BACKGROUND When opportunistic infections occur, patients with inflammatory bowel disease(IBD) commonly display a significantly increased rate of morbidity and mortality.With increasing use of immunosuppressive agents ...BACKGROUND When opportunistic infections occur, patients with inflammatory bowel disease(IBD) commonly display a significantly increased rate of morbidity and mortality.With increasing use of immunosuppressive agents and biological agents,opportunistic infections are becoming a hot topic in the perspective of drug safety in IBD patients. Despite the well-established role of opportunistic infections in the prognosis of IBD patients, there are few epidemiological data investigating the incidence of opportunis-tic infections in IBD patients in China. Besides, the risk factors for opportunistic infection in Chinese IBD patients remain unclear.AIM To predict the incidence of opportunistic infections related to IBD in China, and explore the risk factors for opportunistic infections.METHODS A single-center, prospective study of IBD patients was conducted. The patients were followed for up to 12 mo to calculate the incidence of infections. For each infected IBD patient, two non-infected IBD patients were selected as controls. A conditional logistic regression analysis was used to assess associations between putative risk factors and opportunistic infections, which are represented as odds ratios(OR) and 95% confidence intervals(CIs).RESULTS Seventy(28.11%) out of 249 IBD patients developed opportunistic infections.Clostridium difficile infections and respiratory syncytial virus infections were found in 24 and 16 patients, respectively. In a univariate analysis, factors such as the severity of IBD, use of an immunosuppressant or immunosuppressants, high levels of fecal calprotectin, and C-reactive protein or erythrocyte sedimentation rate were individually related to a significantly increased risk of opportunistic infection. Multivariate analysis indicated that the use of any immunosuppressant yielded an OR of 3.247(95%CI: 1.128-9.341), whereas the use of any two immunosuppressants yielded an OR of 6.457(95%CI: 1.726-24.152) for opportunistic infection. Interestingly, when immunosuppressants were used in combination with infliximab(IFX) or 5-aminosalicylic acid, a significantly increased risk of opportunistic infection was also observed. The relative risk of opportunistic infection was greatest in IBD patients with severe disease activity(OR = 9.090; 95%CI: 1.532-53.941, relative to the remission stage). However, the use of IFX alone did not increase the risk of opportunistic infection.CONCLUSION Factors such as severe IBD, elevated levels of fecal calprotectin, and the use of immunosuppressive medications, especially when used in combination, are major risk factors for opportunistic infections in IBD patients. The use of IFX alone does not increase the risk of opportunistic infection.展开更多
BACKGROUND Currently, it is difficult to predict the complications of children at the early stage of sepsis. Brighton pediatric early warning score(PEWS) is a disease risk assessment system that is simple and easy to ...BACKGROUND Currently, it is difficult to predict the complications of children at the early stage of sepsis. Brighton pediatric early warning score(PEWS) is a disease risk assessment system that is simple and easy to operate, which has good sensitivity and specificity in disease recognition among children. Because detection indicators vary widely in children, a single indicator is difficult to assess the posttreatment status of children with sepsis.AIM To investigate the relationship between serological markers, Brighton PEWS, and death in children with sepsis after treatment.METHODS A total of 205 children diagnosed with sepsis at our hospital were enrolled. The baseline data, serum scores, and PEWS scores were recorded. In the nested casecontrol study, children who died during the study period were included in an observation group. According to the matching principle, the children who were not dead in the same cohort were included in a control group. The influencing factors of death in children with sepsis after treatment and the value of each evaluation index in predicting the prognosis of children were analyzed.RESULTS A total of 96 children were enrolled in the study, including 48 each in the observation group and the control group. Multivariate logistic regression analysis indicated that antibacterial treatments within 1 h(P = 0.017), shock(P = 0.044),multiple organ dysfunction syndrome(MODS)(P = 0.027), serum procalcitonin(PCT)(P = 0.047), serum albumin(ALB)(P = 0.024), and PEWS(P = 0.012) were independent risk factors for the death of children with sepsis. The area under the curve of the combination of ALB, PCT, and PEWS to predict the death in children with sepsis was the highest(0.908).CONCLUSION Antibacterial treatments within 1 h, shock, MODS, PCT, ALB, and PEWS are independent risk factors for the death of children with sepsis. The predictive accuracy of the combination of PCT, ALB, and PEWS for the prognosis of children with sepsis is the best.展开更多
To the Editor:Stroke is among the leading public health problems in China,with high rates of recurrent stroke,cardiovascular events and mortality,resulting in a considerable medical and economic burden.[1]The identifi...To the Editor:Stroke is among the leading public health problems in China,with high rates of recurrent stroke,cardiovascular events and mortality,resulting in a considerable medical and economic burden.[1]The identification of new molecular markers and therapeutic targets is necessary to better refine the risk prediction of cardiovascular events and develop new treatment strategies for ischemic stroke.Succinate is a tricarboxylic acid(TCA)cycle intermediate and has received considerable attention for its involvement in various signaling pathways associated with cardiovascular diseases.[2–4]Recent studies have reported that succinate is a novel mediator that promotes atherosclerotic lesion progression,fibroblast activation,and apoptosis resistance.展开更多
目的分析不同孕期膳食铁摄入量对小于胎龄儿(small for gestational age,SGA)发生风险的影响。方法采用巢式病例对照研究方法,选取2010年1月至2012年12月在甘肃省妇幼保健院建档并随访至出生结局的8325对母婴为研究对象,根据新生儿是否...目的分析不同孕期膳食铁摄入量对小于胎龄儿(small for gestational age,SGA)发生风险的影响。方法采用巢式病例对照研究方法,选取2010年1月至2012年12月在甘肃省妇幼保健院建档并随访至出生结局的8325对母婴为研究对象,根据新生儿是否为SGA分为SGA组(n=666)和适于胎龄儿(appropriate for gestational age,AGA)组(n=7659)。采用24 h膳食回顾法分别在孕早、中、晚期对孕妇进行膳食调查,根据中国标准食品消费表估算每个时期的每日铁摄入情况,并随访至胎儿分娩。统计学方法采用独立样本t检验、秩和检验、χ^(2)检验并采用多因素Logistic回归分析评估不同孕期膳食铁摄入量对SGA发生的影响。结果与AGA组相比,SGA组母亲年龄更小,文化程度和家庭人均月收入更低,孕期体质量获得更少,主被动吸烟率更高,妊娠期高血压比例更高,孕期矿物质和铁剂补充率更低,父母身高更低,差异均有统计学意义(P值均<0.05)。分娩SGA的孕妇膳食铁摄入量在孕早、中期达推荐摄入量(recommended national intake,RNI)的分别有395例(59.31%)、300例(45.05%),均低于分娩AGA的孕妇。多因素Logistic回归分析结果显示,孕早、中期孕妇膳食铁摄入量低于平均需要量(estimated average requirement,EAR)对SGA的发生有统计学意义(OR=1.497,95%CI:1.185~1.892,P<0.001;OR=1.223,95%CI:1.006~1.487,P=0.044)。将SGA进一步分为不同亚型后,孕早期孕妇膳食铁摄入量低于EAR对足月SGA的发生有统计学意义(OR=1.492,95%CI:1.168~1.907,P<0.001)。结论孕早、中期膳食铁摄入量低于EAR将增加SGA的发生风险,建议孕妇在孕早、中期适量增加膳食铁摄入量。展开更多
基金National Natural Science Foundation of China,No.81473506Natural Science Foundation of Zhejiang Province,No.LY16H290001 and No.LY17H290009+1 种基金Project of Department of Construction of Zhejiang Province,No.WKJ-ZJ-1531Zhejiang TCM Science and Technology Project,No.2016ZB047 and No.2017ZA056
文摘BACKGROUND When opportunistic infections occur, patients with inflammatory bowel disease(IBD) commonly display a significantly increased rate of morbidity and mortality.With increasing use of immunosuppressive agents and biological agents,opportunistic infections are becoming a hot topic in the perspective of drug safety in IBD patients. Despite the well-established role of opportunistic infections in the prognosis of IBD patients, there are few epidemiological data investigating the incidence of opportunis-tic infections in IBD patients in China. Besides, the risk factors for opportunistic infection in Chinese IBD patients remain unclear.AIM To predict the incidence of opportunistic infections related to IBD in China, and explore the risk factors for opportunistic infections.METHODS A single-center, prospective study of IBD patients was conducted. The patients were followed for up to 12 mo to calculate the incidence of infections. For each infected IBD patient, two non-infected IBD patients were selected as controls. A conditional logistic regression analysis was used to assess associations between putative risk factors and opportunistic infections, which are represented as odds ratios(OR) and 95% confidence intervals(CIs).RESULTS Seventy(28.11%) out of 249 IBD patients developed opportunistic infections.Clostridium difficile infections and respiratory syncytial virus infections were found in 24 and 16 patients, respectively. In a univariate analysis, factors such as the severity of IBD, use of an immunosuppressant or immunosuppressants, high levels of fecal calprotectin, and C-reactive protein or erythrocyte sedimentation rate were individually related to a significantly increased risk of opportunistic infection. Multivariate analysis indicated that the use of any immunosuppressant yielded an OR of 3.247(95%CI: 1.128-9.341), whereas the use of any two immunosuppressants yielded an OR of 6.457(95%CI: 1.726-24.152) for opportunistic infection. Interestingly, when immunosuppressants were used in combination with infliximab(IFX) or 5-aminosalicylic acid, a significantly increased risk of opportunistic infection was also observed. The relative risk of opportunistic infection was greatest in IBD patients with severe disease activity(OR = 9.090; 95%CI: 1.532-53.941, relative to the remission stage). However, the use of IFX alone did not increase the risk of opportunistic infection.CONCLUSION Factors such as severe IBD, elevated levels of fecal calprotectin, and the use of immunosuppressive medications, especially when used in combination, are major risk factors for opportunistic infections in IBD patients. The use of IFX alone does not increase the risk of opportunistic infection.
文摘BACKGROUND Currently, it is difficult to predict the complications of children at the early stage of sepsis. Brighton pediatric early warning score(PEWS) is a disease risk assessment system that is simple and easy to operate, which has good sensitivity and specificity in disease recognition among children. Because detection indicators vary widely in children, a single indicator is difficult to assess the posttreatment status of children with sepsis.AIM To investigate the relationship between serological markers, Brighton PEWS, and death in children with sepsis after treatment.METHODS A total of 205 children diagnosed with sepsis at our hospital were enrolled. The baseline data, serum scores, and PEWS scores were recorded. In the nested casecontrol study, children who died during the study period were included in an observation group. According to the matching principle, the children who were not dead in the same cohort were included in a control group. The influencing factors of death in children with sepsis after treatment and the value of each evaluation index in predicting the prognosis of children were analyzed.RESULTS A total of 96 children were enrolled in the study, including 48 each in the observation group and the control group. Multivariate logistic regression analysis indicated that antibacterial treatments within 1 h(P = 0.017), shock(P = 0.044),multiple organ dysfunction syndrome(MODS)(P = 0.027), serum procalcitonin(PCT)(P = 0.047), serum albumin(ALB)(P = 0.024), and PEWS(P = 0.012) were independent risk factors for the death of children with sepsis. The area under the curve of the combination of ALB, PCT, and PEWS to predict the death in children with sepsis was the highest(0.908).CONCLUSION Antibacterial treatments within 1 h, shock, MODS, PCT, ALB, and PEWS are independent risk factors for the death of children with sepsis. The predictive accuracy of the combination of PCT, ALB, and PEWS for the prognosis of children with sepsis is the best.
基金This study was supported by the National Natural Science Foundation of China(Nos.82273706 and 82220108001)the Suzhou Science and Technology Project(No.SYW2024067)+1 种基金Interdisciplinary Basic Frontier Innovation Program of Suzhou Medical College of Soochow University(No.YXY2302013)the Project of MOE Key Laboratory of Geriatric Diseases and Immunology(No.JYN202406).
文摘To the Editor:Stroke is among the leading public health problems in China,with high rates of recurrent stroke,cardiovascular events and mortality,resulting in a considerable medical and economic burden.[1]The identification of new molecular markers and therapeutic targets is necessary to better refine the risk prediction of cardiovascular events and develop new treatment strategies for ischemic stroke.Succinate is a tricarboxylic acid(TCA)cycle intermediate and has received considerable attention for its involvement in various signaling pathways associated with cardiovascular diseases.[2–4]Recent studies have reported that succinate is a novel mediator that promotes atherosclerotic lesion progression,fibroblast activation,and apoptosis resistance.
文摘目的分析不同孕期膳食铁摄入量对小于胎龄儿(small for gestational age,SGA)发生风险的影响。方法采用巢式病例对照研究方法,选取2010年1月至2012年12月在甘肃省妇幼保健院建档并随访至出生结局的8325对母婴为研究对象,根据新生儿是否为SGA分为SGA组(n=666)和适于胎龄儿(appropriate for gestational age,AGA)组(n=7659)。采用24 h膳食回顾法分别在孕早、中、晚期对孕妇进行膳食调查,根据中国标准食品消费表估算每个时期的每日铁摄入情况,并随访至胎儿分娩。统计学方法采用独立样本t检验、秩和检验、χ^(2)检验并采用多因素Logistic回归分析评估不同孕期膳食铁摄入量对SGA发生的影响。结果与AGA组相比,SGA组母亲年龄更小,文化程度和家庭人均月收入更低,孕期体质量获得更少,主被动吸烟率更高,妊娠期高血压比例更高,孕期矿物质和铁剂补充率更低,父母身高更低,差异均有统计学意义(P值均<0.05)。分娩SGA的孕妇膳食铁摄入量在孕早、中期达推荐摄入量(recommended national intake,RNI)的分别有395例(59.31%)、300例(45.05%),均低于分娩AGA的孕妇。多因素Logistic回归分析结果显示,孕早、中期孕妇膳食铁摄入量低于平均需要量(estimated average requirement,EAR)对SGA的发生有统计学意义(OR=1.497,95%CI:1.185~1.892,P<0.001;OR=1.223,95%CI:1.006~1.487,P=0.044)。将SGA进一步分为不同亚型后,孕早期孕妇膳食铁摄入量低于EAR对足月SGA的发生有统计学意义(OR=1.492,95%CI:1.168~1.907,P<0.001)。结论孕早、中期膳食铁摄入量低于EAR将增加SGA的发生风险,建议孕妇在孕早、中期适量增加膳食铁摄入量。
