Objective To investigate the therapeutic effect of dexamethasone on children with severe community acquired pneumonia ( CAP) . Methods 120 children with severe CAP admitted from January 2009 to June 2011 were recruited in the study. The patients were randomly divided into a dexamethasone group ( n = 62) and a control group ( n = 58) . The patients in the dexamethasone group received additional dexamethasone intravenous injection for 3 days ( 0. 2-0. 4 mg· kg- 1 · d- 1 , qd) on the basic treatment of the control group. Length of hospital stay, serum C reactive protein ( CRP) concentration on 4th day after admission, overall efficacy, mortality, incidence of adverse events during treatment were compared between the two groups. Results Median length hospital stay was 8 days in the dexamethasone group compared with 9 days in the control group without significant difference ( P gt;0. 05) . The serumCRP concentration on 4th day was lower in the dexamethasone group than that in the control group [ ( 23. 4 ±5. 6) mmol /L vs. ( 41. 3 ±6. 2) mmol /L, P lt;0. 05] . The overall efficacy was higher in the dexamethasone group than that in the control group ( 88. 7% vs. 74. 1% , P lt; 0. 05) . The in-hospital mortality and incidence of severe adverse events were not significantly different between the two groups ( P gt; 0. 05) . Conclusions Dexamethasone treatment is associated with a significant attenuation in systematic inflammatory response, but does not decrease mortality in hospitalized children with severe CAP.
ObjectiveTo investigate the clinical, imaging features, diagnosis, treatment and prognosis of pulmonary lymphomatoid granulomatosis (PLG).MethodsA case of PLG confirmed by autopsy and pathology was reported, and the related literature was reviewed.ResultsA 44-year-old male patient presented with cough, expectoration and shortness of breath as the main symptoms. The imaging findings of lung CT were diffuse vascular nodular and patchy changes in the lungs, especially in the lower lung. Clinical symptoms were not relieved with anti-infection and symptomatic treatment. The patient's condition gradually exacerbated and finally died. The autopsy revealed PLG with pathological grade Ⅲ. The infiltration of lymphocytes centered with blood vessel and necrosis were observed under light microscope. EBER in situ hybridization was positive. Totally 28 Chinese articles and 34 foreign articles were screened out. Literature review suggested that PLG usually occurred in middle-aged men and was associated with EBV infection. It is frequent with immunodepression. Its clinical symptoms were atypical. The main imaging manifestations were multiple nodules and masses more frequent along the bronchovascular bundle. A diagnosis of PLG depended on pathological histology, immunohistochemistry and EBER in situ hybridization. Surgery was the main treatment for local lesions. The patients of grade I and Ⅱ with rapid progress and all grade Ⅲ were usually treated with RCHOP regimen combined with chemotherapy. The prognosis was correlated with grading. Grade Ⅲ was aggressive and the prognosis was poor.ConclusionsPLG is an atypical pulmonary lymphoproliferative disorder. It can be seen in many immunosuppressive diseases. The CT imaging features of PLG have certain characteristics, but the final diagnosis should be combined with pathological diagnosis. Some patients can be relieved by treatment, and patients with grade Ⅲ have poor prognosis.
Objective To analyze the diagnostic value of shear wave elastography (SWE) combined with vascular endothelial growth factor B (VEGF-B) and hemoglobin A1c (HbA1c) in early diabetic peripheral neuropathy (DPN). Methods A total of 100 patients with type 2 diabetes mellitus (T2DM) admitted to Mianyang Central Hospital between October 2020 and October 2023 were selected and divided into a T2DM with DPN group (n=31) and a T2DM without DPN group (n=69) based on the presence or absence of DPN. Additionally, 50 healthy individuals from the same hospital’s health examination center were included as a healthy control group. The basic clinical characteristics, mean elasticity (Emean) values of the left and right median and tibial nerves, serum VEGF-B, and HbA1c levels were compared among the three groups. The diagnostic efficacy of SWE, VEGF-B, and HbA1c for DPN was evaluated using receiver operating characteristic (ROC) curves, and Pearson correlation analysis was performed to assess the relationships between median/tibial nerve Emean and VEGF-B/HbA1c. Results The Emean values of the left and right median nerves, Emean values of the left and right tibial nerves, serum VEGF-B, and HbA1c levels in the T2DM with DPN group were significantly higher than those in the T2DM without DPN group and the healthy control group (P<0.05). The Emean values of the left and right median and tibial nerves, Emean values of the left and right tibial nerves, and HbA1c level in the T2DM without DPN group were significantly higher than those in the healthy control group (P<0.05), while no significant difference was observed in serum VEGF-B level between the T2DM without DPN group and the healthy control group (P>0.05). The area under the ROC curve for the combined diagnosis of DPN using SWE, VEGF-B, and HbA1c was 0.859 [95% confidence interval (0.828, 0.955)]. The sensitivity of the combined diagnosis (93.72%) was significantly higher than that of individual diagnoses (78.82%, 75.39%, and 71.05%, respectively; P<0.05), while the specificity (88.64%) showed no significant difference compared to individual diagnoses (80.18%, 78.96%, and 82.88%, respectively; P>0.05). Positive correlations were observed between median/tibial nerve Emean and VEGF-B/HbA1c levels (r=0.428, 0.395, 0.416, and 0.416, respectively; P<0.05). Conclusions Elevated median/tibial nerve Emean, serum VEGF-B, and HbA1c levels are closely associated with DPN. The combination of SWE, VEGF-B, and HbA1c improves diagnostic sensitivity for DPN, demonstrating significant clinical value.
In order to monitor the emotional state changes of audience on real-time and to adjust the music playlist, we proposed an algorithm framework of an electroencephalogram (EEG) driven personalized affective music recommendation system based on the portable dry electrode shown in this paper. We also further finished a preliminary implementation on the Android platform. We used a two-dimensional emotional model of arousal and valence as the reference, and mapped the EEG data and the corresponding seed songs to the emotional coordinate quadrant in order to establish the matching relationship. Then, Mel frequency cepstrum coefficients were applied to evaluate the similarity between the seed songs and the songs in music library. In the end, during the music playing state, we used the EEG data to identify the audience’s emotional state, and played and adjusted the corresponding song playlist based on the established matching relationship.
ObjectiveTo investigate the distribution and drug resistance of Acinetobacter baumannii (AB) in a women and children's hospital. MethodsStrains of AB isolated from clinical specimens between January 2011 and December 2013 were identified with Vitek2-compact microbiology analyzer; antimicrobial susceptibility test was performed by Kirby-Bauer disk diffusion method. The resistant rate, intermediate rate and susceptibility rate of drugs were calculated according to the criteria in guidelines of Clinical and Laboratory Standards Institute. WHONET 5.6 software was used to analyze the data. ResultsA total of 167 strains of AB were isolated and tested. Neonatal ward had the highest detection proportion. Most strains of AB were isolated from sputum. The drug resistance rate of AB to piperacillin tazobactam, cefepime and carbapenem was<25%. ConclusionThe drug sensitivity rate of AB to piperacillin/tazobactam, cefepime and carbapenems was high, but drug resistence to antimicrobial drugs increased continuously in three years. Medical institutions should strengthen the monitoring of AB resistance, implement rational use of antibiotics, and carry out hand hygiene education, to reduce the generation and dissemination of AB resistant strains.
Objective To establish the evidence-based treatment strategy for an advanced lung cancer case with spinal metastasis, regarding the patient’s condition and treatment expectations. Methods According to PICO principles, questions in the patient’s treatment were converted into a search strategy. The literature searching was performed in several databases. In accordance with the five evidence grading standards in evidence-based medicine, the best clinical evidence was interpreted to guide the treatment decisions. Results A total of 148 papers were detected and screened, of which 4 systematic reviews or meta-analyses were included finally. Four issues that patients concerned, including restoring spinal cord function (walking and sphincter function), local pain control, long-term survival, and treatment complications, were all supported by grade-1 evidence. The patient finally chose surgical decompression, which was of a higher complication risk, but better possibility of restoring nerve function, significant pain relief, and improved long-term survival. The patient obtained fully recovery and regained walking function after surgery. Conclusion The evidence-based treatment is able to provide reasonable treatment options for lung cancer patients with spinal metastasis. Decompression surgery for patients with walking dysfunction should be carried out as soon as possible, in order to early restore spinal marrow function, relieve pain and improve long-term survival. But both doctors and patients should fully acquaint themselves with the higher risk of surgical complications.