嗜酸性粒细胞计数与冠心病危险因素相关分析

目的 探讨白细胞中的嗜酸粒细胞计数与冠心病影响因素的相关性.方法 收集128例非急性冠状动脉造影患者一般资料,进行血细胞参数、生化指标等检测.冠状动脉造影确定冠状动脉病变部位及损伤程度.根据嗜酸性粒细胞计数分组,进行趋势分析,判断冠心病患者危险因素与嗜酸性粒细胞计数相关性.结果 患者按嗜酸性粒细胞计数分三组(＜0.1×109/L;0.1～0.2×109/L;＞0.2×109/L).嗜酸性粒细胞增高与男性性别、经皮冠状动脉介入治疗或冠脉再造术呈正相关.嗜酸性粒细胞增高与血小板计数、血红蛋白、白细胞计数、血肌酐、甘油三酯、糖化血红蛋白等冠心病危险因素呈正相关(P＜0.01),与高密度脂蛋白呈负相关(P＜0.01).趋势分析显示,多支血管病变、左主干病变、冠脉内血栓、慢性阻塞、支架内再狭窄等参数在不同嗜酸性粒细胞分组中的差异有统计学意义(P＜0.05).结论 嗜酸性粒细胞增高与冠心病患者的危险因素有一定关联.     

不同术式治疗结核性脓胸的手术疗效及对胸水中嗜酸性粒细胞计数的影响

目的探讨不同术式治疗结核性脓胸的手术疗效及对胸水中嗜酸性粒细胞计数的影响。方法选取本院2014年2月~2016年6月收治的结核性脓胸患者57例,根据不同的手术方式分为3组,每组各19例,第1组行胸膜纤维板剥脱术,第2组行带蒂肌瓣胸腔内移植术,第3组行胸廓成形术。观察并对比3组的临床疗效以及术前、术后1周、术后1个月3组患者胸水中嗜酸性粒细胞的变化情况。结果第1组患者治疗后临床有效率94.74%,明显高于第2组84.21%和第3组78.95%(P0.05),第2组与第3组比较疗效相当(P0.05)。3组患者中共有23例患者出现嗜酸性粒细胞增多现象,第1组患者嗜酸性粒细胞增多发生率21.05%,明显低于第2组52.63%和第3组47.37%(P0.05)。术后1周第1组患者胸水中嗜酸性粒细胞较第2组、第3组下降更明显(P0.05),但仍高于正常值。术后1个月3组患者胸水中嗜酸性粒细胞均降至正常值10%以下,3组比较无显著差异(P0.05)。3组患者术后随访6个月~1年发现2例(3.51%)脓胸复发,其中第2组、第3组各1例。结论胸膜纤维板剥脱术治疗结核性脓胸临床疗效显著,胸水中嗜酸性粒细胞可降至正常水平,值得临床推广应用。     

AMI患者PCI术后再发的危险因素分析

目的:探讨急性心肌梗死(Acute myocardial infarction,AMI)患者经皮冠状动脉介入治疗(Percutaneous Coronary Intervention,PCI)术后再发的危险因素,并分析其观察要点。方法:选择2018年1月至2019年3月在我院接受PCI治疗的185例AMI患者进行研究。术后行常规治疗,患者均随访12个月,记录PCI术后再发情况。收集患者性别、年龄等一般资料,分析AMI患者PCI术后再发的危险因素。结果:本研究185例患者中共30例(16.22%)患者出现术后再发。年龄(OR=1.516,95%CI=1.231~1.794)、体质指数(Body mass index,BMI)(OR=1.893,95%CI=1.534~2.558)、有糖尿病史(OR=1.682,95%CI=1.343~2.095)、多支病变(OR=1.557,95%CI=1.204~1.979)、术前Killip分级Ⅱ~Ⅳ级(OR=1.651,95%CI=1.203~2.394)、支架长度(OR=1.527,95%CI=1.194~1.858)及支架数量(OR=1.927,95%CI=1.691~2.842)是AMI患者PCI术后再发的危险因素;服药依从性(OR=0.523,95%CI=0.233~0.747)及支架直径(OR=0.412,95%CI=0.288~0.617)为保护因素(P<0.05)。结论:AMI患者PCI术后再发与患者年龄、BMI、糖尿病史等多方面因素有关,临床上应针对上述因素采取积极的预防措施以降低患者术后再发风险。     

冠状动脉旁路移植术后患者情绪障碍发生特征及影响因素

目的:探讨冠状动脉旁路移植术后患者情绪障碍发生特征及影响因素。方法:选取2018年1月1日-6月30日在我院行冠状动脉旁路移植术的200例冠心病患者作为研究对象,以有、无情绪障碍将其分为研究组114例和对照组86例,采用汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)对两组焦虑、抑郁症状情况进行调查,并采用单因素分析以及Logistic逐步回归分析患者冠状动脉旁路移植术后患者情绪障碍发生影响因素,并对调查结果进行分析。结果:冠状动脉旁路移植术后情绪障碍发生率为57.00%,抑郁症状得分为(18.14±3.56)分;单因素分析结果显示:性别、医疗费用支付方式、既往合并抑郁病史等因素与冠状动脉旁路移植术后情绪障碍相关(χ~2=13.142,P0.001;χ~2=3.949,P=0.047;χ~2=5.235,P=0.022);Logistic逐步回归分析结果显示:女性、既往抑郁病史为冠心病患者经冠状动脉旁路移植术后情绪障碍发生的独立预测因素[Or=2.14(1.33～3.44),Or=2.18(1.33～3.56)]。结论:冠状动脉旁路移植术后患者焦虑、抑郁症状发生率较高。     

术前外周血NLR 和PLR 在结直肠癌预后评估中的价值

目的:探讨术前外周血中性粒细胞计数与淋巴细胞计数比值(NLR)、血小板计数与淋巴细胞计数比值(PLR)对行结直肠癌根治术后患者预后的预测价值。方法:回顾性分析2007年至2012年就诊于湖南省常德市第一人民医院普外科行根治性手术且术后,随访资料完整的237例结直肠癌患者的临床资料。用ROC曲线确定NLR和PLR的Cut-off值后,分为高NLR/PLR组和低NLR/PLR组,比较两组患者的术后总体生存期。结果:NLR和PLR的Cut-off值分别是5. 26和169. 18;与低NLR水平患者相比较,高NLR水平患者的总体生存期明显低于低NLR水平患者(χ2=34. 252,P0. 001);与低PLR水平患者相比较,高PLR水平患者的总体生存期明显低于低PLR水平患者(χ2=28. 698,P0. 001); COX单因素回归分析或多因素回归分析均支持NLR (HR=5. 493,95%CI:2. 891～10. 437,P0. 001; HR=3. 508,95%CI:1. 675～7. 345,P=0. 001)或PLR(HR=5. 094,95%CI:2. 624～9. 887,P0. 001; HR=2. 092,95%CI:1. 006～4. 348,P=0. 048)可能是评判结直肠癌预后的独立风险因素。结论:NLR和PLR可用于评估结直肠癌患者的预后,NLR≥5. 26或PLR≥169. 18提示预后差。     

天津市18岁及以上社区人群睡眠质量调查

目的:了解天津市18岁及以上居民睡眠质量及相关因素。方法:调查对象来源于2011年7月-12月进行的天津市精神障碍流行病学调查项目,有11618名18岁及以上社区居民完成匹兹堡睡眠质量指数量表(PSQI)对睡眠质量的评估,以及一般健康问卷(GHQ-12)对是否可能存在心理障碍的筛查。PSQI总分7分为低睡眠质量。用χ2检验分析各变量组间低睡眠质量检出率的差异,多因素logistic回归分析睡眠质量的相关因素。结果:11618人中低睡眠质量980人,调整后天津市低睡眠质量的检出率为6.6%。Logistic回归分析显示:女性(OR=1.47,95%CI:1.19~1.82)、年龄越大(30~39岁OR值1.72,95%CI:1.10-2.69;40~49岁OR值2.55,95%CI:1.66-3.91;50~59岁OR值4.41,95%CI:2.85-6.83;60~69岁OR值5.34,95%CI:3.32-8.59;70岁及以上OR值5.40,95%CI:3.21-9.08)、医疗花费为自费(OR=1.52,95%CI:1.15~2.00)、职业为失业/无业(OR=1.46,95%CI:1.05~2.03)或离/病退(OR=1.45,95%CI:1.02~2.06)、吸烟(OR=1.49,95%CI:1.22~1.83)、因躯体疾病难以从事日常工作或活动(OR=2.30,95%CI:1.85~2.85)、GHQ-12得分≥4分(OR=6.51,95%CI:5.46~7.46)为低睡眠质量的危险因素。结论:天津市18岁以上居民低睡眠质量的检出率虽然较同类研究低,但睡眠问题依然值得关注。女性、年龄较大、医疗自费、无职业、有躯体疾病及可能存在心理障碍是低睡眠质量的相关因素。     

肺结节患者影像学特征分析

目的探讨恶性肺结节患者影像学信息的相关危险因素及保护因素。方法收集454例肺结节患者的一般个人信息和影像学信息,其中恶性312例,良性142例。校正个人信息中的混杂因素后,应用非条件Logistic回归方法,根据各因素的优势比(OR值)及其95%置信区间(95%CI)分析影像学中恶性肺结节的相关危险及保护因素。结果个人信息中有统计学差异的混杂因素包括:年龄较大(55岁及以上,OR=4.112;75岁及以上,OR=3.616)、有既往肿瘤史(OR=3.206)。校正个人信息后,恶性肺结节患者影像学信息中的危险因素包括有淋巴结肿大(OR=2.734,95%CI:1.257~5.946)、结节直径2 cm及以上(OR=10.477,95%CI:2.229~49.251)、呈现毛玻璃结节(OR=14.569,95%CI:3.320~63.928)、边缘粗糙(OR=3.113,95%CI:1.632~5.939)、有分叶(OR=4.508,95%CI:2.326~8.736)、有空泡征(OR=5.173,95%CI:1.920~13.940)、有胸膜凹陷征(OR=2.076,95%CI:1.078~3.999),保护因素为结节有钙化(OR=0.208,95%CI:0.091~0.479)。结论在关注年龄较大、有既往肿瘤史的患者同时,也要关注胸部影像中呈现淋巴结肿大、结节直径大、毛玻璃结节、边缘粗糙、有分叶、有空泡征、胸膜凹陷症、结节无钙化的患者。     

江苏盐城地区留守儿童抑郁状况及相关因素

目的:了解江苏盐城地区留守儿童的抑郁状况及相关的影响因素。方法:采用自制的一般资料问卷及儿童抑郁问卷(Children's Depression Inventory,CDI)对盐城地区3所农村中心小学356名留守儿童进行调查。结果:留守儿童的抑郁检出率为25.6%。Logistic回归分析显示,与父母交流频率为每半年(P0.001,OR=7.321,95%CI=2.876~15.128)、双亲缺失型留守儿童(P=0.021,OR=2.134,95%CI=1.654~6.980)、交流中谈论日常琐事(P=0.006,OR=4.321,95%CI=1.908~9.978)、家庭年收入为0~2000元(P=0.012,OR=3.223,95%CI=2.011~8.830)、5~6年级(P=0.003,OR=8.342,95%CI=2.113~19.232)、11~13岁(P=0.015,OR=5.299,95%CI=1.809~15.098)为留守儿童抑郁发生的危险因子,而交流内容为自我感受(P=0.001,OR=0.342,95%CI=0.190~0.799)、1~2年级(P0.001,OR=0.543,95%CI=0.221~0.879)、7~8岁(P0.001,OR=0.655,95%CI=0.207~0.911)为留守儿童抑郁的抗性因素。结论:盐城地区留守儿童的抑郁发生率较高,危险因素和抗性因素应当给予关注。     

乳腺癌改良根治术中发生低体温风险列线图预测模型的构建

目的 分析乳腺癌改良根治术中发生低体温的危险因素,并基于危险因素构建预测乳腺癌改良根治术中发生低体温的风险列线图模型。方法 选取我院收治的383例行乳腺癌改良根治术患者为研究对象,根据是否发生低体温分为低体温组(n=58)和正常组(n=325)。收集患者的临床资料,采用单因素和Logistic回归分析筛选出术中发生低体温的独立危险因素,采用R软件构建预测术中发生低体温的风险列线图模型,并对模型进行验证。结果 2组患者甲状腺功能减退、术前基础体温、术中室温、手术时间、麻醉时间、术中出血量、术中输液量等资料比较差异有统计学意义(P<0.05)。甲状腺功能减退(OR=2.156,95%CI:1.158～4.016,P=0.015)、术前基础体温异常(OR=2.451,95%CI:1.309～4.588,P=0.005)、术中室温<23℃(OR=2.027,95%CI:1.085～3.786,P=0.027)、手术时间>2 h(OR=2.316,95%CI:1.239～4.327,P=0.008)、麻醉时间>3 h(OR=2.264,95%CI:1.206～4.252,...     

维生素D水平与成人哮喘及非哮喘的相关性研究

目的 评估哮喘及非哮喘者的血清维生素D水平及其与肺功能、嗜酸性粒细胞计数的相关性。方法 选取我院2015年9月1日~2016年1月20日收治的85例哮喘患者以及73例健康体检者作为研究对象。根据皮肤过敏试验结果将哮喘患者分为过敏哮喘组56例和非过敏性哮喘组29例,对比两亚组间维生素D水平的差异性;采外周血测量嗜酸性粒细胞计数,用肺功能仪测量肺功能,包括肺活量（FVC）、第1秒最大呼气量（FEV1）、第1秒最大呼气率（FEV1/FVC）,分析过敏哮喘组和非过敏性哮喘组维生素D水平与肺功能、嗜酸性粒细胞计数的相关性。结果 哮喘患者的维生素D水平为（14.36±0.57）ng/ml,低于健康体检组的（22.13±0.84）ng/ml,统计学意义显著（P＜0.01）。过敏哮喘组和非过敏哮喘组的维生素D水平比较,差异无统计学意义（P＞0.05）。低水平维生素D患哮喘的风险增加1.2倍（优势比:1.194,95%可信区间:1.194~1.286,P＜0.01）。维生素D水平与肺功能和嗜酸性粒细胞计数水平无显著相关性。结论 哮喘患者的维生素D水平低于正常人群,维生素D的缺乏与哮喘的发生密切相关;维生素D水平与肺功能、嗜酸性粒细胞计数没有相关性。     

Risk factors for ventilator dependency following coronary artery bypass grafting

Background: Ventilator dependency following coronary artery bypass grafting (CABG) is often associated with significant morbidity and mortality. However, few reports have focused on the independent risk factors for ventilator dependency following CABG. This study aimed to evaluate the independent risk factors for ventilator dependency following coronary artery bypass grafting (CABG). Methods: The relevant pre-, intra- and post-operative data of patients without a history of chronic obstructive pulmonary disease undergoing isolated CABG from January 2003 to December 2008 in our center were retrospectively analyzed. Elapsed time between CABG and extubation of more than 48 hours was defined as postoperative ventilator dependency (PVD). Results: The incidence of PVD was 13.8% (81/588). The in-hospital mortality in the PVD group was significantly higher than that in the non-PVD group (8.6% versus 2.4%, p=0.0092). Besides the length of ICU and hospital stay, PVD correlated with negative respiratory outcomes. The independent risk factors for PVD were preoperative congestive heart failure (OR=2.456, 95%CI 1.426-6.879), preoperative hypoalbuminemia (OR=1.353, 95%CI 1.125-3.232), preoperative arterial oxygen partial pressure (PO₂) (OR=0.462, 95%CI 0.235-0.783) and postoperative anaemia (OR=1.541, 95%CI 1.231-3.783). Conclusions: Preoperative congestive heart failure, preoperative hypoalbuminemia, low preoperative PO₂ and postoperative anaemia were identified as four independent risk factors for ventilator dependency following CABG.     

普外科术后继发脑梗死的多因素Logistic回归分析

目的 探讨普外科术后并发脑梗死的高危因素,为早期识别及干预提供依据。方法 收集2013年1月~2017年12月我院普外科术后发生脑梗死患者及同期其它手术患者共2835例的临床资料,通过多因素Logistic回归分析确定普外科术后并发脑梗死的独立危险因素。结果 多因素回归分析显示,年龄（OR=2.001,95%CI:1.117~3.472）、手术类型（OR=2.199,95%CI:1.203~4.425）及术中低灌注（OR=2.421,95%CI:1.387~4.974）是普外科术后继发脑梗死的独立因素（P＜0.05）。结论 年龄≥65岁、恶性肿瘤手术及术中低灌注是普外科术后脑梗死形成的可能原因,早期识别高危患者及对相关高危因素进行干预,对预防普外科围手术期脑梗死的发生意义重大。     

Incidence of postoperative hypothermia and its risk factors in adults undergoing orthopedic surgery under brachial plexus block: A retrospective cohort study

Postoperative hypothermia increases patient mortality and morbidity. However, the incidence of, and risk factors for, postoperative hypothermia in patients undergoing surgery under brachial plexus block (BPB) as the primary method of anesthesia remain unclear. This study aimed to determine the incidence of, and risk factors for, postoperative hypothermia in patients undergoing surgery under BPB. We retrospectively analyzed 660 patients aged ≥ 19 years who underwent orthopedic surgery under BPB in our hospital between October 2014 and October 2019. Postoperative hypothermia was defined as a tympanic membrane temperature < 36 °C when the patient arrived in the post-anesthesia care unit. Multivariate logistic regression analysis was performed to identify the independent risk factors for postoperative hypothermia. Postoperative hypothermia was observed in 40.6% (268/660) of patients. Independent risk factors for postoperative hypothermia were lower baseline core temperature before anesthesia (odds ratio [OR] 0.355; 95% confidence interval [CI] 0.185-0.682), alcohol abuse (OR 2.658; 95% CI 1.105-6.398), arthroscopic shoulder surgery (OR 2.007; 95% CI 1.428-2.820), use of fentanyl (OR 1.486; 95% CI 1.059-2.087), combined use of midazolam and dexmedetomidine (OR 1.816; 95% CI 1.268-2.599), a larger volume of intravenous fluid (OR 1.001; 95% CI 1.000-1.002), and longer duration of surgery (OR 1.010; 95% CI 1.004-1.017). Postoperative hypothermia is common in adult patients undergoing orthopedic surgery under BPB. The risk factors identified in this study should be considered to avoid postoperative hypothermia in these patients.     

Predictors of pneumocystosis or tuberculosis in HIV-infected Asian patients with AFB smear-negative sputum pneumonia

OBJECTIVES: To identify predictors of Pneumocystis jiroveci pneumonia (PCP) or pulmonary tuberculosis (TB) in acid-fast bacillus smear-negative HIV-infected patients and to develop clinical prediction rules. DESIGN: A cohort study conducted in consecutive hospitalized Asian patients. METHODS: Multivariate analyses were performed on the Cambodian sample to determine clinical, radiological, and biological predictors of PCP or TB at hospital admission. The Vietnamese sample was kept for independent validation. RESULTS: In Cambodia, the gold standard technique for TB and PCP were fulfilled in 172 (27 cases) and 160 (84 cases) patients, respectively. For TB, independent predictors included the following: headache [odds ratio (OR) 3.0; 95% confidence interval (CI) 1.04 to 8.6], localized radiological opacity (OR 5.8; 95% CI 1.9-17.9), and mediastinal adenopathy (OR 10.1; 95% CI 3.5 to 29.0); and for PCP: resting oxygen saturation <90% (OR 3.3; 95% CI 1.3 to 8.5 for resting arterial oxygen saturation >or=80%; and OR 9.1; 95% CI 1.8 to 44.5 for resting arterial oxygen saturation <80%), trimethoprim-sulphamethoxazole prophylaxis (OR 0.1; 95% CI 0.04 to 0.6), and diffuse radiological shadowing (OR 7.0; 95% CI 2.7 to 18.6). PCP risk predicted by a score based on these 3 factors ranged from 3% to 92% (Cambodia). When tested on Vietnamese patients (n = 69, 38 with PCP), the score maintained correct predictive ability (c-index = 0.72) but with poor calibration. CONCLUSIONS: The PCP score could provide a useful clinical tool to identify PCP among acid-fast bacillus smear-negative pneumonia and start specific therapy.     

Risk factors of postoperative pneumonia after lung cancer surgery

The purpose of this study was to investigate risk factors of postoperative pneumonia (POP) after lung cancer surgery. The 417 lung cancer patients who underwent surgical resection in a tertiary referral hospital were included. Clinical, radiological and laboratory data were reviewed retrospectively. Male and female ratio was 267:150 (median age, 65 yr). The incidence of POP was 6.2% (26 of 417) and in-hospital mortality was 27% among those patients. By univariate analysis, age ≥ 70 yr (P < 0.001), male sex (P = 0.002), ever-smoker (P < 0.001), anesthesia time ≥ 4.2 hr (P = 0.043), intraoperative red blood cells (RBC) transfusion (P = 0.004), presence of postoperative complications other than pneumonia (P = 0.020), forced expiratory volume in 1 second/forced vital capacity (FEV(1)/FVC) < 70% (P = 0.002), diffusing capacity of the lung for carbon monoxide < 80% predicted (P = 0.015) and preoperative levels of serum C-reactive protein ≥ 0.15 mg/dL (P = 0.001) were related with risk of POP. Multivariate analysis showed that age ≥ 70 yr (OR = 3.563, P = 0.014), intraoperative RBC transfusion (OR = 4.669, P = 0.033), the presence of postoperative complications other than pneumonia (OR = 3.032, P = 0.046), and FEV(1)/FVC < 70% (OR = 3.898, P = 0.011) were independent risk factors of POP. In conclusion, patients with advanced age, intraoperative RBC transfusion, postoperative complications other than pneumonia and a decreased FEV(1)/FVC ratio have a higher risk for pneumonia after lung cancer surgery.     

Respiratory tract infection in HIV-1-infected adults in Nairobi, Kenya: evaluation of risk factors and the world health organization treatment algorithm

To evaluate the WHO (World Health Organization) algorithm for management of respiratory tract infection (RTI) in HIV-1-infected adults and determine risk factors associated with RTI, we enrolled a cohort of 380 HIV-1-seropositive adults prospectively followed for incident RTI at an outpatient clinic in Nairobi, Kenya. RTI was diagnosed when patients presented with history of worsening or persistent cough. Patients were treated with ampicillin, or antituberculosis therapy when clinically indicated, as first-line therapy and with trimethoprim/sulfamethoxazole as second-line therapy. Five hundred ninety-seven episodes of RTI were diagnosed: 177 of pneumonia and 420 of bronchitis. The WHO RTI algorithm was used for 401 (95%) episodes of bronchitis and 151 (85%) episodes of pneumonia (p <.001). Three percent of bronchitis cases versus 32% of pneumonia cases failed to respond to first-or second-line treatment (p <.0001). Being widowed (adjusted odds ratio [OR] = 2.1, 95% confidence interval [CI]: 1.0-4.4), less than 8 years of education (adjusted OR = 2.5, CI: 1.5 - 4.1), and CD4 count < 200 cells/microl (adjusted OR = 2.4, CI: 1.4-3.9) were risk factors for pneumonia. A high percentage of patients (32%) with pneumonia required a change in treatment from that recommended by the WHO guidelines. Randomized trials should be performed to determine more appropriate treatment strategies in HIV-1-infected individuals.     

Prevalence of and risk factors for penile infection by high‐risk human papillomavirus among men infected with HIV

This study aimed to determine the prevalence of and risk factors for high‐risk human papillomavirus (HPV) genital infection and precursor lesions of penile cancer among patients infected with human immunodeficiency virus (HIV). In total, 276 men with a mean age of 34.6 years were included. All participants were subjected to peniscopic examination under magnification, collection of genital exfoliated cells for detecting HPV types using Hybrid Capture, and biopsy surgery of clinically observable lesions and aceto‐white areas for histopathological studies. The prevalence of high‐risk HPV types was 43%. Peniscopicy showed clinically visible lesions or aceto‐white areas in 75/276 participants (27%), of which genital warts were the most common (22/75; 29%). HIV‐positive (HIV⁺) men with CD4⁺ T‐cell counts <200 cells/mm³ showed a higher prevalence of penile lesions. Multivariate logistic regression was applied to identify independent risk factors for high‐risk HPV types. The results showed that high‐risk HPV was associated with lower education level (OR = 1.89, 95% CI: 1.15–3.13), illicit drug use (OR = 1.80, 95% CI: 1.03–3.14), mulatto ethnicity (OR = 2.51, 95% CI: 1.38–4.54), heterosexual orientation (OR = 2.12, 95% CI: 1.30–3.47) symptomatic AIDS (OR = 2.80, 95% CI: 1.65–4.77), AIDS‐associated opportunistic infections (OR = 2.92, 95% CI: 1.78–4.78), on HAART (OR = 2.91, 95% CI: 1.78–4.77), and CD4⁺ T‐cell count <200 cells/mm³ (OR = 3.31, 95% CI: 1.84–5.96). Immunocompromised men were more susceptible to developing penile lesions associated with high‐risk HPV types. J. Med. Virol. 85:413–418, 2013. © 2013 Wiley Periodicals, Inc.     

Predictive value of Thomsen-Friedenreich antigen activation for Streptococcus pneumoniae infection and severity in pediatric lobar pneumonia

BackgroundMost cases of complicated pneumonia in children are caused by pneumococcal infections. Thomsen-Friedenreich antigen (TA) is present on erythrocytes, platelets and glomeruli, and it can be activated during pneumococcal infection. The aim of this study was to investigate the predictive value of TA activation for pneumococcal infection and association with the severity of complicated pneumonia.Materials and methodsPatients with lobar pneumonia were routinely tested for TA at the Department of Pediatrics, Mackay Memorial Hospital from January 2010 to December 2015. We retrospectively reviewed and analyzed their charts and data including age, sex, etiology of infection, chest tube insertion or video-assisted thoracoscopic surgery, length of hospital stay, TA activation, white blood cell count and level of C reactive protein.ResultsA total of 142 children with lobar pneumonia were enrolled, including 35 with empyema, 31 with effusion, 11 with necrotizing pneumonia and four with lung abscess. Streptococcus pneumoniae was the most commonly identified pathogen. Twenty-two patients (15.4%) had activated TA, all of whom were infected with S. pneumoniae. TA activation had 100% specificity and 100% positive predictive value for pneumococcal infection. In the multivariate analysis in lobar pneumonia, TA activation (OR, 15.8; 95% CI, 3.0–83.5; p = 0.001), duration of fever before admission (OR, 1.2; 95% CI, 1.1–1.5; p = 0.013) and initial CRP level (OR, 1.1; 95% CI, 1.0–1.1; p = 0.004) were independent predictors of empyema.ConclusionsTA activation is a specific marker for pneumococcal pneumonia and might indicate higher risk for complicated pneumonia.     

Risk factors for colonization with extended-spectrum beta-lactamase-producing enterobacteriaceae on admission to rehabilitation centres

Patients newly admitted to rehabilitation centres are at high risk of colonization with multidrug-resistant bacteria because many of them have experienced prolonged stays in other healthcare settings and have had high exposure to antibiotics. We conducted a prospective study to determine the prevalence of and risk factors for colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in this population. Subjects were screened by rectal swab for ESBL-PE within 2 days of admission. Swabs were plated on chromagar ESBL plates and the presence of ESBL was verified by a central laboratory. A multilevel mixed effects model was used to identify risk factors for ESBL-PE colonization. Of 2873 patients screened, 748 (26.0%) were positive for ESBL-PE. The variables identified as independently associated with ESBL-PE colonization were: recent stay in an acute-care hospital for over 2 weeks (OR = 1.34; 95% CI, 1.12, 1.6), history of colonization with ESBL-PE (OR = 2.97; 95% CI, 1.99, 4.43), unconsciousness on admission (OR = 2.59; 95% CI, 1.55, 4.34), surgery or invasive procedure in the past year (OR = 1.49; 95% CI, 1.2, 1.86) and antibiotic treatment in the past month (OR = 1.80; 95% CI, 1.45, 2.22). The predictive accuracy of the model was low (area under the ROC curve 0.656). These results indicate that ESBL-PE colonization is common upon admission to rehabilitation centres. Some risk factors for ESBL-PE colonization are similar to those described previously; however, newly identified factors may be specific to rehabilitation populations. The high prevalence and low ability to stratify by risk factors may guide infection control and empirical treatment strategies in rehabilitation settings.