Search

ObjectiveTo investigate a foodborne disease outbreak and identify the pathogenic factors in order to prevent the occurrence of similar incidents.MethodsEpidemiological study， on-site food hygiene investigation， and laboratory testing were used to analyze the cause of outbreak in Company A.ResultsA total of 24 confirmed cases were screened out. The major clinical symptoms were diarrhea （100.0%）， stomachache （100.0%）， and vomiting （41.7%）. Samples from 24 patients were tested positive for Vibrio parahaemolyticus， and were homologous by Pulsed field gel electrophoresis （PFGE） phylogenetic study. According to the result of case-control study， eating glass noodles salad at the dinner and supper on July 16th， 2019 was the risk factor （OR=15.71，95%CI：1.90‒129.71）.ConclusionThis foodborne disease outbreak was caused by glass noodles salad cross contaminated with Vibrio parahaemolyticus.

Objective To evaluate the role of the log odds of positive lymph nodes (LODDS) in predicting the long-term prognosis of patients with thoracic esophageal squamous cell carcinoma (TESCC). Methods We retrospectively analyzed the clinical data of 731 TESCC patients after radical surgery and the prognostic value of LODDS in the whole group of patients, postoperative lymph node-negative (pN0) patients and patients with the number of intraoperative lymph nodes dissected < 12. Results LODDS was significantly correlated with the number of positive lymph nodes and the number of intraoperative lymph nodes dissected (r=0.696, -0.530, all P=0.000). ROC curve analysis showed that the optimal cut-off point of LODDS was -1.028. Multivariate analysis showed that gender, age, location of esophageal lesions, pT stage, number of positive lymph nodes and LODDS value were independent factors for the survival of the whole group and the OS of the patients with the number of intraoperative lymph nodes dissected≥12 (P < 0.05). Gender, age, location of esophageal lesions, pT stage and LODDS value were independent factors affecting the survival of pN0 patients after operation (P < 0.05). pT stage and LODDS value were independent factors affecting the OS of the patients with the number of intraoperative lymph nodes dissected < 12 (P < 0.05). Conclusion LODDS could be used as an independent prognostic index for the patients with different TESCC after radical surgery.

Objective To analyze the effect of postoperative chemotherapy (POCT) on the prognosis of postoperative lymph node-positive thoracic esophageal squamous cell carcinoma (TESCC) patients. Methods We retrospectively analyzed the prognostic factors for 419 lymph node-positive TESCC patients. Results Compared with POCT group, the 1-, 3- and 5-year OS was significantly lower in patients with surgery alone(χ2= 12.802, P=0.000), while there was no significant difference in 1-, 3- or 5-year DFS (χ2=1.159, P=0.282). Multivariate analysis results showed that gender, age, location of lesion, TNM stage, POCT and chemotherapy cycles were the prognostic factors of OS (P < 0.05), and gender and N stage were the independent prognostic factors of DFS (P < 0.05). Hierarchical analysis results showed that POCT increased OS of male patients ≤60 years of age, lower thoracic lesions, lesions ≤5.0 cm and stage ⅢB, compared with surgery alone (P < 0.05), and also increased DFS of men ≤60 years of age (P < 0.05). Conclusion The prognosis of postoperative lymph node-positive TESCC patients is poor, POCT could improve the prognosis of some patients.

Objective: To observe the clinical characteristics and prognosis of patients with acute respiratory distress syndrome (ARDS) in sepsis combined with acute gastrointestinal injury (AGI) of different grades, and to further explore the risk factors associated with the poor prognosis of patients., Methods: The clinical data of patients with septic ARDS admitted to the intensive care unit (ICU) of Tianjin First Central Hospital from March to October 2023 were collected. According to the 2012 European Association of Critical Care Medicine AGI definition and grading criteria, the patients were categorized into AGI grade 0- IV groups. The clinical characteristics and 28-day clinical outcomes of the patients were observed; the risk factors related to the prognosis of patients with septic ARDS combined with AGI were analyzed by using univariate and multivariate Logistic regression; and the receiver operator characteristic curve (ROC curve) and calibration curves were plotted to evaluate the predictive value of each risk factor on the prognosis of patients with septic ARDS combined with AGI., Results: A total of 92 patients with septic ARDS were enrolled, including 7 patients in the AGI 0 group, 20 patients in the AGI I group, 38 patients in the AGI II group, 23 patients in the AGI III group, and 4 patients in the AGI IV group. The incidence of AGI was 92.39%. With the increase of AGI grade, the ARDS grade increased, and acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), intra-abdominal pressure (IAP), white blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LYM), lymphocyte percentage (LYM%), and 28-day mortality all showed a significant increasing trend, while the oxygenation index (PaO 2 /FiO 2 ) showed a significant decreasing trend (all P < 0.05). Pearson correlation analysis showed that APACHE II score, SOFA score, and ARDS classification were positively correlated with patients' AGI grade (Pearson correlation index was 0.386, 0.473, and 0.372, respectively, all P < 0.001), and PaO 2 /FiO 2 was negatively correlated with patients' AGI grade (Pearson correlation index was -0.425, P < 0.001). Among the patients with septic ARDS combined with AGI, there were 68 survivors and 17 deaths at 28 days. The differences in APACHE II score, SOFA score, ARDS grade, AGI grade, PaO 2 /FiO 2 , IAP, AGI 7-day worst value, length of ICU stay, and total length of hospital stay between the survival and death groups were statistically significant. Univariate Logistic regression analysis showed that SOFA score [odds ratio (OR) = 1.350, 95% confidence interval (95%CI) was 1.071-1.702, P = 0.011], PaO 2 /FiO 2 (OR = 0.964, 95%CI was 0.933-0.996, P = 0.027) and AGI 7-day worst value (OR = 2.103, 95%CI was 1.194-3.702, P = 0.010) were the risk factors for 28-day mortality in patients with septic ARDS combined with AGI. Multivariate Logistic regression analysis showed that SOFA score (OR = 1.384, 95%CI was 1.153-1.661, P < 0.001), PaO 2 /FiO 2 (OR = 0.983, 95%CI was 0.968-0.999, P = 0.035) and AGI 7-day worst value (OR = 1.992, 95%CI was 1.141-3.478, P = 0.015) were the independent risk factors for 28-day mortality in patients with septic ARDS combined with AGI. ROC curve analysis showed that SOFA score, PaO 2 /FiO 2 and AGI 7-day worst value had predictive value for the 28-day prognosis of patients with septic ARDS combined with AGI. The area under the ROC curve (AUC) was 0.824 (95%CI was 0.697-0.950), 0.760 (95%CI was 0.642-0.877) and 0.721 (95%CI was 0.586-0.857), respectively, all P < 0.01; when the best cut-off values of the above metrics were 5.50 points, 163.45 mmHg (1 mmHg≈0.133 kPa), and 2.50 grade, the sensitivities were 94.1%, 94.1%, 31.9%, respectively, and the specificities were 80.9%, 67.6%, 88.2%, respectively., Conclusions: The incidence of AGI in patients with septic ARDS is about 90%, and the higher the AGI grade, the worse the prognosis of the patients. SOFA score, PaO 2 /FiO 2 and AGI 7-day worst value have a certain predictive value for the prognosis of patients with septic ARDS combined with AGI, among which, the larger the SOFA score and AGI 7-day worst value, and the smaller the PaO 2 /FiO 2 , the higher the patients' mortality.

Thrombotic microangiopathy (TMA) is a group of highly heterogeneous, acute and severe clinicopathological syndromes, characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia and ischemic injury of end organs. TMA has the characteristics of dangerous condition, multiple organ involvement and high mortality. Patients with severe TMA need to be admitted to intensive care unit (ICU) for organ function support therapy. Early and rapid evaluation, differential diagnosis, and timely and effective treatment are the key to improve the prognosis of TMA patients. Here, we review the pathophysiological changes, diagnosis differential diagnosis, and treatment of the severe TMA in adult.

Objective: To explore the predictive value of acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA) and modified early warning score (MEWS) in evaluating the prognosis of patients in intensive care unit (ICU) of secondary hospitals, and to provide guidance for clinical application., Methods: The clinical data of adult critical patients admitted to the ICU of Wanzhou District First People's Hospital from October 2022 to April 2023 were retrospectively analyzed. According to the clinical outcome of ICU, the patients were divided into improvement group and death group. The general information, blood routine, heart, liver and kidney function indicators, coagulation indicators, blood gas analysis, APACHE II score, SOFA score, qSOFA score, MEWS score at the time of admission to the ICU, the number of cases of invasive mechanical ventilation (IMV) and continuous blood purification (CBP) were compared between the two groups. Univariate analysis was performed, and multivariate Logistic regression analysis was used to analyze the related factors of death. Receiver operator characteristic curve (ROC curve) was used to analyze the predictive value of the four scores in ICU patients., Results: A total of 126 patients were included, of which 45 patients died in the ICU and 81 patients improved and transferred out. Univariate analysis of death-related critically ill patients showed that procalcitonin (PCT), serum creatinine (SCr), blood urea nitrogen (BUN), albumin (ALB), prothrombin time (PT), activated partial prothrombin time (APTT), D-dimer, pH value, HCO 3 - , blood lactic acid (Lac), number of patients treated with IMV and CBP, APACHE II score, SOFA score, qSOFA score and MEWS score were significantly different between the two groups (all P < 0.05). Multivariate Logistic regression analysis showed that the APACHE II score [odds ratio (OR) = 1.115, 95% confidence interval (95%CI) was 1.025-1.213, P = 0.011], SOFA score (OR = 1.204, 95%CI was 1.037-1.398, P = 0.015), MEWS score (OR = 1.464, 95%CI was 1.102-1.946, P = 0.009), and APTT (OR = 1.081, 95%CI was 1.015-1.152, P = 0.016) were independent risk factors affecting the mortality of critically ill patients in the ICU. ROC curve analysis showed that APACHE II, SOFA, qSOFA, and MEWS scores could predict the prognosis of critically ill ICU patients, among which SOFA score had the strongest predictive effect, and the area under the curve (AUC) was 0.808. There was a statistically significant difference in the time required for the four scores (F = 117.333, P < 0.001), among which the MEWS scoring required the shortest time [(1.03±0.39) minutes], and the APACHE II scoring required the longest time [(2.81±1.04) minutes]., Conclusions: APACHE II, SOFA, qSOFA, and MEWS scores can be used to assess the severity of critically ill patients and predict in-hospital mortality. The SOFA score is superior to other scores in predicting severity. The MEWS is preferred because its assessment time is shortest. Early warning score can help secondary hospitals to detect potentially critical patients early and provide help for clinical rapid urgent emergency decision-making.

Objective: To analyze the clinical characteristics of patients inoculated with different vaccines and underlying diseases, infected with the novel coronavirus Omicron variant., Methods: The data of 430 patients infected with the novel coronavirus Omicron variant who were admitted to Tianjin First Center Hospital from January 21, 2022 to March 7, 2022 were collected. A total of 108 patients with Omicron variant infection with underlying diseases were selected and enrolled. The gender, age, body mass index (BMI), history of underlying diseases, vaccination status (vaccination times, vaccination type), clinical symptoms, laboratory test indicators, imaging data, hospitalization time, nucleic acid negative conversion time, re-positivity and antibody titer from the two groups of the patients were collected and analyzed., Results: In the 108 patients, 93 cases received inactivated vaccine and 15 cases received adenovirus vaccine. There was no statistically significant difference between the two groups in terms of gender, age, BMI, disease types, whether completed the fully vaccinated, whether had prime boost and underlying diseases. Both groups had fever, dry cough, sore throat, runny nose and other clinical symptoms, but there were no statistical difference between the two groups. There were no statistically significant differences in laboratory blood routine tests, biochemical indexes, C-reactive protein (CRP) level and the results of chest computed tomography (CT) imaging between the two groups. There were no statistically significant differences in hospitalization days, nucleic acid negative conversion time, whether admission to intensive care unit (ICU), turn re-positive on nucleic acid tests and immunoglobulin M (IgM) antibody titer expression between the two groups, but immunoglobulin G (IgG) antibody titer in adenovirus group was higher than that in inactivated group (g/L: 229.67±26.13 vs. 194.33±61.56, P = 0.020). There were also no significant differences in laboratory examinations, hospitalization days, nucleic acid negative conversion time, turn re-positive on nucleic acid tests and Novel coronavirus antibody titers expression of the patients with booster shots between the inactivated vaccine group and the adenovirus vaccine group., Conclusions: The protection of inactivated virus vaccine is equivalent to adenovirus vaccine in patients with underlying disease Omicron variant infection, and the titer of IgG antibody in patients with adenovirus vaccine is higher than that in patients with inactivated virus vaccine after one week of recovery.

Objective: To evaluate effects of nutrition intervention on nutrition knowledge, attitude and practice and lunch nutrition situation of students in primary school for children of migrant workers in Shanghai, to provide evidence for promoting children 's growth and development and health education., Methods: A total of 4 primary schools for children of migrant workers in Shanghai were selected by stratified cluster sampling in 2014- 2015, and then were randomly assigned to intervention or control group. All students of 4and 5 grades were selected as subject. Nutrition intervention included the school canteen and students. Survey was implemented before and after intervention, and included demographic questionnaire, physical test and nutrition survey using dietary recall., Results: The average rise in quantity of weight, BMI, the power of gripping, nutrition attitude accuracy and paper folding test score in intervention group were significantly higher than control group. Intervention was helpful to improve the awareness rates of dietary guidelines and the favor rate of school lunch. Except fat, the average rise in intake of energy and main nutrients in intervention group were significantly higher than control group. The average rise in intake of food grains, soybeans and soy products and vegetables and the average falling in intake of animal food in intervention group were significantly higher than control group. All of the differences were statistically significant( P < 0. 05). The average intake of energy, main nutrients and some kinds of food in intervention group were more close to the standard., Conclusion: Nutrition intervention has a positive impact on students ' growth and development, nutrition knowledge and attitude, cognitive ability and dietary intake, and should be put into widespread application.

Objective: To investigate the efficacy and safety of daptomycin in Chinese patients with serious infections of Gram-positive coccus., Methods: Clinical data were retrospectively collected from patients who were suspected with Gram-positive coccal infections and received daptomycin treatment between August 2010 and October 2012., Results: A total of 203 Chinese patients from 26 centers were enrolled in our study, including 94 microbiologically diagnosed. Staphylococcus aureus was the most common pathogen (33%, 31/94) with 45.2% (14/31) methicillin-resistant Staphylococcus aureus (MRSA). According to the infection sites, primary bloodstream infection (45.8%, 93/203) was the most frequent, which was followed by skin and soft tissue infections (15.3%, 31/203). Seventy-seven cases (37.9%, 77/203) had bloodstream infections complicated with other infections (37.9%, 77/203), 13 of which were endocarditis. The clinical efficacy of intention-to-treatment (ITT) and modified ITT (MITT) analysis were 70.44% (143/203) and 78.72% (74/94), respectively. Seven patients (3.4%) represented drug-related adverse effect, but no serious adverse effect was reported. Moderate creatine phosphate kinase (CPK) elevation was observed in 4 patients (2%), which returned to normal range after drug withdrawl., Conclusion: Daptomycin is effective and safe for Chinese patients with serious infections of Gram-positive cocci. (registration number NCT10212601).

Objective: To study the feasibility of the acute gastrointestinal injury (AGI) classification standard for evaluation of gastrointestinal function in intensive care unit (ICU) patients, and to discuss its value in administration of early enteral nutrition (EN)., Methods: A perspective study was conducted. 85 patients with AGI admitted to ICU of Tianjin First Center Hospital from January 2013 to June 2013 were enrolled. EN was conducted after ICU admission or within 12-24 hours after high catabolic state. The patients were divided into four groups according to the AGI classification, i.e. grade I, II, III, and IV, and they were treated according to the treatment procedure for AGI. The primary end points were 7-day rate of intake of standard EN, the degree of disease and nutrition, and their correlation with AGI classification. Secondary endpoint was rate of giving EN within 48 hours., Results: Gastrointestinal dysfunction patients accounted for 49.42% (85/172) of the ICU patients, and number of patients in grade I, II, III, IV were 29, 28, 19, 9 respectively. On the first day of ICU stay, there were no statistical differences in age, acute physiology and chronic health evaluation II (APACHEII) score, serum albumin (ALB) and prealbumin (PA) among four groups, and it was demonstrated that the baseline data were comparable. APACHEII score on the seventh day of ICU stay was significantly lower than that on the first day in grade I, II and III patients (grade I: 20.48±2.45 vs. 22.59±2.06, t=-3.120, P=0.031; grade II: 19.34±1.80 vs. 21.65±2.22, t=-4.316, P=0.012; grade III: 20.63±1.34 vs. 23.31±1.70, t=-5.640, P=0.000), and serum PA was significantly increased (grade I: 24.37±6.54 g/L vs. 10.62±7.24 g/L, t=-4.866, P=0.000; grade II: 19.79±12.48 g/L vs. 11.57±8.94 g/L, t=-2.116, P=0.031; grade III: 19.15±8.43 g/L vs. 13.78±6.59 g/L, t=-3.601, P=0.000). On the seventh day of ICU stay, the APACHEII score was higher in grade IV than that in grade I, II and III patients (22.87±3.31 vs. 20.48±2.45, 19.34±1.80, 20.63±1.34, P<0.05 or P<0.01), and PA was obviously lower in grade IV than that in grade I, II and III patients (14.02±8.70 g/L vs. 24.37±6.54 g/L, 19.79±12.48 g/L, 19.15±8.43 g/L, P<0.05 or P<0.01). There was no statistically significant difference among four groups in respect of serum ALB (F=0.454, P=0.722). The rate of giving EN in 24 hours in grade I, II, III, IV patients was 95.4%, 72.1%, 52.0% and 0, respectively (χ2=8.310, P=0.016), and in 48 hours it was 100.0%, 83.0%, 76.0%, and 0 (χ2=5.470, P=0.025). 7-day standard EN intake rate was 100.0%, 88.7%, 84.0% and 34.0% respectively in grade I, II, III, IV patients (χ2=0.720, P=0.017). Correlation analysis showed that there was a negative correlation between AGI classification and rate of giving EN in 1 day (r=-0.62, P=0.04) and 7-day standard EN intake rate (r=-0.76, P=0.02)., Conclusions: AGI classification can be used to estimate the gastrointestinal function of patients with critical illness, and it has a significant correlation with early EN support. An early goal achieving intervention based on the AGI classification can improve the nutritional status and the general state of the patients.