Objective To describe the disease characteristics of osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE) who experiencing prolonged glucocorticoid (GC) exposure. Methods Between January 2016 and June 2019, 449 SLE patients meeting the criteria were recruited from multiple centers. Hip MRI examinations were performed during screening and regular follow-up to determine the occurrence of ONFH. The cohort was divided into ONFH and non-ONFH groups, and the differences in demographic baseline characteristics, general clinical characteristics, GC medication information, combined medication, and hip clinical features were compared and comprehensively described. ResultsThe age at SLE diagnosis was 29.8 (23.2, 40.9) years, with 93.1% (418 cases) being female. The duration of GC exposure was 5.3 (2.0, 10.5) years, and the cumulative incidence of SLE-ONFH was 9.1%. Significant differences (P<0.05) between ONFH and non-ONFH groups were observed in the following clinical characteristics: ① Demographic baseline characteristics: ONFH group had a higher proportion of patients with body mass index (BMI)<20 kg/m2 compared to non-ONFH group. ② General clinical characteristics: ONFH group showed a higher proportion of patients with cutaneous and renal manifestations, positive antiphospholipid antibodies (aPLs) and anticardiolipin antibodies, severe SLE patients [baseline SLE Disease Activity Index 2000 (SLEDAI-2K) score ≥15], and secondary hypertension. Fasting blood glucose in ONFH group was also higher. ③ GC medication information: ONFH group had higher initial intravenous GC exposure rates, duration, cumulative doses, higher cumulative GC doses in the first month and the first 3 months, higher average daily doses in the first 3 months, and higher proportions of average daily doses ≥15.0 mg/d and ≥30.0 mg/d, as well as higher full-course average daily doses and proportion of full-course daily doses ≥30.0 mg/d compared to non-ONFH group. ④ Combined medications: ONFH group had a significantly higher rate of antiplatelet drug use than non-ONFH group. ⑤ Hip clinical features: ONFH group had a higher proportion of hip discomfort or pain and a higher incidence of hip joint effusion before MRI screening than non-ONFH group. Conclusion The incidence of ONFH after GC exposure in China’s SLE population remains high (9.1%), with short-term (first 3 months), medium-to-high dose (average daily dose ≥15 mg/d) GC being closely associated with ONFH. Severe SLE, low BMI, certain clinical phenotypes, positive aPLs, and secondary hypertension may also be related to ONFH.
Objective To investigate the clinical characteristics and drug resistance changes of nosocomial infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) in different types of clinical departments, and to provide evidence for prevention and control of CRKP infection. Methods The hospital infection real-time monitoring system was used to retrospectively collect the inpatients with CRKP nosocomial infection in the First People’s Hospital of Lianyungang from January 2019 to December 2023 as the research objects. According to the different sources of departments, they were divided into intensive care unit (ICU) group, internal medicine group and surgery group. The changes of clinical characteristics and drug resistance to common antibiotics were analyzed. Results A total of 636188 inpatients were monitored, and 225 cases were infected with CRKP, with an overall infection detection rate of 0.035%. The detection rates of CRKP infection in the ICU group, internal medicine group, and surgery group were 0.736% (138/18749), 0.013% (44/336777), and 0.015% (43/280662), respectively, with the ICU group demonstrating a significantly higher rate than the other groups (P<0.05). The detection rates fluctuated in the early stage and then decreased rapidly in different years. The main infection site of CRKP in all groups was lower respiratory tract, but the proportion of device-related infections in the ICU group was higher than that in the internal medicine and surgery groups (P<0.05). In terms of the infected population, there was no significant difference in gender among groups (P>0.05) with the proportion of males more than 60%, while the difference in the proportion of patients aged ≥65 years among groups was statistically significant (P<0.05), with the highest in the internal medicine group (86.36%). The burden of underlying diseases and invasive operation exposure of the infected patients were high, and the proportion of cardiovascular and cerebrovascular diseases and indwelling catheters were as high as 69.33% and 83.56%, respectively. The differences in the proportions of cardiovascular and cerebrovascular diseases, diabetes mellitus, ≥3 underlying diseases, and surgical and invasive procedures among groups were statistically significant (P<0.05). The distribution of infection specimens in each group showed no statistically significant difference (P>0.05), with sputum, blood, and mid-stream urine specimens being the main detected specimens in all groups. The resistance rates of CRKP to penicillins and cephalosporins were more than 93%, and the resistance rates to aminoglycosides and sulfonamides were relatively low and showed a decline year by year. The resistance rate to ceftazidime/avibactam was only 7.41%, but the resistance rate to tigecycline increased. The difference in resistance rate of CRKP to co-trimoxazole among groups was statistically significant (P<0.05), while the differences in resistance to other antimicrobial agents were not statistically significant (P>0.05). Conclusions The detection rate, clinical characteristics and drug resistance of CRKP infection in different types of departments of medical institutions are different and changing. It is necessary to strengthen the rational use of antibiotics and the prevention and control of nosocomial infection.
Objective To explore the clinical characteristics of Crohn’s disease (CD) with perianal fistula by analyzing the clinical data of them. Methods A total of 139 cases of CD with perianal fistula who got treatment from January 2010 to January 2017 in The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine were analyzed retrospectively. Results The proportion of males and females in 139 patients was about 3.3∶1.0, the age was (28±8) years, and 47.5% of patients had perianal fistula before CD diagnosis. The percents of patients with perianal surgery history and medication history were 64.7% and 74.1%, respectively. The ratio of L3 type (diseased position) was 49.6%. The ratios of inflammatory type (B1 type) and stenotic type (B2 type) of the disease were 51.8% and 41.0%, respectively. The complex perianal fistula accounted for 90.6%, and 31.7% of patients combined analrectal stricture. Symptoms of diarrhea were found in 46.0% of patients and perianal lesions alone in 29.5% of patients; 54.0% of patients combined with abnormal BMI; 64.7% of patients were in the active stage of Crohn’s disease activity index (CDAI) and 94.2 % of patients were in the active period of perianal disease activity index (PDAI). The patients with erythrocyte sedimentation rate (ESR) higher than normal were 53.2%. The results of logistic showed that, age and degree of CDAI were influencing factors for CD with stenosis of perianal fistula. Conclusions Characteristics of patients with CD combined with perianal fistula include: young, men predominant, high prevalence of ileocolic position involvement, as well as inflammation and stenosis disease behavior. Fistula symptoms often preced the intestinal symptoms and diarrhea is the most common intestinal performance. History of perianal abscess and fistula operation are common. The anorectal stricture are complicated usually. Intestinal inflammation is active. Some patients show abnormal laboratory indicators of inflammation. This suggests that patients with perianal fistula with these clinical features should be alert to the possibility of CD, so as toavoid the consequences of blind surgery. The higher CDAI score and the older the diagnosis age, the higher the risk ofrectal stenosis.
ObjectiveTo investigate the clinical characteristics and prognosis of resectable esophageal small cell carcinoma after surgical resection.MethodsA retrospective study of patients with resectable esophageal small cell carcinoma undergoing surgical resection from January 2009 to June 2015 in the Department of Thoracic Surgery, Sichuan Provincial Fourth People's Hospital and Department of Thoracic Surgery, West China Hospital of Sichuan University was performed. Survival analysis was conducted by Kaplan-Meier analysis and log-rank test. Cox regression model was used for identifying independent prognostic factors.ResultsA total of 53 patients with resectable esophageal small cell carcinoma were included for analysis. The mean age was 58.4 ± 8.3 years and there were 42 male patients and 11 female patients. Forty-two patients were diagnosed as pure esophageal small cell carcinoma while 11 patients were diagnosed with mixed esophageal small cell carcinoma, who were all mixed with squamous cell carcinoma. Most of the esophageal small cell carcinomas were located in the middle (58.5%) and lower (32.1%) segments of the esophagus. Thirty patients (56.6%) were found to have lymph node metastasis, and 7 patients (13.2%) were found to have lymphovascular invasion. According to the 2009 TNM staging criteria for esophageal squamous cell carcinoma, there were 12 patients with stage Ⅰ disease, 19 patients with stage Ⅱ disease, and 22 patients with stage Ⅲ disease. Most of the patients underwent left thoracotomy with two-field lymphadenectomy. Postoperatively, only twenty-two patients (41.5%) received adjuvant chemoradiotherapy. The median survival time of these patients was 20.1 months, and the 1- and 3-year survival rate was 75.5% and 33.1%, respectively. For prognosis, age, gender, pathological type, tumor location, and lymphovascular invasion had no significant impact on long-term survival of these patients. However, TNM stage (1 year survival rate: stage Ⅰ: 91.7%; stage Ⅱ: 78.9%; stage Ⅲ: 63.6%; P=0.004) and postoperative adjuvant therapy (1 year survival rate: 81.8% vs. 71.0%; P=0.005) had significant impact on the survival of patients with esophageal small cell carcinoma. In multivariate analysis, TNM stage and postoperative adjuvant therapy were independent prognostic factors for long-term prognosis of patients with esophageal small cell carcinoma.ConclusionEsophageal small cell carcinoma is very rare, with high malignancy and poor prognosis. For patients with resectable esophageal small cell carcinoma, the TNM staging system of esophageal squamous cell carcinoma can be used to direct the choice of treatment options. For early stage esophageal small cell carcinoma (stage Ⅰ/Ⅱ), surgery plus postoperative adjuvant chemoradiotherapy can be the prior therapeutic choice, while for locally advanced esophageal small cell carcinoma (stage Ⅲ), chemoradiotherapy should be the preferred treatment.
Objective To analyze the clinical characteristics of antimitochondrial antibody (AMA)-associated cardiac injury. Methods AMA positive patients admitted to West China Hospital of Sichuan University between June 2008 and November 2023 were retrospectively selected. They were categorized into the simple cardiac involvement group and the cardiac and skeletal muscle involvement group according to the presence of skeletal muscle injury. Differences in demographic characteristics, serologic indices, cardiac structure and function, and arrhythmias were compared between the two groups. Results A total of 55 AMA-M2 positive patients with myocardial injury were enrolled. There were 18 cases in the simple cardiac involvement group and 37 cases in the cardiac and skeletal muscle involvement group among them. The age (P=0.002) and mortality rate (P=0.031) of the simple cardiac involvement group were higher than those of the cardiac and skeletal muscle involvement group. There were significant differences in biochemical indicators such as lactate dehydrogenase and α-hydroxybutyrate dehydrogenase between the two groups, and the levels of myocardial enzymes such as creatine kinase isoenzyme, myoglobin and troponin T in the cardiac involvement group were lower than those in the cardiac with skeletal muscle involvement group (P<0.05). Meanwhile, there were significant differences in the incidence of atrial premature beats, atrial fibrillation and other arrhythmias between the two groups (P<0.05). In terms of treatment modalities, glucocorticoids and immunosuppressants were used more frequently in the cardiac combined skeletal muscle involvement group than in the cardiac involvement alone group, whereas β-blockers and diuretics were more prevalent in the cardiac involvement alone group (P<0.05). Conclusion Patients with cardiac involvement alone may have a more insidious or rapid progression of the disease, which requires clinicians to pay higher attention to and provide timely and effective treatment, thus improving the overall prognosis and quality of life of the patients.
Objective To explore the clinical features, treatment methods and prognostic factors of primary appendiceal tumors. Methods The clinicopathologic data of 82 patients with primary appendiceal tumor who met the inclusion and exclusion criteria and were treated in the Affiliated Hospital of Southwest Medical University from January 2013 to November 2022 were retrospectively collected, and the clinicopathologic characteristics of the patients were summarized. Log-rank and Cox proportional hazard regression models were further used for univariate and multivariate survival analysis for patients without other malignant tumors. Results Among the 82 patients with primary appendiceal tumor, 9 cases (11.0%) were complicated with other malignant tumors. Low-grade mucinous tumors were the most common (51.2%, 42/82), 25 cases were complicated with appendicitis and 12 cases were complicated with intestinal obstruction. Common clinical manifestations included abdominal pain, changes in bowel habits, abdominal distension, vomiting, nausea, etc. Among the patients without other malignancies, 69 patients were followed up for a median of 32 months (4–106 months), 18 of whom died. The 1-year, 2-year, 3-year and 5-year cumulative survival rates were 91.1%, 87.5%, 80.5% and 60.7%, respectively. Multivariate Cox proportional hazard regression analysis showed that platelet-to-lymphocyte ratio (P=0.004), anemia (P=0.015), tumor metastasis (P=0.007) and diabetes mellitus (P=0.011) were prognostic factors. Among them, patients with platelet-to-lymphocyte ratio >190.1, anemia, tumor metastasis and diabetes mellitus had poor prognosis. Conclusions The main pathological type of primary appendiceal tumors is low grade mucinous tumors. It lacks characteristic clinical manifestations, with abdominal pain and changes in bowel habits as the main manifestations, and can be accompanied by appendicitis and intestinal obstruction. There is no unified standard for treatment. For patients characterized by prognostic risk factors including platelet-to-lymphocyte ratio >190.1, anemia, tumor metastasis and diabetes, further monitoring and intervention are required.
Objective To investigate the epidemiological and clinical characteristics of patients with thoracolumbar osteoporotic vertebral compression fracture (OVCF) treated by percutaneous vertebroplasty (PVP). MethodsThe clinical and imaging data of 681 patients with thoracolumbar OVCF treated with PVP between January 2017 and December 2021 were collected. The epidemiological and clinical characteristics of the patients with thoracolumbar OVCF in single center were summarized from the aspects of demographic distribution (mainly including gender, age), fracture characteristic analysis [including pathological segments, bone mineral density, and body mass index (BMI)], and operation related results (including the distribution of unilateral and bilateral puncture and bone cement injection, postoperative effectiveness analysis and refracture). ResultsOf the 681 patients, 134 (19.68%) were male and 547 (80.32%) were female, with a male-to-female ratio of 1∶4.08. The age ranged from 53 to 105 years, with an average of 75.3 years. The age group of 60-90 years old had the largest number of patients (91.04%); the high incidence age group of men was 70-90 years old (13.95%), and that of women was 60-80 years old (72.98%). A total of 836 vertebrae were involved, and the morbidity of thoracolumbar vertebrae (T11-L1) was the highest (56.34%, 471/836). The main type of fracture was compression fracture (92.58%, 774/836) and Kümmell disease (7.42%, 62/836). There were 489 cases (71.81%) of osteoporosis, including 66 males and 423 females, with a male-to-female ratio of 1∶6.42. There was significant difference in distribution of bone mineral density between male and female groups (Z=–5.810, P<0.001). BMI showed 206 cases (30.25%) of underweight, 347 (50.95%) cases of normal, 58 cases (8.52%) of overweight, 42 cases (6.17%) of obese, and 28 cases (4.11%) of extremely obese. The difference in BMI distribution between male and female groups was significant (Z=–2.220, P=0.026). Of 836 vertebral bodies, 472 (56.46%) were punctured unilaterally and 364 (43.54%) bilaterally. Most of the vertebral bodies (49.88%, 417/836) were injected with 5.0-6.9 mL bone cement, and most of them were distributed in thoracolumbar and lumbar vertebral bodies (T11-L3). The visual analogue scale (VAS) score and Oswestry disability index (ODI) of patients with unilateral puncture and bilateral puncture significantly improved at 6 months after operation (P<0.001), and also the difference was significant between the two groups in the difference of pre- and post-operation (P<0.001). There were 628 cases (92.22%) with the first occurrence of OVCF, and 53 cases (7.78%) with two or more times of OVCF, all of which were female patients, and 26 cases (49.06%) occurred in the adjacent segment of the previous PVP operation. ConclusionFemale were more than male in OVCF patients. Thoracolumbar vertebral body has the highest morbidity. Patients with low BMI are more likely to have osteoporosis, and patients with high BMI have a higher risk of compression fracture. The amount of bone cement injected through bilateral puncture was greater than that through unilateral puncture.
Objective To explore the risk factors, clinical characteristics and pathogenic bacteria of late-onset septicemia (LOS) in neonates, so as to guide clinical diagnosis and treatment. Methods Collect LOS in neonates admitted to the Department of Pediatrics, Chaohu Hospital of Anhui Medical University between January 2015 and February 2020, and set them as the observation group. The neonates born at the same time and hospitalized without septicemia were selected as the control group. The general situation and risk factors of the two groups of neonates were analyzed, and the clinical manifestations, complications and pathogenic bacteria of LOS in neonates were analyzed. Results 182 neonates were enrolled, 91 in each group. There were significant differences between the two groups in mechanical ventilation, indwelling peripherally inserted central catheter, parenteral nutrition, tracheal intubation, neonatal asphyxia, gestational age<37 weeks, birth weight<2.0 kg (P<0.05). Logistic regression analysis showed that gestational age<37 weeks [odds ratio (OR)=3.010, 95% confidence interval (CI) (1.489, 6.085), P=0.002], parenteral nutrition [OR=3.506, 95%CI (1.681, 7.312), P=0.001] were independent risk factors for LOS. The main clinical manifestations of LOS were abnormal temperature, feeding difficulties, jaundice, apnea, hypersensitive C-reactive protein and procalcitonin increase. The neonates with LOS were prone to necrotizing enterocolitis and purulent meningitis. A total of 74 pathogenic bacteria were cultured from neonates with LOS, including 49 Gram-positive bacterium, 21 Gram-negative bacteria and 4 fungi. The critical and death cases were mainly infected by Gram-negative bacteria. Conclusions A number of factors are related to LOS. Gestational age<37 weeks and parenteral nutrition are independent risk factors for LOS. In order to avoid LOS, attention should be paid to prevention, aseptic concept should be strengthened, and drugs should be used reasonably.
Objective To explore the clinical and inflammatory characteristics and risk factors of severe asthma to improve clinicians' awareness of the disease. Methods The general information of patients with asthma who visited the Department of Respiratory Medicine, the First Hospital of Shanxi Medical University from May 2018 to May 2021, as well as the diagnosis and treatment of asthma, personal history, comorbidities, auxiliary examination, asthma control test (ACT) score were collected. A total of 127 patients were included, including 40 in the severe asthma group and 87 in the mild-to-moderate asthma group. Chi-square test, independent sample t test and logistic regression were used to analyze the clinical characteristics, inflammatory markers and risk factors of severe asthma. Results Compared with the patients with mild to moderate asthma, the patients with severe asthma were more older (51.0±12.0 years vs 40.7±12.8 years, P<0.05), had more smokers (32.5% vs. 14.9%, P<0.05), and more males (67.5% vs. 40.2%, P<0.05). The patients with severe asthma got poor FEV1%pred [(56.1±23.8)% vs. (93.2±18.0)%, P<0.05] and FEV1/FVC [(56.7±13.2)% vs. (75.8±9.0)%, P<0.05)], and more exacerbations in the previous year (2.7±3.1 vs. 0.1±0.4, P<0.05), lower ACT score (14.4±3.7 vs. 18.0±5.0, P<0.05), and higher blood and induced sputum eosinophil counts [(0.54±0.44)×109/L vs. (0.27±0.32)×109/L, P<0.05; (25.9±24.2)% vs. (9.8±17.5)%, P<0.05]. There was no significant difference in the proportion of neutrophils in the induced sputum or FeNO between the two groups (P>0.05). Analysis of related risk factors showed that smoking (OR=2.740, 95%CI 1.053 - 7.130), combined with allergic rhinitis (OR=14.388, 95%CI 1.486 - 139.296) and gastroesophageal reflux (OR=2.514, 95%CI 1.105 - 5.724) were risk factors for severe asthma. Conclusions Compared with patients with mild to moderate asthma, patients with severe asthma are characterized by poor lung function, more exacerbations, and a dominant eosinophil inflammatory phenotype, which is still poorly controlled even with higher level of treatment. Risk factors include smoking, allergic rhinitis, and gastroesophageal reflux, etc.
ObjectiveTo study the clinical characteristics of overseas imported and related local COVID-19 patients in Chengdu.MethodsFifty overseas imported patients who were Chinese and 14 related local patients with COVID-19 who were admitted to Public Health Clinical Center of Chengdu from November to December 2020 were selected. The epidemiological characteristics, clinical manifestations, auxiliary examination, treatment and prognosis were summarized and analyzed.ResultsThe local group were older, and they were mostly elderly and females (P≤0.05). Compared with the imported group, the proportion of the local group was higher in heart disease and tumor. More patients had cough, fever and expectoration symptoms (P≤0.05). C-reactive protein, fasting blood glucose and fibrinogen were higher, and the lymphocyte count, blood platelet count, CD3+ T lymphocyte count, CD4+ T lymphocyte count, CD8+ T lymphocyte count were lower. The positive rate of novel coronavirus total antibody, IgG antibody and IgM antibody in the imported group were higher than those in the local group (P≤0.05). The negative conversion time of the median nucleic acid was shorter than that of local patients (P≤0.05).ConclusionThere are differences in sex ratio, age, complications, clinical manifestations, lymphocyte measurement value, T lymphocyte count and negative conversion time of nucleic acid between overseas imported and local COVID-19 patients in Chengdu. The local patients are mostly elderly and have more complicated conditions, but all of them have good prognosis.