Shandong Provincial Hospital Research Articles

A Retrospective Analysis of the Effect of Tigecycline on Coagulation Function.

A number of clinical trials demonstrated that tigecycline was effective and well tolerated in the treatment of patients with various bacterial infections, but few literatures had shown the coagulopathy induced by tigecycline. To address this concern, we performed a retrospective analysis to assess the impact of tigecycline treatment on coagulation parameters in 50 patients with bacterial infections in our hospital (Shandong Provincial Hospital, China). These patients were treated with tigecycline at Shandong Provincial Hospital in 2015-2016 at either a recommended (50 mg q12h) or a higher dose (100 mg q12h). Coagulation parameters, including Fibrinogen (FIB) levels, prothrombin time (PT), activated partial thromboplastin time (aPTT), platelet count (PLT) and D-dimer, were evaluated in order to assess the impact of tigecycline treatment in these severely infected patients. What we found was that the plasma fibrinogen (FIB) level was 4.63 ± 1.56 g/L before tigecycline treatment, and decreased to 2.92 ± 1.23 g/L during treatment, which was statistically significant (p < 0.001). The mean values of aPTT and PT were significantly increased from 39.58 ± 8.72 to 44.05 ± 10.45 s (p = 0.002), and from 15.37 ± 1.53 to 16.37 ± 2.64 s (p = 0.004), respectively. This study demonstrates that treatment of tigecycline could reduce FIB, prolong aPTT and PT. In conclusion, we advise that it is necessary for practitioners routinely monitor coagulation level in at-rick patient populations treated with tigecycline.

Utility of brain CT for predicting delayed encephalopathy after acute carbon monoxide poisoning.

Delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) is a serious complication that occurs several days or weeks after carbon monoxide (CO) intoxication. This study identified computed tomography (CT) findings in the prediction of DEACMP development. Adults with CO poisoning admitted to Beijing Chaoyang Hospital, Shenyang Ninth People's Hospital, Shanxi Second People's Hospital and Shandong Provincial Hospital in China from January 2013 to January 2016 were retrospectively analyzed. Baseline demographic and clinical characteristics were extracted from the medical records. Brain CT imaging was carried out within 24 h of admission, and an integrated CT score was calculated to semi-quantify lesion severity. Patients were followed-up for 6 months. Baseline characteristics and CT findings were compared among patients who developed DEACMP (DEACMP group) and those who did not (non-DEACMP group). The receiver operating characteristic (ROC) curve analysis was used to examine the utility of integrated CT score for predicting DEACMP. Among the 123 patients included in the analysis, 27 (22.0%) developed DEACMP. The DEACMP and non-DEACMP groups did not differ with regard to age, sex and carboxyhemoglobin (COHb) level at admission. However, compared with the non-DEACMP group, the patients in the DEACMP group had longer onset time of symptoms and duration of exposure to CO, higher acute physiology and chronic health evaluation-II (APACHE-II) score, lower Glasgow Coma Scale (GCS) score, and there was a higher proportion of patients with severe symptoms and brain CT abnormalities (81.5 vs. 51.0%; P<0.05). Integrated CT score in the DEACMP group was significantly higher than that in the non-DEACMP group (73.63 vs. 51.39; P<0.01). ROC curve was used to analyze the utility of integrated CT score in the prediction of DEACMP. The area under the ROC curve was 0.700 (95% confidence interval, 0.584–0.817; P<0.01). In conclusion, brain integrated CT score has the potential to identify DEACMP in patients.

The correlations between distance stereoacuity and levels of control at different far distances in children with intermittent exotropia

Objective: To study the correlations between the distance stereoacuity and the levels of control at different far distance fixations in children with intermittent exotropia. Methods: In this prospective, non-interventional case series study, 52 children with intermittent exotropia (basic, divergence excess and pseudo-divergence excess types, exodeviation angles≥15 PD) admitted to the Shandong Provincial Hospital Affiliated to Shandong University for surgery between August 2014 and March 2015 were enrolled. The distance stereoacuity was tested with the distance Randot stereotest, and the control of exodeviation was assessed at outdoor far distance fixation of 50 m, indoor far distance fixation of 30 m, and indoor distance fixation of 3 m, respectively, using the office-based 6-point control scale proposed by Mohney and Holmes. The distance stereoacuity and control scores of every intermittent exotropia child were tested 3-4 times in a single day with an interval of at least 2 hours. Nonparametric Spearman rank method was used to analyze the correlations between distance stereoacuity and levels of control at three different far distances in children with intermittent exotropia. Results: The mean age of 52 enrolled children (26 males, 26 females) was 7 years (range, 5-12 years), and 192 groups of distance stereoacuity and control scores were got for the 52 children. Positive correlations between the distance stereoacuity and the levels of control at outdoor far distance fixation of 50 m, indoor far distance fixation of 30 m, and indoor distance fixation of 3 m were observed (coefficients of correlations; r=0.489, 0.472, 0.282, all P<0.001). Conclusion: There are correlations between the distance stereoacuity and the levels of control at outdoor far distance fixation of 50 m, indoor far distance fixation of 30 m and indoor distance fixation of 3 m in children with intermittent exotropia, and the former two are found to be stronger than the latter one. (Chin J Ophthalmol, 2019, 55:25-30).

Establishment of a predictive nomogram model for enteral nutrition feeding intolerance in patients with severe acute pancreatitis

Objective To establish a individualized predictive nomogram model for enteral nutrition feeding intolerance (ENFI) by analyzing the risk factors of ENFI in patients with severe acute pancreatitis (SAP) . Methods The clinical data of 188 SAP patients hospitalized in Shandong Provincial Hospital Affiliated to Shandong University from January 2015 to December 2017 were retrospectively collected by objective sampling. Univariate and multivariate Logistic regression analysis were used to identify the independent risk factors of ENFI. R software was used to establish a predictive nomogram model. Bootstrap method was used to validate the nomogram model and ROC curve was used to explore the predictive efficacy of the model in predicting the ENFI. Results A total of 49 cases out of 118 SAP patients developed ENFI, with an incidence of 41.5%. The result of Logistic regression analysis showed that the independent risk factors of ENFI in SAP patients were age≥70 years old (OR=1.377, 95%CI: 1.088-1.743) , fasting blood glucose≥11.0 mmol/L (OR=3.222, 95%CI: 1.545-6.719) , enteral nutrition starting time≥72 h (OR=3.800, 95%CI: 1.541-9.370) , no dietary fiber added (OR=7.419, 95%CI: 2.651-20.760) and intra-abdominal pressure≥15 mmHg (OR=3.881, 95%CI: 1.735-8.679) (P<0.05) . The nomogram model showed that the consistency index for predicting the risk of ENFI in SAP patients was 0.869, while ROC curve showed that the area under the curve for the nomogram model predicting ENFI was 0.857 (95%CI: 0.779-0.931) . Conclusions The independent risk factors of ENFI in SAP patients are age≥70 years old, fasting blood glucose≥11.0 mmol/L, enteral nutrition starting time≥72 h, no dietary fiber added and intra-abdominal pressure ≥15 mmHg. The nomogram established in this study can predict the risk of ENFI in SAP patients with good discrimination and accuracy, which could be used for predicting individual ENFI in SAP patients. Key words: Pancreatitis; Nutrition support; Nomograms; Enteral nutrition; Feeding intolerance; Risk incidence

1821: ADENOVIRAL Β-ARKCT CARDIAC GENE TRANSFER AMELIORATES POST-RESUSCITATION MYOCARDIAL INJURY IN PIGS

1Department of Emergency, Shandong Provincial Hospital affiliated with Shandong University, Jinan, China

Digital Anatomy to Improve Screw Insertion Techniques for Plate-Screw Fixation of the Pubic Body.

Objectives This study aims to investigate screw insertion sites on the pubic body and the safe screw insertion parameters of a plate-screw fixation system based on the premise of avoiding damage to the inguinal canal and disruption of the rectus abdominis at the pubic symphysis and pubic crest. Research Methods Excluding cases with poor image quality, tumors, malformations, and fractures, the data of 80 healthy adults (40 males and 40 females aged from 21 to 83 years old, with an average age of 51.65 years) undergoing a computed tomography (CT) scan of the pelvis between January and June of 2017 were collected from Shandong Provincial Hospital. The CT scans were imported to Mimics® software to reconstruct three-dimensional pelvic models. A 3.5 mm pelvic reconstruction plate was placed starting at the outer edge of the pubic tubercle and along the pelvic brim. The two innermost screw insertion sites were marked. The safe range for the screw insertion sites was then determined. The screw insertion plane was selected to measure the safe screw insertion parameters. The length of the screw, the direction of insertion, and intersex differences were then explored via statistical analyses. Results The medial inclination angles (MIAs) of the screw insertion plane for males and females were 30.42±7.95° and 32.88±10.65°, respectively, with no statistically significant differences. For the medial screw, the maximum anterior inclination angle (MAIA), the maximum screw length, and the maximum posterior inclination angle (MPIA) were 46.51±4.01°, 12.40±9.53 mm, and 11.78±10.22° on average, respectively, with no significant differences by gender (P>0.05). For the lateral screw, the MAIA was 10.35±9.46° and showed no gender differences (P>0.05), but the male group had a greater MPIA (male 11.80±11.00° vs. female 6.23±7.91°, P<0.05) and maximum screw length (male 55.71±6.36 mm vs. female 48.68±8.65, P<0.001). For the tangential screw, the maximum screw length, MIA, and anterior/posterior inclination angle (APIA) were 52.19±8.33 mm, 31.65±9.42°, and 7.53±10.18°, respectively, with no significant differences in the angles by gender (both P>0.05), although the screw length in the male group was significantly longer than that in the female group. Conclusions Insertion of two screws into the pubic body through a plate from the lateral side of the pubic tubercle is safe and can maintain the origin of the rectus abdominis and the integrity of the inguinal canal compared to traditional plate-screw fixation. Considering that the pubic body is thinner on the lateral side, we suggest a more medial inclination angle for the lateral screw.

Medium-Dose VP-16 Intensified Conditioning Regimen Is Effective in Allogeneic Stem Cell Transplantation for Acute Lymphoblastic Leukemia

Objective: Retrospectively analysing the outcome of additional medium-dose etoposide (VP-16 30mg/kg) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) for acute lymphoblastic leukemia (ALL).Methods: From 2010.10.1 to 2018.6.30, 53 ALL patients received allo-HSCT in Shandong provincial hospital. 20 conditioning with medium-dose VP-16 (15 in CR , 5 in refractory and/or relapse disease) (VP-16 group), 33 conditioning without medium-dose VP-16 (32 in CR and 1 in refractory and/or relapse disease) (control group) . The basic conditions of the primary disease, treatment-related toxicity, leukemia-free survival (LFS), overall survival (OS), graft-versus-host disease (GVHD) and relapse-free survival (GRFS), non-relapse mortality (NRM), relapse incidence (RI), GVHD and so on were compared between the two groups.Results: The VP-16 group included more R/R(refractory and/or relapse disease) patients and was associated with improved 3-year-LFS (70.7% vs. 56.5%, p= 0.565) and 3-year-OS (68% vs. 59.4%, p=0.825), although there was no statistical difference. Moreover, the additional of VP-16 lead to reduced incidence of aGVHD (II,III,IV) (10% vs. 30.7%, p=0.146) and cGVHD (9.1% vs 24%, p=0.25), resulting in improved GRFS (63.6% vs. 48.7%, P=0.343). RI was similar between the two group (29.3% vs 27.2%, p=0.76). Meanwhile, the addition of VP-16 enhanced the intensity of conditioning regimen, its NRM was relatively lower than control group (0% vs. 20.2%, P=0.371).Conclusion: The intensified conditioning regimen with medium-dose VP-16 did not increase NRM and GVHD, with tendency to increase OS and LFS, may become an effective pre-treatment scheme in allo-HSCT for ALL. DisclosuresNo relevant conflicts of interest to declare.

Pre-Treatment Derived Neutrophil to Lymphocyte Ratio As a Prognostic Factor in Extranodal Natural Killer/T-Cell Lymphoma

Introduction: Extranodal natural killer/T-cell lymphoma (ENKTL) is an aggressive type of non-Hodgkin lymphoma (NHL), which is relatively more common in Asia. Accumulating evidence suggested that tumor microenvironment and inflammatory response played important roles in determining the clinical course and outcome of human malignancies. Recently, the derived neutrophil to lymphocyte ratio (dNLR) was demonstrated to act as prognostic factor in several malignancies. Nevertheless, the significance of dNLR in ENKTL has not been elucidated to date. The aim of this study is to investigate the prognostic value of dNLR in ENKTL.Methods: We included patients with pathological diagnosis of ENKTL from February 2002 to June 2018 at Shandong Provincial Hospital Affiliated to Shandong University. All the diagnoses were based on the criteria of the WHO 2016 Classifications of the Tumors and Hematopoietic and Lymphoid Tissues. The pretreatment clinical-pathological data, such as age, gender, stage, performance status, serum lactate dehydrogenase (LDH) levels, bone marrow involvement, and neutrophil count and leukocyte count were collected. The dNLR was calculated by absolute neutrophil count divided by (leukocyte count - neutrophil count).The primary end point was overall survival (OS). The secondary end point was progression-free survival (PFS). Survival analyses were performed using the Kaplan-Meier method and log-rank test. Multivariate analyses were performed using Cox proportional-hazards regression model. This study was approved by the Medical Ethical Committee of Shandong Provincial Hospital Affiliated to Shandong University. P<0.05 was considered statistically significant.Results: A total of 33 patients with pathological diagnosis of ENKTL were included in this study, including 26 (78.8%) male patients and 7 (21.1%) female patients. The median age at diagnosis was 50 years (range 13-75 years), and 6 (18.2%) of them were more than 60 years old. Among them, 13 (39.4%) patients were diagnosed at stage I/II with mean dNLR of 1.801 ± 0.832, versus 20 (60.6%) at stage III/IV with mean dNLR of 2.834 ± 1.962 (P=0.047). In addition, elevated serum LDH (P=0.026), distant lympho-node involvement (P=0.013), high β2-microglobulin (β2-MG, P=0.035) and high International Prognostic Index (IPI) score (P=0.044) were also significantly associated with high dNLR at diagnosis of ENKTL (Table 1).To determine the clinical significance of dNLR, cutoff value of 3.6 for dNLR, which was determined by receiver operating characteristic (ROC) analysis, was selected as the best discriminate between patients' survival and death (AUC 0.714, 95%CI 0.524-0.904, P=0.043, Figure 1). Patients were divided into dNLR<3.6 and dNLR≥3.6 groups. Patients with elevated dNLR (≥3.6) presented adverse pre-treatment factors, including elevated serum LDH (P<0.001), high Eastern Cooperative Oncology Group performance status (ECOG PS) score (P=0.004), increased β2-MG (P=0.008) and high IPI score (P=0.018). Kaplan-Meier curve revealed that high dNLR (≥3.6) was related to shorter OS (P=0.001) and PFS (P=0.047) of ENKTL patients (Figure 2-3).We next explored the correlation between clinical characteristics and survival of ENKTL patients by univariate and multivariate analysis. Univariate Cox proportional analysis revealed that high ECOG PS score (≥2, P=0.004), elevated β2-MG (P=0.014), high IPI score (≥2, P=0.007) and elevated dNLR (>3.6, P=0.001) as prognostic factors of poor outcome of patients. To further assess whether dNLR could act as an independent prognostic value for OS, multivariate analysis with Cox proportional hazard model was performed. In the multivariate analysis, which included all independent parameters significantly associated with clinical outcome in univariate analysis, we identified that high dNLR (≥3.6) as an independent prognostic factor for OS in patients with ENKTL (P=0.004).Conclusions: In this study, we validated for the first time the prognostic value of dNLR in ENKTL patients. High dNLR was associated with poor survival of ENKTL. The dNLR may serve as a novel and convenient prognostic factor for untreated ENKTL patients. Further validation of these results in larger cohorts of patients with ENKTL is warranted. DisclosuresNo relevant conflicts of interest to declare.

Safety and efficacy of radiofrequency fetal ablation for monozygotic triplet and quadruplet pregnancies

Objective To investigate the safety and efficacy of radiofrequency fetal ablation (RFA) in the treatment of monozygotic triplet and quadruplet pregnancies. Methods We analyzed retrospectively the clinical data of eight gravidas, including seven monozygotic triplets and one monozygotic quadruplets admitted to the Department of Obstetrics, Shandong Provincial Hospital Affiliated to Shandong University from March 2014 to January 2017. All of the eight women accepted ultrasound-guided selective fetal reduction by RFA to reduce to twins. Descriptive methods were used to analyze the perioperative status of the gravidas, maternal and fetal outcomes and neonatal follow-up. Results (1) In seven cases, the fetuses were deprived of blood flow after one heating cycle of radiofrequency ablation, while in the other, blood flow was stopped after two heating cycles. Heart beats of the reduced fetuses slowed down gradually after RFA, and stopped at 10, 20-25 and 40 minutes after operation in one, four and three cases, respectively. The conserved fetus showed normal heartbeats. (2) All patients accepted regular obstetrical examination after RFA. One was diagnosed with gestational diabetes mellitus at 26 weeks, and hospitalized for 4 d because of preterm labor at 30+6 weeks. One women was hospitalized to receive a two-week tocolysis treatment one day after surgery, and diagnosed with severe preeclampsia at 35 weeks. One patient who had a fever six days after surgery and was hospitalized for antiinfection treatment progressed to inevitable abortion on the day of admission. The other five pregnant women had no abnormalities. (3) Except for one miscarriage, the rest seven cases all continued the pregnancy until delivery by cesarean, among which two with preterm premature rupture of membranes eventually delivered before term (35+1 and 33 weeks), one with severe preeclampsia also preterm delivered (35+4 weeks) and four term deliveries. Apgar scores at 1 and 5 minutes of all newborns were over 7. Three of the 14 newborns were hospitalized and recovered, including one pathological jaundice, one laryngeal stridor and one premature. The last follow-up in September 2018 of all 14 babies did not show any abnormalities. Conclusions RFA is a feasible treatment for monozygotic triplets and quadruplets. Key words: Pregnancy, multiple; Pregnancy reduction, multifetal; Radiofrequency ablation; Pregnancy outcome

Surgical treatment of old die-punch fractures of distal radius

Objective To report the effects of surgical treatment of old die-punch fractures of the distal radius. Methods A retrospective study of case series was made of the 21 old die-punch fractures of the distal radius which had been surgically treated from January 2012 to January 2017 at Department of Orthopaedics, Shandong Provincial Hospital. There were 13 males and 8 females, aged from 34 to 63 years (average, 46.9 years). According to the preoperative definite diagnoses by the X-ray and CT images, there were 14 metacarpal compression fractures and 7 dorsal compression fractures. The palmar approach was used in 13 cases, the dorsal approach in 7 and the combined approach in one. Autogenous iliac bone grafting was performed for all the cases. Their preoperative and postoperative Cooney scoring and visual analogue scale (VAS) of the wrist, and postoperative complications as well, were observed and recorded. Results This cohort was followed up for 8 to 14 months (average, 9.2 months). All their postoperative wounds healed by the first intention. Their Cooney functional scores of the wrist were, respectively, 58.5±4.2 and 84.0±3.1 points preoperatively and at the final follow-up, and their corresponding VAS scores 7.6±0.9 and 3.4±1.3 points, showing significant differences between preoperation and the final follow-up (P<0.05). Carpal arthritis was observed in one case. Conclusion For old die-punch fractures of the distal radius, surgical treatment can obviously reduce pain, improve function of the wrist and enhance the quality of life of the patients. Key words: Wrist joint; Fracture fixation, internal; Range of motion, articular; Die-punch fractures

Clinical observation of the effect of prophylaxis on allodynia in patients with migraine.

ObjectiveThe clinical characteristics of migraine with and without allodynia were compared to evaluate the risk factors of cutaneous allodynia in migraine. The effects of prophylactic therapy on allodynia in patients with migraine were assessed based on the change in pain threshold after therapy.Patients and methodsA total of 71 patients with migraine admitted to the Department of Neurology of Shandong Provincial Hospital were recruited in this study. The included patients were aged 18–70 years and did not present positive symptoms according to the nervous system examination. The variation in cutaneous allodynia was assessed for the role of classic prophylactic therapy in migraine-related allodynia, also termed as central sensitization (CS). Patients with migraine were randomized into two groups (topiramate and flunarizine groups), and the effect of drugs was evaluated by the change in cutaneous pain threshold between the two groups. Fifty-five patients were tested for pain threshold due to instrument failure. Pressure allodynia was measured with a force gage, and pricking was measured with Electronic von Frey Anesthesiometer. The pain threshold was measured every 3 months for 6 months. The variations in pain threshold after treatment were compared using t-test and χ2 test.ResultsAllodynia was seen in 70.4% of the patients; of these, 76.3% were females. Female gender, duration of illness, and frequency of migraine attacks per month were significantly associated with allodynia. The rate of allodynia and frequency of headache declined significantly, the number of patients with allodynia was reduced, and the pain threshold improved dramatically after treatment. The composite adverse events were low after treatment with topiramate and flunarizine.ConclusionAllodynia was observed, especially in females who experienced frequent migraine attacks for a prolonged period. Gender, duration of illness, and number of migraine attacks per month were the major predictors of allodynia. Topiramate and flunarizine administered orally for a short duration can effectively improve the pain threshold and CS of patients with migraine, and efficiently relieve allodynia.

Diagnosis and survival values of neutrophil-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) in esophageal cancer

BackgroundRecent studies have borne out claims that inflammation has a vital role in the development and progression of many diseases, including cancers. It has been reported that neutrophil-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) could act as independent prognostic factors for several malignant tumors. We evaluated the diagnosis and prognosis values of preoperative inflammatory indicators, including NLR and RDW in esophageal cancer (EC). MethodsWe retrospectively analyzed the clinical data of 354 EC patients and 220 early esophageal cancer (EEC) undergoing potentially curative esophagectomy in Shandong Provincial Hospital Affiliated to Shandong University and chose 201 age and sex-matched healthy volunteers as the control group. We compared the clinicopathological features, survival curves and prognosis of the EC patients between the high and low groups according to the cutoff values of NLR and RDW. ResultsSignificant higher preoperative NLR and RDW values were detected in patients with EEC and EC compared to the healthy controls (P < .001). A high RDW was significantly associated with an older age (P < .05). NLR and RDW values after surgery in EC group were significantly higher than those before surgery (P < .001 and P < .001, respectively). For EEC group, a higher RDW value showed a significantly worse overall survival (OS) and disease-free survival (DFS) (P = .040 and P = .013, respectively). For EC group, an increased NLR indicated a significantly association with poor overall survival (OS) (P = .004) and DFS (P = .001). Preoperative NLR can act as an independent prognostic indicator for EC. ConclusionThe preoperative NLR and RDW are convenient, practical easily measured biomarkers of clinical diagnosis and prognostic assessment of patients with EC. Furthermore, NLR was more effective than RDW acting as an independent prognostic biomarker for EC.

Effect of early nursing intervention on promoting physical and mental development of premature low birth weight infants

Objective To explore the effects of early care intervention on promoting physical and mental development in premature low birth weight infants. Methods A total of 78 cases of preterm low birth weight infants in Shandong Provincial Hospital Affiliated to Shandong University from January to August 2016 were selected by random number table method, and randomly divided into control group and observation group, with 39 cases in each group. The control group was given routine neonatology nursing, while the observation group was given early care intervention on the basis of control group. The intelligence development status of the two groups was evaluated after intervention, and the height and weight of the children were measured. Results There were significant differences in intelligence development index, motor development index, sensory development index, height and weight between the two groups after intervention (P<0.05) . Conclusions Early care intervention is helpful to the physical and intellectual development of premature low birth weight infants, can better improve the prognosis of children, and promote their healthy growth. Key words: Infant, premature; Low birth weight infants; Early care intervention; Intelligence; Physical development

Clinical and imaging characteristics of pediatric neuromyelitis optica spectrum disorders

Objective To analyze the clinical and imaging characteristics of pediatric neuromyelitis optica spectrum disorders(NMOSD) in children. Methods The clinical data, imaging manifestations and follow-up data of 16 NMOSD patients at Department of Pediatric Neurology, Shandong Provincial Hospital Affiliated to Shandong University between July 2013 and September 2017 were respectively analyzed. Results In 16 patients, initial presentations included optica neuritis(ON) in 5 cases, longitudinally extensive transverse myelitis(LETM) in 6 cases, and among them there were 2 cases with acute disseminated encephalomyelitis and 3 cases with both ON and LETM. Eleven cases received aquaporin-4(AQP4) antibody examination and 4 cases were found seropositive.One case out of 7 detected cases was found AQP4 antibody positive in cerebrospinal fluid.Eleven cases received optica magnetic resonance imaging (MRI), and 8 cases were found abnormal signals in optic nerve and optica chiasma.The spinal cord MRI showed 13 cases with LETM manifestations, and abnormal signals were found in vertebral segments(5-13), and among them 1 case had cervical cord, 3 cases were thoracic cord and 9 cases were both of the above.Lesions in the cervical cord in 2 cases were extended upward to the medulla.Fifteen cases received brain MRI and all of them had brain lesions, which were mainly involved in the central and subcortical white matter, thalamus, corpus callosum, brainstem, the junction of spinal cord and medulla, cerebellum, and so on.All patients received treatment for acute attacks with high-dose Methylprednisolone and/or gamma globulin and got obvious relief.Two cases with recurrent ON received treatment of Rituximab and their vision became improved.Fifteen patients were followed up, and 2 cases had limb disorders and 4 cases had visual impairment, other patients had no clinical symptoms. Conclusions Pediatric NMOSD has a diverse clinical pre-sentation at the onset disease.Those who are initial diagnosed acute myelitis, ON and acute disseminated encephalomyelitis should be considered the possibility of NMOSD.Antibody to AQP4 testing can assist the diagnosis.The typical imaging characters of NMOSD children are abnormal signals in the high expression area of AQP4.Intracranial lesions are more common in children.The acute treatment includes the high-dose Methylprednisolone and gamma globulin.Rituximab can be used for the recurrent patients. Key words: Neuromyelitis optica spectrum disorders; Aquaporin-4; Child

Homology analysis of Carbapenems-resistant klebsiella pneumoniae by MALDI-TOF MS

Objective To evaluate the ability of matrix-assisted laser desorption/ionization-time of flight mass spectrometry(MALDI-TOF MS) in the homology analysis of Carbapenems-resistant klebsiella pneumonia. Methods Twenty-one non-duplicated strains of Carbapenems-resistant klebsiella pneumoniae were isolated from Shandong Provincial Hospital affiliated to Shandong University during April 2011 and October 2013 in this study. Twenty isolates were from neonatal unit and one from cardiac surgery. The homology analysis of Carbapenems-resistant klebsiella pneumoniae was performed with pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and MALDI-TOF MS respectively. Results The result of PFGE was consistent with MLST. The twenty-one CRKPN strains were divided into three groups by MALDI-TOF MS according to their relationship, 18 of them belonged to II group, and the homology was higher than 75%. From the analysis of protein mass spectra of 18 strains, the protein peaks were roughly the same. Thus, it was concluded that their relationship was close, and the results were basically consistent with the results of PFGE and MLST. The H13 strain with low homology (<60%) was different from the above strains, especially in the molecular weight 4365, 5381 and 6289.The PFGE analysis showed that the homology between H13 and other strains was 61%, and the MLST classification result was ST54. Conclusions MALDI-TOF MS can be used to identify CRKPN accurately and analyze its homology analysis more conveniently than other methods in clinical laboratory. MALDI-TOF MS has the potential to be used as an easy and rapid epidemiology typing tool for nosocomial infection investigation caused by drug-resistant bacteria.(Chin J Lab Med, 2018, 41: 589-595) Key words: Klebsiella pneumoniae; Carbapenems; Drug resistance, bacterial; Sequence homology; Spectrometry, mass, matrix-assisted laser desorption-ionization

Correlation between auditory-vestibular functions and estrogen levels in postmenopausal patients with Meniere's disease.

To investigate auditory and vestibular functions, estrogen levels, and its clinical correlation in postmenopausal females with Meniere's disease (MD). We retrospectively analyzed the serum estradiol (E2) levels and the auditory and vestibular functions measured by auditory brainstem response (ABR) to high click rate, pure-tone audiometry (PTA), and caloric test on postmenopausal women who suffered from MD or not at the Specialist Clinic of Vertigo, Shandong Provincial Hospital, during September 2010 to October 2014. A total of 76 postmenopausal patients with MD and 50 healthy postmenopausal controls were included. The patients with MD had lower estrogen levels (22.50±16.66pg/mL vs 30.69±18.59pg/mL, P=0.011), longer I-V interpeak latency of ABR (left 0.22±0.16mseconds vs 0.18±0.10mseconds, P=0.118; right 0.24±0.13mseconds vs 0.17±0.09mseconds, P=0.001), and higher unilateral weakness (UW) value (P<0.001) in comparison with the controls. The mean pure-tone thresholds of at the speech frequency (500Hz, 1 kHz, 2 kHz, and 3 kHz) were significantly elevated in patients with MD than those in the controls (left P<0.001, right P<0.01). The estradiol level of patients with MD was correlated with ABR latency (left r=-0.229, P<0.05; right r=-0.220, P<0.05) and UW value (r=-0.328, P<0.05), but not with mean pure-tone threshold. Estrogen levels correlated with auditory and vestibular function in postmenopausal patients with MD. Low estrogen may be involved in the microcirculatory disturbance of the inner ear, affecting the occurrence and development of MD.

Prognostic and predictive value of the macroscopic growth pattern in patients undergoing curative resection of colorectal cancer: a single-institution retrospective cohort study of 4,080 Chinese patients.

PurposeThe purpose of this study was to determine whether macroscopic growth patterns had an impact on the prognosis of colorectal cancer (CRC) patients with different tumor–node–metastasis (TNM) stages and responses to chemotherapy in stage III patients.Patients and methodsWe retrospectively recruited 4,080 stage I–III CRC patients who underwent curative resection at Shandong Provincial Hospital affiliated to Shandong University. All patients were grouped by macroscopic growth patterns (expansive, infiltrative and ulcerative subtypes), and stage III patients were further divided into chemotherapy and nonchemotherapy groups. Kaplan–Meier methods, univariate and multivariate analyses and subset analyses were performed to assess the overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS).ResultsKaplan–Meier survival curves and univariate analyses revealed better OS (HR=0.731; 95% CI=0.584–0.916), CSS (HR=0.714; 95% CI=0.548–0.932) and DFS (HR=0.722; 95% CI=0.602–0.864) in the expansive subtype and worse OS (HR=2.121; 95% CI=1.457–3.088), CSS (HR=2.499; 95% CI=1.664–3.753) and DFS (HR=2.360; 95% CI=1.756–3.170) in the infiltrative subtype. Subset analyses based on the tumor–node–metastasis stage showed that the infiltrative subtype was associated with inferior DFS in stage II (HR=2.357; 95% CI=1.210–4.595) and stage III patients (HR=1.941; 95% CI=1.394–2.702) and inferior OS and CSS in stage III patients (HR=1.805; 95% CI=1.210–2.693 and HR=1.981, 95% CI=1.280–3.065, respectively). In addition, multivariate Cox proportional hazard regression models revealed similar results. Furthermore, in stage III patients, the OS, CSS and DFS in both the expansive and ulcerative subtypes were significantly extended after the administration of chemotherapy (all, P<0.001). However, the OS, CSS and DFS in the infiltrative subtype did not change significantly after the administration of chemotherapy (P=0.486, 0.290 and 0.731, respectively).ConclusionThe macroscopic growth pattern was an independent prognostic factor among stage I–III CRC patients. The infiltrative subtype had the worst prognosis in stage III patients and did not display survival benefits from chemotherapy.

Genotype-Phenotype Correlation Study and Mutational Analysis in a Chinese Cohort with 21-Hydroxylase Deficiency

Background: Steroid 21-hydroxylase deficiency (21OHD) is the most common enzymatic defect. Genotype-phenotype associations were concluded in different ethnic group. However, such correlations have not been well established in Chinese. This study aimed to analyze this correlation in a Chinese 21OHD cohort and the function of four novel mutations of CYP21A2 gene. Methods: A Chinese 21OHD cohort was enrolled to investigate the clinical, biochemical, and genetic characteristics of this disorder. Symptoms and laboratory findings of all the members were collected. Mutation analysis of CYP21A2 gene, 21-hydroxylase activity assays and in silico predictions of protein structure were performed. Genotype and phenotype associations were analyzed in both the cohort and 487 Chinese CAH patients ever reported. Findings: Among the total cohort, 47 patients (65.3%) were diagnosed as SW phenotype, 11 (15.3%) were SV type and 14 (19.4%) were NC type. Interestingly, the value of FSH and LH for the prediction of the severe SW phenotype was up to 0.862 and 0.669, respectively. Overall, the detection rate of CYP21A2 mutation was 97.9%, which revealed 25 mutations and 36 genotypes. Four novel mutations (p.L199X, p.E321del, p.H393Q and p.L459-P464del) were detected. All these four mutations were predicted to destroy 21-hydroxylase three-dimensional structure and induced a significantly reduced CYP21 activity of less than 5% compared with the wild type. Interpretation: A high consistency of genotype-phenotype association was found in SW CAH and a less matched correlation in SV and NC CAH. Moreover, FSH and LH levels were proved to be a promising marker for predicting the severity of the disease. Funding: This work was supported by grants from the National Natural Science Foundation (No. 81370891 and No. 81670720), Special Funds for Taishan Scholar Project (No. tsqn20161071). Declaration of Interests: The author reports no conflicts of interest in this work. Ethical Approval Statement: This study was approved by the Ethics Committee of the Shandong Provincial Hospital. Written informed consent was obtained from all patients or their guardians.

Evaluating analytical quality in clinical biochemistry laboratory using Six Sigma.

IntroductionIn recent years, Six Sigma metrics has became the hotspot in all trades and professions, which contributes a general procedure to explain the performance on sigma scale. Nowadays, many large companies, such as General Healthcare, Siemens, etc., have applied Six Sigma to clinical medicine and achieved satisfactory results. In this paper, we aim to evaluate the process performance of our laboratory by using Sigma metrics, thereby choosing the correct analytical quality control approach for each parameter.Materials and methodsThis study was conducted in the clinical chemistry laboratory of Shandong Provincial Hospital. The five-months data of internal quality control were harvested for the parameters: amylase (AMY), lactate dehydrogenase (LD), potassium, total bilirubin (TBIL), triglyceride, aspartate aminotransferase (AST), uric acid, high density lipoprotein-cholesterol (HDL-C), alanine aminotransferase (ALT), urea, sodium, chlorine, magnesium, alkaline phosphatase (ALP), creatinine (CRE), total protein, creatine kinase (CK), total cholesterol, glucose (GLU), albumin (ALB). Sigma metrics were calculated using total allowable error, precision and percent bias for the above-mentioned parameters.ResultsSigma values of urea and sodium were below 3. Sigma values of total protein, CK, total cholesterol, GLU and ALB were in the range of 3 to 6. Sigma values of AMY, uric acid, HDL-C, TBIL, ALT, triglyceride, AST, ALP and CRE were more than 6.ConclusionAmylase was the best performer with a Sigma metrics value of 19.93, while sodium had the least average sigma values of 2.23. Actions should be taken to improve method performance for these parameters with sigma below 3.

A nomogram prediction of postoperative pulmonary complications in patients undergoing lung cancer surgery

Objective To analyze the risk factors for postoperative pulmonary complications (PPC) in patients undergoing lung cancer surgery to establish a nomogram model to predict the risk of PPC. Methods From January 2014 to October 2017, 316 patients undergoing lung cancer surgery at Shandong Provincial Hospital Affiliated to Shandong University were enrolled in this study. Their clinical data were analyzed and univariate analysis was used to determine the risk factors related to PPC. The significant variables were included in the multivariate logistic regression analysis to analyze the independent risk factors for PPC. Then the R software was used to establish a predictive nomogram model. Bootstrap method was used to validate the nomogram model and ROC curve was used to explore the predictive efficacy of the model in predicting the PPC. Results A total of 55 cases out of 316 patients undergoing lung cancer surgery had PPC. The prevalence rate was 17.4%. Age (OR=1.151, 95% CI 1.041-1.274), chronic obstructive pulmonary disease (COPD) (OR=3.659, 95%CI 1.498-8.939), smoking index (OR=1.171, 95% CI 1.055-1.300), pN stage (N1: OR=6.686, 95%CI 1.959-22.814; N2:OR=7.714,95%CI 2.390-24.900; N3: OR=15.943, 95%CI 4.318-58.869)and the poor compliance of breathing exercise (OR=1.298, 95%CI 1.031-1.635) were all independent risk factors for PPC. The nomogram model showed a conformance-index of 0.841, while ROC curve showed that the area under the curve for the nomogram model predicting pressure sores was 0.820 (95% CI: 0.760-0.881). Conclusions The nomogram built based on age, COPD, smoking index, pN stage, and the poor compliance of breathing exercises has good discrimination and accuracy which could be used for predicting individual PPC risk and screening the patients with high risk, with potentially high clinical application value. Key words: Lung neoplasms; Postoperative complications; Forecasting nomograms