThe total effective rate was 96.7%, 93.3%, 93.3% and 86.7% in the therapy group 3, 6, 12, and 24 months after treatment, while it was 80.0%, 63.3%, 60.0%, and 50.0% in the control group, and the diTherence between the two groups in each time point was significant (P<0.05). The rate of positive sign in the top pressure test and Brachial plexus traction test lowered significantly 3, 6, and 12 months after treatment in both the two groups (P<0.05), while the rate lowered significantly only in the therapy group 2 years after treatment (P<0.05). Paraspinal tenderness lowered significantly at each time point in the therapy group after treatment (P<0.05), while the decrease in the control group had no significance (P<0.05). The interpeak latency of somatosensory evoked potential N9-N13 got significantly shorter at each time point after treatment in the therapy group (P<0.05), while this only happened at the time points of 3 and 6 months after treatment in the control group (P<0.05). The latency of wave F got significantly shorter at each time point after treatment in the therapy group (P<0.05), while the shortening only occurred 6 months after treatment in the control group (P<0.05). ConclusionNon-heated silver needle decompression under the guidance of pathogenic principle of muscle shortening is an effective treatment for patients with cervical vertebra disease of the nerve root type.
Objective To analyze the distribution of pathogens, drug susceptibility and multi-drug resistant bacteria (MDRB) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pneumonia. Methods The clinical data of patients whose discharge diagnosis included AECOPD with pneumonia or pulmonary infection from January 2012 to December 2015 were retrospectively analyzed. Strain identification and drug sensitivity analysis were performed in the pathogenic bacterias isolated from sputum culture. Results A total of 1 978 patients were enrolled in this study, and pathogenic bacterias were isolated from the sputum of 708 patients, including 485 cases of community-acquired pneumonia (CAP) and 223 cases of hospital-acquired pneumonia (HAP); and 786 strains of pathogens were isolated (501 strains from CAP cases, 285 strains from HAP cases), including 448 strains of Gram-negative (G–) bacilli (57.0%), 117 strains of Gram-positive (G+) cocci (14.9%), and 221 strains of fungi (28.1%). Susceptibility testing results showed that G– bacilli were highly resistant to penicillins, third generation cephalosporins, ciprofloxacin, gentamicin, etc., and G+ cocci were highly resistant to penicillin, clindamycin and erythromycin. There were 238 strains of MDRB, mainly including 69 strains of Acinetobacter baumanii [multiple drug resistance rate (MDRR)=67.6%], 27 strains of Escherichia coli (MDRR=52.9%), 25 strains of Klebsiella pneumoniae (MDRR=34.2%), 33 strains of Pseudomonas aeruginosa (MDRR=33.0%) and 24 strains of Stenotrophomonas maltophilia (MDRR=100.0%). MDRR of Enterococcus genus and methicillin-resistant Staphylococcus aureus was 50.0% and 48.0%, respectively. Conclusions The pathogenic bacterias in elderly AECOPD patients complicated with pneumonia are mainly G– bacterias, and the proportion of fungal infection tends to increase. Bacterial drug resistance is serious and the MDRB tends to increase, especially in patients with HAP. Physicians should early find out the characteristics of local pathogenic bacteria and drug sensitivity, rationally select antibiotics, reduce the occurrence of drug-resistant strains and superinfection when treating the elderly patients with AECOPD complicated with pneumonia.
Objective To explore the difference between bone marrow edema syndrome (BMES) and avascular necrosis of femoral head (ANFH). Methods Recent original articles about BMES and ANFH were extensively reviewed, and were comprehensively analysed. Results The pathology, pathogenesis, clinical features, treatment selection, and prognosis are different between these two diseases. Conclusion BMES and ANFH are two different diseases. Micro-fracture may be the cause of bone marrow edema.
Objective Glucocorticoid is the main cause of non-traumatic avascular necrosis of femoral head. To explore the changes of reactive oxygen species (ROS) in the bone microvascular endothel ial cells treated with glucocorticoid so as to investigate the pathogenesis of steroid-induced avascular necrosis of femoral head. Methods The cancellous bone of femoral head was harvested from voluntary donators undergoing total hip arthroplasty, and then the bone microvascular endothel ial cells were isolated by enzyme digestion. The cells at passage 3 were cocultured with different concentrations of hydrocortisone (0, 0.03, 0.10, 0.30, and 1.00 mg/mL) for 24 hours. MTT assay was used for the inhibitory rate of cell prol iferation, flow cytometry for apoptosis rate, and fluorescence probe for the production of ROS and xanthine oxidase (XOD). Results At 2-3 days primary culture, the cells were spindle and arranged l ike cobbles and they reached confluence after 1 week. The inhibitory rates of cell prol iferation in 0.03, 0.10, 0.30, and 1.00 mg/mL groups were 20.22% ± 2.97%, 22.94% ± 4.52%, 43.98% ± 3.35%, and 78.29% ± 3.85%, respectively; and 2 high-concentration groups (0.30 and 1.00 mg/mL groups) were significantly higher (P lt; 0.05) than 2 low-concentration groups (0.03 and 0.10 mg/mL groups). The apoptosis rates in 0, 0.03, 0.10, 0.30, and 1.00 mg/mL groups were 0.10% ± 0.01%, 0.23% ± 0.02%, 1.83% ± 0.04%, 6.34% ± 0.11%, and 15.33% ± 0.53%, respectively; 2 high-concentration groups (0.30 and 1.00 mg/mL groups) were significantly higher (P lt; 0.05) than 0 mg/mL group. In 0, 0.30, and 1.00 mg/ mL groups, the ROS levels were 57.35 ± 7.11, 120.47 ± 15.68, and 166.15 ± 11.57, respectively, and the XOD levels were 0.017 9 ± 0.000 9, 0.028 3 ± 0.001 7, and 0.067 7 ± 0.004 1, respectively; there were significant differences in the levels of ROS and XOD among 3 groups (P lt; 0.05). Conclusion Increasing of ROS production in bone microvascular endothel ial cells can be induced by high concentration glucocorticoid, and it can result in cell injury
ObjectiveTo explore the distribution and rule of pathogen strains in the third quarter and fourth quarter of 2012, and to provide the basis for clinical medication. MethodsTo retrospectively analyze the bacterial culture and drug susceptibility test results in the third quarter and the fourth quarter of 2012. ResultsThere were isolated 932 plants in the third quarter, and 915 plants isolated in the fourth quarter. Heavy drug resistance rates of detection of Pseudomonas aeruginosa decrease slightly. There was more multiple drug resistance of A. baumanii, Escherichia coli, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus in the fourth quarter than in the third one. ConclusionThe resistant strain increases in the fourth quarter. We should attach importance to the clinical examination, bacterial drug resistance monitoring, and rational use of antimicrobial agents.
ObjectiveTo analyze the clinical characteristics and pathogenesis in patients with chronic obstructive pulmonary disease (COPD) with ventilator-associated pneumonia (VAP). MethodsNinety-two patients with VAP who underwent mechanical ventilation via tracheal incubation due to COPD and respiratory failure were recruited in the study.The clinical characteristics,bacterial culture and antibiotics sensitivity of specimen from tracheal secretion and bronchoalveolar lavage fluid were retrospectively analyzed. ResultsThe main pathogenic bacteria in the patients with COPD with VAP were as following,ie. Ainetobacter baumanii(24.1%),Pseudomonas aeruginosa (17.6%),Klebsiella spp (15.9%),Methicillin-resistant Staphylococcus aureus(14.7%),and Escherichia coli(10.6%) in which Gram negative bacteria were predominant. When compared with the patients who received antibiotics before mechanical ventilation,the mortality in the patients who did not receive antibiotics before mechanical ventilation was significantly lower (17.9% vs. 40.6%,P<0.01). The patients who received de-escalation antibiotics therapy had lower mortality than those who received escalation antibiotics therapy(19.3% vs. 57.1%,P<0.01). There was no significant difference in mortality between the patients who suffered from VAP less or more than 4 days after mechanical ventilation (54.8% vs. 45.2%,P>0.05). ConclusionsHigh drug resistant rate is observed in patients with COPD and VAP especially in those patients who using antibiotic before mechanical ventilation. De-escalation antibiotics therapy can lower the mortality. The mortality rate is not significant different between early-onset and late-onset VAP in patients with COPD.
Bacterial biofilm is the key problem of chronic wound infection and difficult healing. How to prevent and control bacterial biofilm and improve the prognosis of chronic wound has become a research hotspot in the field of wound care. This paper will summarize from the following aspects: four major stages in the process of chronic wound bacteria biofilm formation (surface adhesion, formation of small colonies, biofilm maturation, and dispersion and separation); characteristics of host immune response in the presence of biofilms; morphological, microbiological, and molecular detection methods for biofilms; and progress in in vitro trials, animal trials, clinical trials, and new therapeutic methods of biofilm. The purpose of this review is to provide evidence for the treatment of biofilms for chronic wounds.
【Abstract】ObjectiveTo review the research advance of intestinal barrier changes and its pathogenesis in stress conditions.MethodsThe literatures in recent years on the changes of the intestinal barrier,and its pathogenesis in stress conditions were reviewed.Results In some severe stress conditions, such as trauma, severe inflammation and acute severe pancreatitis, etc, a series of pathophysiologic disorders of intestinal barrier， even systemic inflammatory response syndrome and multiple organ dysfunction syndrome or multiple organ failure were induced. The pathogenesis was a result of a series of neurologic, immunologic and endocrine factors making one another. ConclusionRecognizing the changes and pathogenesis have an important clinical significance for treating and preventing the intestinal barrier dysfunction induced by stress.
Objective To study the distribution and drug resistance of pathogens causing hospital-acquired pneumonia (HAP) and explore the related risk factors, so as to provide valuable clinical reference for prevention and treatment of HAP. Methods A case-control study was conducted in a 3700-bed tertiary hospital. Nosocomial infections reported from January 2014 to December 2014 were investigated. A total of 419 inpatients with HAP were enrolled in as a study group, and 419 inpatients without nosocomial infection in the same period and department, with same gender, underlying diseases, and same age, were chosen as a control group. Risk factors of HAP, distribution and drug resistance of pathogens of HAP were analyzed. Results The incidence rate of HAP was 0.62% and the mortality rate was 19.81%. Multivariate analysis identified chronic lung diseases, admission in ICU, two or more kinds of antibiotics used, hospitalization time≥5 days, cerebrovascular disease, and mechanical ventilation were significant risk factors. Totally 492 strains of pathogens were isolated, including 319 strains of gram-negative bacteria, 61 strains of gram-positive bacteria, 112 strains of fungi.Acinetobacter baumannii,Klebsiella pneumonia,Candida albicans,Pseudomonas aeruginosa,Candida glabrata ranked the top five predominant pathogens. Drug resistance rates ofAcinetobacter baumannii to commonly used antibiotics were higher than 75%. Drug resistance rates ofKlebsiella pneumoniae to piperacillin and third-generation cephalosporin were higher than 50%. Conclusions HAP prevails in patients with hospitalization time≥5 days, admission in ICU, cerebrovascular diseases, two or more antibiotics combined used, chronic lung diseases, and mechanicalventilation. It is associated with increased length of hospital stay, decreased quality of life, and elevated morbidity and mortality. The main pathogens of HAP are Gram-negatives.Acinetobacter baumannii andKlebsiella pneumoniae are resistant to the common antibiotics in different degree.