Local Infection Group Research Articles

Total triiodothyronine level associated with disease severity for patients with emergent status

Thyroid hormones are metabolic indicators to evaluate the physical condition of emergency hospitalized patients, while the relationship between total triiodothyronine and the severity of emergency inpatients is still unclear. To explore the thyroid function levels of inpatients in emergency ward and the status of combined Nonthyroidal illness syndrome (NTIS), and to emphasize the importance of thyroid hormone examination for non-endocrinology inpatients. According to thyroid function of inpatients in emergency ward, they were divided into NTIS group and non-NTIS group, the hematological characteristics and TH levels of each group were analyzed. Based on clinical diagnoses, the hospitalized patients were divided into three major groups, namely infection group, non-infection group and impaired organ function group. Among them, infection group was further divided into sepsis group, lung infection group and local infection group, altogether five groups. The thyroid function levels and low values in each group were evaluated, and the correlation between hormone levels and inflammatory factors, nutritional indicators and the relationship with the risk of death was discussed. The inpatient rate in emergency ward complicated with NTIS was 62.29%, T3 was the most sensitive index of NTIS, followed by FT3. Compared to non-NTIS group, the NTIS group had an increased risk of death. The sepsis group and impaired organ function group had the highest rates of complicated NTIS, reaching 83.33% and 78.12% respectively. Spearman's correlation analysis implied T3/T4/FT3 levels were positively correlated with ALb and PLT (except T4), and negatively correlated with CRP, D-Dimer, IL-6 and Fer. The Receiver Operating Curve (ROC) and Area under the curve (AUC) showed T3 levels alone were strongly associated with the risk of death (AUC 0.750; 95% CI 0.673–0.828; P < 0.001). T3 is the most sensitive indicator for emergency patients, followed by FT3. The decrease of T3 level has a good predictive value for mortality risk. Thyroid function should be monitored in critically ill patients.

Early vs. late lead extraction in CIED infections: evaluating the interplay of infection type, timing, and comorbidities

Abstract Background Cardiovascular Implantable Electronic Devices (CIEDs) may be associated with peri- and post-procedural complications like device-related infection, one of the most serious challenge of CIEDs therapy associated with significant morbidity, mortality, and financial healthcare burden. Despite a routine use of antibiotics, recent studies reported an increase in CIEDs infections, with or without systemic involvement, that often require surgical interventions like transvenous lead extraction. Purpose This study evaluates the outcomes of transvenous lead extraction in patients with infected CIEDs, focusing on the impact of early versus delayed extraction timing on patient outcomes. Methods A retrospective analysis of 165 patients who underwent transvenous lead extraction for CIED infections between 2019 and 2022 was conducted. Patients were categorized into systemic (n=64) or local (n=101) infection groups and further into early (within 7 days from admission, n=102) or delayed (after 7 days, n=63) extraction groups. Post-procedural outcomes, including septic shock, complications, and mortality rates were described. Results The majority of patients were male (75%) with a median age of 73 (IQR 64-80) years. In the early extraction group, the 1-year mortality rate was significantly lower at 6.4%, compared to 25% in the delayed group. Patients with systemic infections had higher 1-month and 1-year mortality rates compared to those with local infections. The success rates of complete device removal were similar across groups. However, the delayed extraction group exhibited higher rates of comorbidities like anemia, chronic kidney disease, and elevated C-reactive protein levels, which were prevalent in 70% of these patients, compared to 45% in the early extraction group. Conclusions Timely management of CIED infections is crucial for improving patient outcomes. Early extraction within 7 days from hospital admission is associated with significantly lower mortality, regardless of local or systemic infection. Patients undergoing delayed extraction often present with greater comorbidity, which may contribute to their higher mortality rates. This underscores the importance of considering patient comorbidities and prompt intervention in managing CIED infections.

Diagnostic Value of PTX-3 Combined with PCT and CRP for Neonatal Sepsis

Aim: Neonatal sepsis is a critical illness among neonates and is the leading cause of neonatal death. In this study, we compared the changes in serum PTX-3 levels in neonates with sepsis and non-septicemia, as well as the diagnostic advantages and value of serum PTX-3 compared to traditional indicators such as WBC, CRP, and PCT. Methods: A total of 109 neonates were included in this study. Neonates were divided into three groups: 35 neonates were assigned to the sepsis group; 36 to the local infection group; and 38 assigned to the control group. Blood was collected to measure complete blood counts, CRP, PCT, liver and kidney function, lactate, and PTX-3 levels. Results: CRP, PCT, and PTX-3 in the sepsis group were significantly higher compared to the local infection group and non-infection group (P&lt;0.01 or P&gt;0.05). PCT and PTX-3 levels in the local infection group were significantly higher compared to the non-infection group (P&gt;0.05). The combination of WBC+CRP+PCT+PTX-3 was more sensitive for the diagnosis of neonatal infection. For the diagnosis of neonatal sepsis, CRP was the most sensitive index, with PTX-3 having the best specificity. The combination of WBC+CRP+PTX-3 was found to significantly improve the sensitivity and specificity of diagnosis. Conclusion: PTX-3 could be used as a new biomarker for neonatal sepsis, while the combination with WBC, CRP, and PCT could significantly improve the sensitivity and specificity for sepsis diagnosis.

Establishment of a nomogram model for the early diagnosis of childhood sepsis

To establish a nomogram model for the early diagnosis of sepsis in children. A total of 76 children with sepsis who were admitted to Sichuan Maternal and Child Health Hospital from January 2018 to June 2021 were retrospectively selected as the sepsis group. After matching for sex and age (±2 years) at a ratio of 1:1:1, 76 children with local infection who were hospitalized during the same period were enrolled as the local infection group, and 76 children with non-infectious diseases were enrolled as the control group. The three groups were compared in terms of laboratory markers and the results of quick Sequential Organ Failure Assessment (qSOFA) and Pediatric Critical Illness Score (PCIS). A multivariate logistic regression analysis was used to investigate the association between the above indicators and sepsis. R4.1.3 software was used to establish and validate the nomogram model for the early diagnosis of sepsis based on the results of the multivariate analysis. A receiver operating characteristic (ROC) curve analysis was used to evaluate the value of the nomogram model, and the Bootstrap method was used to perform the internal validation of the model. The multivariate logistic regression analysis showed that soluble triggering receptor expressed on myeloid cells-1, qSOFA score, PCIS score, C-reactive protein, interleukin-6, and interleukin-10 were independently associated with childhood sepsis (P<0.05). The above indicators were used to establish a nomogram for the early diagnosis of sepsis, with an area under the ROC curve of 0.837 (95%CI: 0.760-0.914), and the calibration curve results showed a mean absolute error of 0.024, suggesting that the performance of this model was basically consistent with that of the ideal model. The indicators soluble triggering receptor expressed on myeloid cells-1, qSOFA score, PCIS score, C-reactive protein, interleukin-6, and interleukin-10 are independently associated with childhood sepsis, and the nomogram model established based on these indicators has high discriminatory ability and accuracy in the early diagnosis of sepsis in children.

T lymphocyte subsets combined with inflammatory indicators for auxiliary diagnosis and prognosis evaluation of sepsis

Objective: To explore the application value of T lymphocyte subsets combined with procalcitonin (PCT), C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR) and white blood cell count (WBC) in the auxiliary diagnosis and prognosis evaluation of sepsis. Methods: In a retrospective study, seventy-two patients with sepsis diagnosed and treated in Tianjin First Central Hospital from June 2018 to April 2021 were selected as the research objects, and included in the sepsis group were 46 males and 26 females, aged 68 (57.3, 80.3) years. In addition, 111 patients with local infection admitted to hospital during the same period were included in the local infection group, including 62 males and 49 females, aged 68 (51, 77) years. Sepsis patients were divided into survival group (43 cases) and death group (29 cases) according to the 28-day outcome. CD3+, CD4+, CD8+, CD4+/CD8+ ratio were detected by flow cytometry within 24 h after admission, PCT was detected by ELISA, CRP was detected by immunoturbidimetry, blood routine examination, blood lactic acid (Lac) and oxygen partial pressure (PO2) were detected by instrumental method. Multivariate Logistic regression analysis was used to evaluate the correlation between each indicator and sepsis, and receiver operating characteristic curve (ROC) was drawn to evaluate the diagnostic value of each indicator for sepsis. Multivariate Logistic regression analysis and Kaplan Meier survival analysis were used to evaluate the prognostic value of each index for patients with sepsis. Results: Peripheral blood CD3+, CD4+, CD8+, CD4+/CD8+ ratio and PLT in sepsis group were significantly lower than those in local infection group(Z=-8.184,P<0.001;Z=-7.210,P<0.001;Z=-5.936,P<0.001;Z=-2.700,P=0.007;Z=-6.381,P<0.001); PCT, CRP, NLR and Lac levels were significantly higher than those in local infection group(Z=-8.262,P<0.001;Z=-3.094,P=0.002;Z=-9.004,P<0.001;Z=-4.770,P<0.001). Multivariate Logistic regression model showed that PCT, NLR, CD3+, CD8+, CD4+/CD8+ were independent risk factors for sepsis. According to ROC curve analysis, AUC of sepsis patients diagnosed by each indicator were 0.862, 0.894, 0.858, 0.760 and 0.618, respectively. The cut-off values were 3.075 ng/ml, 10.715, 44.935×109/L, 27.463×109/L and 0.750, respectively. The NLR sensitivity was 80.6%, and the CD3+ specificity was 94.6%. The AUC of combined detection of PCT and NLR was 0.947, sensitivity was 87.5% and specificity was 91.9%. The combined detection AUC of PCT, NLR, CD3+, CD4+/CD8+ was 0.958, the sensitivity and specificity were 90.3% and 91.0% respectively(P<0.001). PCT and Lac in death group were significantly higher than those in survival group(Z=-2.302,P=0.021;Z=-3.095,P=0.002);Peripheral blood CD4+/CD8+ levels were significantly lower than those in survival group(Z=-3.691,P<0.001),Multivariate Logistic regression model showed that CD4+/CD8+ ratio was an independent risk factor for 28 d mortality in patients with sepsis (P<0.001). The ROC curve showed that the AUC was 0.758, and the Youden index reached the maximum when the cut-off value was 1.27, the sensitivity and specificity were 79.3% and 60.5%, respectively. Compared with patients with CD4+/CD8+ ≥1.27, 28-day mortality was significantly increased in patients with CD4+/CD8+<1.27 (P=0.032). Conclusion: The combined detection of PCT, NLR, CD3+ and CD4+/CD8+ can improve the auxiliary diagnostic efficiency of sepsis, and the ratio of CD4+/CD8+ in peripheral blood may have certain predictive value for the prognosis of sepsis.

Urinary neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury in sepsis patients in the emergency department

BackgroundPlasma neutrophil gelatinase-associated lipocalin (NGAL) is a useful biomarker for predicting acute kidney injury (AKI). The purpose of this study was to evaluate the diagnostic performance of urinary NGAL in predicting AKI in sepsis patients in the emergency department. MethodsA total of 140 patients were enrolled. We compared serum procalcitonin and urinary NGAL concentrations between patients with local infection, sepsis, and septic shock, and between patients who did and did not develop AKI with sepsis. Receiver-operating characteristic curve analysis was used to evaluate the ability to predict AKI in sepsis patients. ResultsBoth serum procalcitonin and urinary NGAL concentrations were significantly higher in the sepsis and septic shock groups than in the local infection group (both p < 0.001). In sepsis patients, serum procalcitonin and urinary NGAL concentrations were higher in AKI patients than in those without AKI (p = 0.006, p < 0.001, respectively). The area under the curve for predicting of AKI was higher for a urinary NGAL of 0.820 (95% confidence interval (CI) 0.721–0.895) than for a serum procalcitonin concentration of 0.76 (95% CI 0.597–0.800). ConclusionUrinary NGAL concentration may predict AKI in patients with sepsis in the emergency department.

Predictive value of procalcitonin for infection of patients with type-2 diabetes mellitus.

The aim of the present study was to investigate the predictive value of procalcitonin (PCT) for infection in patients with type 2 diabetes mellitus (T2DM). A retrospective analysis of 178 patients with T2DM who were divided into non-infection, local infection and sepsis groups was conducted; in conjunction with 33 healthy control patients. Clinicopathological characteristics and inflammatory indicators were compared between the four groups. Patients in the non-infection group exhibited significantly higher PCT levels compared with healthy controls (P=0.002). In addition, PCT, C-reactive protein (CRP), white blood cell count and neutrophil percent were significantly different amongst patients with T2MD across different infection groups (all P<0.001) with the following rank order: Sepsis group > local infection group > non-infection group (all P<0.05). In addition, the following observations were made: i) PCT and CRP demonstrated larger areas under the curve (AUC) for predicting local infection (0.804 and 0.741, respectively); ii) PCT displayed lower sensitivity of only 21.8% at its classical cutoff value (0.500 ng/ml) whereas CRP exhibited higher sensitivity and specificity at 64.1 and 76.1%, respectively, at its classical cutoff value (10.0 mg/l); and iii) PCT exhibited the largest AUC (0.914) for predicting sepsis with high sensitivity and specificity (86.4 and 84.5%, respectively) at its cutoff value (0.990 ng/ml). Patients with T2DM without infection demonstrated higher baseline PCT levels. The present study clarified the value of PCT in predicting infection of T2DM patients. The application of PCT to predict local infection in patients with T2DM was identified to be inferior to CRP, but its ability to predict sepsis was concluded to be the best when compared with CRP, white blood cell count and neutrophil percent.

Biomarkers and risk factors for sepsis in stage 5 chronic kidney disease: a retrospective case-control study.

To assess the predictive value of procalcitonin (PCT) in the risk of sepsis in patients with stage 5 chronic kidney disease (CKD). A total of 373 inpatients with stage 5 CKD were retrospectively analyzed. The patients were divided into non-infection group, local infection group, and sepsis group. The clinical characteristics and inflammatory parameters including PCT, C-reactive protein (CRP), white blood cell count (WBC), and neutrophil percentage (NEU%) were compared and the receiver operating characteristic (ROC) curves to predict sepsis were plotted. Related risk factors of sepsis were analyzed by logistic regression analysis. (1) The hemodialysis ratio of sepsis group was the highest at 92.3%. PCT, CRP, and NEU% were significantly different among the three subgroups (P < 0.05 for all). Total cholesterol and low density lipoprotein (LDL) levels in sepsis group were significantly lower than that in local infection group (P < 0.05 for both). (2) CRP and WBC were unable to predict sepsis (P > 0.05 for all), while PCT and NEU% could predict sepsis with areas under the curve (AUC) of 0.838 and 0.691, respectively (P < 0.05 for all). (3) Multivariate logistic regression analysis showed that PCT > 1.650ng/mL was a risk factor (OR = 6.926, P = 0.002) while LDL was probably a protective factor (OR = 0.336, P = 0.040) of sepsis in patients with stage 5 CKD. At stage 5 CKD, the predictive value of PCT for sepsis is best among inflammatory markers, and PCT and LDL levels are independent factors of sepsis.

Respiratory tract infections in children with tracheostomy.

Children with tracheostomy are at increased risk for respiratory tract infections, yet the risk involved in tracheostomy related infections is unclear. We conducted a retrospective review of the medical records of children who underwent tracheostomy between January 2002 and December 2016 at a teaching hospital in Taipei. Demographics, underlying disease, indication for tracheostomy, laboratory data and management, and long-term outcome data were collected. Infection episodes were grouped into definite, possible, non-bacterial pneumonia, and local infection groups. Ninety patients were enrolled. Forty-two (46.7%) patients had infections that required hospitalization. Definite bacterial pneumonia accounted for 12 (8.5%) episodes, 113 episodes (80.1%) were possible bacterial pneumonia, 12 (8.5%) were non-bacterial pneumonia, and 4 (2.8%) were local infections. Patients with definite and possible bacterial pneumonia were found to have a longer hospital duration than patients with non-bacterial pneumonia (p=0.024), with mean hospitalization stays of 8.83±5.59 days and 5.67±2.55 days, respectively. The median duration from tracheostomy to bacterial pneumonia was 1.78 years (range, 0.04- 11.38) whereas for the non-bacterial pneumonia group it was 0.57 years (range, 0.04-6.61). Cerebral palsy (CP) (adjusted odds ratio [AOR] 3.65; 95% confidence interval [CI]: 1.11-11.99; p=0.033) and gastroesophageal reflux disease (GERD) (AOR 2.84; 95% CI: 1.09-7.38; p=0.033) were independently associated with respiratory tract infections in these children. In this study, CP and GERD were associated with infections in children with tracheostomy. Bacterial and non-bacterial pneumonia are difficult to differentiate clinically which may lead to unnecessary antibiotics use.

Study on the clinical value of serum procalcitonin in early diagnosis of systemic bacterial infection

Objective To study the clinical value of serum procalcitonin(PCT) in early diagnosis of systemic bacterial infection. Methods 57 suspected bacterial infectious patients in our hospital were selected as observation group, and another 57 healthy subjects were selected as control group.Patients in the observation group were divided into sepsis group (A group, 19 cases), local bacterial infection group (B group, 19 cases) and bacterial infectious SIRS group (C group, 19 cases) according to ACCP/SCCM consensus conference and their clinical manifestations.The serum PCT levels in the 4 groups were detected and compared. Results There was no statistically significant differences in general situation (age, sex, height, weight and body mass index (BMI), etc.) between the two groups(P>0.05). After admission, the PCT level in the observation group was obviously higher than that in the control group, the level of PCT was the highest in group A, and the difference was statistically significant(F=94.88, P 0.05); the PCT level in the observation group was gradually decreased, the level of PCT in A group was still higher than that in the other three groups, and the differences were statistically significant(F=62.40, P<0.001; F=65.00, P<0.001; F=58.84, P<0.001; F=63.05, P<0.001). Conclusion Serum PCT has a certain advantage in sensitivity and specificity, it can reflect the severity of disease, it also has certain clinical significance in judging the development and prognosis of disease.Therefore, it can be considered as one of the first choice for clinical detection of bacterial infection. Key words: Procalcitonin; Bacterial infection; Early diagnosis; Clinical value

Effects of Antibiotic Timing on Culture Results and Clinical Outcomes in Pediatric Musculoskeletal Infection.

Musculoskeletal infection (MSI) is a common cause of morbidity and hospital resource utilization in the pediatric population. Many physicians prefer to withhold antibiotics until tissue cultures can be taken in an effort to improve culture yields. However, there is little evidence that this practice improves culture results or outcomes in pediatric MSI. Therefore, investigating the effects of antibiotic timing may lead to improved clinical practice guidelines for treating children with MSI. An IRB-approved retrospective review was conducted that identified 113 patients aged 0 to 18 who presented to the pediatric emergency room at a tertiary care children's hospital with MSI from 2008 to 2013. Demographic data, culture results, severity markers, and intervention timing were obtained from the medical record. Logistic regression and Cox survival analysis were performed to determine the relationship of antibiotic timing with culture sensitivity and time to discharge. No difference was seen in culture sensitivity antibiotic administration in either the local (55% culture before antibiotics vs. 89% after antibiotics) or disseminated group (76% before vs. 79% after), which persisted when further accounting for disease severity with C-reactive protein. However, later administration of antibiotics in the local infection group correlated with a decreased likelihood of discharge (3.91 d when cultured before antibiotics vs. 2.93 d when cultured after antibiotics; hazard ratio, 0.53; P<0.05). In patients with disseminated infection, antibiotic administration was not shown to correlate with any difference in time to discharge (hazard ratio, 1.08). The authors were surprised to find that tissue culture sensitivities were not decreased by antibiotic administration in either local or disseminated MSI, suggesting that antibiotic administration should not be delayed to obtain tissue cultures. The correlation of earlier antibiotic administration with shorter length of stay in children with local MSI led the authors to conclude that antibiotics should be initiated as quickly as possible. Further study is necessary to confirm these findings and establish clinical practice guidelines. Level III-retrospective cohort.

Are there standardized cutoff values for neutrophil-lymphocyte ratios in bacteremia or sepsis?

Bacteremia and sepsis are common causes of morbidity and mortality worldwide, with incorrect or delayed diagnoses being associated with increased mortality. New tests or markers that allow a more rapid and less costly detection of bacteremia and sepsis have been investigated. The aim of this study was to clarify the cutoff value of the neutrophillymphocyte ratio (NLR) according to procalcitonin (PCT) level in the decision-making processes for bacteremia and sepsis. In addition, other white blood cell subgroup parameters, which are assessed in all hospitals, for bacteremia and sepsis were explored. This retrospective study included 1,468 patients with suspected bacteremia and sepsis. Patients were grouped according to the following PCT criteria: levels <0.05 ng/ml (healthy group), 0.05-0.5 ng/ml (local infection group), 0.5-2 ng/ml (systemic infection group), 2-10 ng/ml (sepsis group), and >10 ng/ml (sepsis shock group). One important finding of this study, which will serve as a baseline to measure future progress, is the presence of many gaps in the information on pathogens that constitute a major health risk. In addition, clinical decisions are generally not coordinated, compromising the ability to assess and monitor a situation. This report represents the first study to determine the limits of the use of NLR in the diagnosis of infection or sepsis using a cutoff value of <5 when sufficient exclusion criteria are used.

PROCALCITONIN TEST IN RHEUMATIC DISEASES

Estimation of serum procalcitonin (PCT) levels is of great interest in rheumatology in both the diagnosis of coinfections and the differential diagnosis between rheumatic disease activity and the current infectious process. Objective: to estimate the value of PCT as a specific marker for generalized and local infection in rheumatic patients. Subjects and methods. A retrospective study investigated the case histories of 100 inpatients examined and treated at the V.A. Nasonova Research Institute of Rheumatology. Serum PCT concentrations were determined by a quantitative electrochemiluminescence assay using a Cobas E 411 analyzer (Roche, Switzerland). Results. Infectious diseases were diagnosed in 41 of the 100 patients. The infectious process was generalized and local in 11 and 30 cases, respectively. In the patients with generalized infection, the level of PCT was more than 2.0 ng/ml in 81.8% of the cases. In the local infection and non-infection groups, it was below 0.5 mg/ml in 70 and 84.7% of cases, respectively. In the generalized infection group, the content of PCT was significantly higher (3.6 [2.3; 10.5]) than in the local infection (0.24 [0.15; 0.7]; р = 0.004) and non-infection (0.15 [0.09; 0.26]; р = 0.0001) groups. It did not depend on rheumatic disease activity. C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR) correlated with PCT concentrations in different patient groups. ROC analysis showed the optimal sensitivity (82%) and specificity (98%) of PCT as a marker of systemic infection only in the rheumatic patients with its concentration of ≥2.3 ng/ml. Conclusion. The determination of PCT is certain to contribute to the diagnosis of generalized infections and the differential diagnosis of systemic rheumatic diseases and infectious ones.

Diagnostic and prognostic values of serum procalcitonin and C-reactive protein in patients of bacterial sepsis

To explore the diagnostic and prognostic values of serum procalcitonin (PCT) and C-reactive protein (CRP) in patients of bacterial sepsis. From July 2012 to May 2013, a total of 120 critically ill patients at our intensive care unit (ICU) were recruited. They included septic (sepsis group, n = 63) local infection (local infection group, n = 57) and healthy people (control group, n = 30). The serum levels of PCT and CRP were measured. Septic patients were divided into survival and death groups according to the prognosis. They were also divided into gram-positive and gram-negative bacteria groups according to the results of bacterial cultivation. The serum levels of PCT and CRP, as well as acute physiology and chronic health evaluation II (APACHEII) scores and sepsis related organ failure assessment (SOFA) scores in the sepsis group were significantly higher than those in the local infection and control groups (P < 0.05). And those in the local infection group were higher than those in the control group (P < 0.05). The sensitivity, specificity, positive predictive value and negative predictive value for serum PCT in diagnosing bacterial sepsis were significantly larger than those for serum CRP (P < 0.05). The serum levels of PCT and CRP in survival group were less than those in death group at Day 1, 5, 10 and 15 (P < 0.05). Moreover, there were significant time effects on the serum levels of PCT and CRP in the survival group (P < 0.05), but not in the death group (P > 0.05). When PCT was ≥ 10.0 µg/L, the patients of gram-negative bacteria were more than those of gram-positive bacteria (P < 0.05). The serum levels of PCT and CRP are reliable in the diagnostic and prognostic evaluations of bacterial sepsis. Both also have certain reference value for local infection. Moreover the sensitivity and specificity of serum PCT were better those of serum CRP.

Changes of interleukin-6, interleukin-8, tumor necrosis factor-α and soluble form of triggering receptor expressed on myeloid cells-1 in full term neonates with infection

Objective To evaluate and compare the value of interleukin(IL)-6,IL-8,tumor necrosis factor(TNF)-α,and soluble form of triggering receptor expressed on myeloid cells (sTREM)-1 in neonatal infection and detect the relationship between them.Methods Eighty-five full-term newborns who were admitted to the neonatal ward of Shanghai Children's Hospital of Shanghai Jiaotong University were enrolled,according to the locations and severity of infection,the patients were divided into three groups:systemic infection group (n =27),local infection group(n =28),and non-infection group (n =30).The level of plasma sTREM-1 was measured by enzyme-linked immunosorbent assay,and the levels of IL-6,IL-8 and TNF-α were measured using cytometric bead array.Results (1) The levels of sTREM-1,IL-6,IL-8 and TNF-α were significantly higher in infants with systemic infection group than local infection group and non-infection group(P ＜0.05).(2) There were 17 survivors and 10 deaths in systemic infection group,and the level of sTREM-1 in the non-survivor [(121.64 ±49.31) pg/ml] was higher than the survivor[(73.13 ± 34.92) pg/ml,P =0.006].But the levels of IL-6,IL-8 and TNF-α were not statistically significant in the survivor and the death (P ＞ 0.05).(3) Based on the receiver operating characteristic analysis,cutoff values were identified for each variable that maximized both the sensitivity and specificity.These markers were considered positive if sTREM-1 ≥43.75 pg/ml,IL-6 ≥ 89.80 pg/ml,IL-8 ≥569.55 pg/ml and TNF-α ≥ 24.80 pg/ml.Among these indexes,the sensitivities were 85.5％,89.1％,70.1％ and 69.5％ respectively; the specificity were 80.0％,100％,100％ and 93.3％ respectively.Compared the area under curve(AUC) of them,IL-6(AUC =0.981)＞ sTREM-1 (AUC =0.868) ＞ TNF-α (AUC =0.864) ＞ IL-8 (AUC =0.852).sTREM-1 was correlated with IL-6,IL-8 and TNF-α(Spearman coefficient of rank r =0.532,P ＜0.01 ;r =0.420,P ＜0.01 ;r =0.531,P ＜0.01).Conclusion (1) The levels of plasma sTREM-1,IL-6,IL-8 and TNF-α were higher in neonatal infections;(2) sTREM-1 was associated with prognosis; (3) sTREM-1 was correlated with IL-6,IL-8 and TNF-α. Key words: Infection; Soluble form of triggering receptor expressed on myeloid cells-1 ; Interleukin-6; Interleukin-8 ; Tumor necrosis factor-α; Infant,newborn

Bacterial vaginosis and biomarkers of oxidative stress in amniotic fluid

Objective: In this study we tried to determine if the activities of the primary antioxidant enzymes are detectable in amniotic fluid and if they can be used as early biomarkers of complications in pregnancy connected with bacterial vaginosis. Methods: This was a prospective study in which amniotic fluid was taken between 16 and 19 weeks of gestation. 161 pregnant women were divided into two groups: study group—patients with the treated local infection and control group—healthy pregnant women. Levels of reduced glutathione, and the activities of glutathione peroxidase, glutathione reductase, glutathione S-transpherase, xanthine oxidase, superoxide dismutase and lipid peroxidation were determined spectrophotometrically in amniotic fluid samples. Results: Concentration of malonyldialdehide (product of lipid peroxidation) varied greatly between investigated groups. Xanthine oxidase and superoxide dismutase activities, though very low, were present in amniotic fluid samples. Also, enzymes of glutathione cycle and reduced glutathione concentrations were detectable and showed certain variations. Conclusion: Although, biomarkers of antioxidant activity are present in the amniotic fluid, they are not differrent between women with and without bacterial vaginosis.

Biomarkers of oxidative stress in amniotic fluid and complications in pregnancy

Objective. In this study, we tried to determine whether the activities of the primary antioxidant enzymes are detectable in amniotic fluid and whether they can be used as early biomarkers of complications in pregnancy such as pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), and bacterial vaginosis.Methods. This was a prospective study in which amniotic fluid was taken between 16 and 19 week of gestation. In all, 161 pregnant women were divided into two groups: study group – patients with the treated local infection, PIH, and GDM, and control group – healthy pregnant women. Levels of reduced glutathione (GSH) and activities of supeoxide dismutase (SOD), glutathione peroxidase (GSH-Px), glutathione reductase (GSHR), glutathione S-transpherase (GST), xanthine oxidase (XOD) and lipid peroxidation (LP) were determined spectrophotometrically in amniotic fluid samples.Results. Concentration of malondialdehyde varied greatly between investigated groups. XOD and SOD activities, though very low, were present in amniotic fluid samples. Also, enzymes of glutathione cycle and GSH concentrations were detectable and showed certain variations.Conclusion. Parameters of oxidative stress in amniotic fluid could be altered in certain pathological conditions. Their use as clinical biomarkers is limited due to great variations of amniotic fluid volume between patients which gives favor to hemolysate or serum of pregnant women.

The Appearance of Vegetation-Like Mass in Device Pocket Infections

Background: According to HRS guideline revised in 2009, Cardiovascular Implantable Electronic Device (CIED) pocket infection became class I indication for complete system removal. In many institutions, conservative treatments such as antimicrobial therapy, local debridement and relocation of the pacemaker pocket have been considered for the complex lead extraction procedure. The purpose of this study is to evaluate the characteristics of infection in patients with CIED infections. Methods: The pre-operative clinical, microbiological, echocardiographic conditions were analyzed in a retrospective cohort including all consecutive 39 patients diagnosed CIED infections between February 2006 and September 2010. Results: The patients were divided into 2 groups, with local pocket infection (Group I=35) and with elevated CRP·WBC without local pocket infection (Group II=4). Among the patients underwent TEE (Group I=24, Group II=4), the vegetation-like masses (VLMs) were observed in 46% and 75% in each group. Though the blood cultures were positive only in 7.7%, the lead cultures were positive in 58% in Group I. And among 11 patients with VLMs in Group I, 9 patients underwent the lead cultures and it was positive in 56%. In Group II, the blood cultures were positive in 75%. Conclusions: Since the appearance of VLMs is not uncommon in patients with local pocket infection, complete system removal should be considered.

Percutaneous placement of Hickman catheters: comparison of sonographically guided and blind techniques.

We studied the value of sonographically guided puncture of the subclavian vein for placement of indwelling right atrial and permanent subcutaneously tunneled catheters (Hickman) for long-term venous access. The commonly used blind puncture is associated with complications such as pneumothorax, arterial puncture, and hemothorax. The results and complications of 40 sonographically guided punctures and fluoroscopically controlled catheterizations of the subclavian vein (group 1, 31 patients) performed in the radiology department were compared with those of 40 blind percutaneous punctures and fluoroscopically controlled catheterizations (group 2, 29 patients) performed in the operating room. The patients were selected consecutively. The groups were comparable in age, sex, and indication for catheter placement; administration of chemotherapy for hematologic malignancies was the major indication (group 1, 84%; group 2, 83%). All punctures in group 1 were successful; group 2 had two failures (5%). Puncture-related complications occurred significantly more in group 2 (10%) than in group 1 (0%) (p less than .05). These complications were pneumothorax in three cases and hemothorax in one. Complications not related to the puncture technique were prolonged bleeding at the entrance site (groups 1 and 2, two cases each), local infection (group 1, one case), thrombosis (group 1, three cases; group 2, two), catheter sepsis (group 1, 10 cases; group 2, 14), catheter occlusion (group 2, three cases), and catheter migration (groups 1 and 2, two cases each). We conclude that sonographically guided puncture increases the success rate and significantly decreases the puncture-related complications of percutaneous placement of Hickman catheters.