We present a rare case of invasive liver abscess syndrome due to Klebsiella pneumoniae (K. pneumoniae) with metastatic meningitis and septic shock. A previously healthy, 55-year-old female patient developed fever, liv...We present a rare case of invasive liver abscess syndrome due to Klebsiella pneumoniae (K. pneumoniae) with metastatic meningitis and septic shock. A previously healthy, 55-year-old female patient developed fever, liver abscess, septic shock, purulent meningitis and metastatic hydrocephalus. Upon admission, the clinical manifestations, laboratory and imaging examinations were compatible with a diagnosis of K. pneumoniae primary liver abscess. Her distal metastasis infection involved meningitis and hydrocephalus, which could flare abruptly and be life threatening. Even with early adequate drainage and antibiotic therapy, the patient’s condition deteriorated and she ultimately died. To the best of our knowledge, this is the first case of K. pneumoniae invasive liver abscess syndrome with septic meningitis reported in China's Mainland. Our findings reflect the need for a better understanding of the epidemiology, risk factors, complications, comorbid medical conditions and treatment of this disease.展开更多
AIM To evaluate the outcomes of furazolidone-and amoxicillin-based quadruple therapy for treatment of Helicobacter pylori(H. pylori) infection and identify predictors of failed eradication.METHODS Patients with H. pyl...AIM To evaluate the outcomes of furazolidone-and amoxicillin-based quadruple therapy for treatment of Helicobacter pylori(H. pylori) infection and identify predictors of failed eradication.METHODS Patients with H. pylori infection treated with furazolidone, amoxicillin, bismuth, and proton pump inhibitor therapy(January 2015 to December 2015) who received the ^(13)C-urea breath test > 4 wk after treatment were evaluated. Demographic and clinical data including prior H. pylori treatment attempts, medication adherence, alcohol and cigarette consumption during therapy, and treatment-related adverse events were recorded by reviewing medical records and telephone surveys. H. pylori eradication rates for overall and subgroups were evaluated. Multivariate analysis was performed to identify independent predictors of failed H. pylori eradication.RESULTS Of the 992 patients treated and retested for H. pylori infection, the overall eradication rate was 94.5% [95% confidence interval(CI): 94.1%-95.9%]. H. pylori eradication rate of primary therapy was 95.0%(95%CI: 93.5%-96.5%), while that of rescue therapy was 91.3%(95%CI: 86.8%-95.8%). Among the 859 patients who completed the study protocol, 144(17%) reported treatment-related adverse events including 24(3%) leading to premature discontinuation. On multivariate analysis, poor medication adherence [adjusted odds ratio(AOR) = 6.7, 95%CI: 2.8-15.8], two or more previous H. pylori treatments(AOR = 7.4, 95%CI: 2.2-24.9), alcohol consumption during therapy(AOR = 4.4, 95%CI: 1.5-12.3), and possibly smoking during therapy(AOR = 1.9, 95%CI: 0.9-4.3) were associated with failed H. pylori eradication. CONCLUSION Furazolidone-and amoxicillin-based quadruple therapy for H. pylori infection in an area with a high prevalence of clarithromycin resistance demonstrated high eradication rates as primary and rescue therapies with a favorable safety profile. Patient education targeting abstinence from alcohol during therapy and strict medication adherence may further optimize H. pylori eradication.展开更多
AIM： To investigate the relationship between H pylori infection, blood ammonia concentration and hepatic encephalopathy （HE）, and the effect of Hpylori eradication in cirrhotic patients. METHODS： From July 2003 to...AIM： To investigate the relationship between H pylori infection, blood ammonia concentration and hepatic encephalopathy （HE）, and the effect of Hpylori eradication in cirrhotic patients. METHODS： From July 2003 to January 2005, 457 cirrhotic patients in five regions of Zhejiang Province were enrolled. Patients were evaluated for demographics, number connection test, Hpylori infection, liver impairment, blood ammonia concentration and HE. Patients with Hpylori infection were given I wk therapy with omeprazole plus clarithromycin and tinidazole. ^14C urea breath test was performed and mental symptoms and blood ammonia level were reassessed after RESULTS： Overall H pylori infection rate was 60.6%, and HE occurred in 47.5% of cirrhotic patients. Subclinical HE （SHE） was detected in 55 of 117 cirrhotic patients. Blood ammonia concentration in H pylori negative （n = 180） and positive （n = 277） cirrhotic patients was 53.8 ± 51.4 and 78.4 ± 63.6 μmol/L, respectively （P 〈 0.01）, which was significantly reduced to 53.5 ± 37.7 μmol/L after bacterium eradication （n = 126） （P 〈 0.01）. Blood ammonia was 97.5 ± 81.0 μmol/L in H pylori-positive cirrhotic patients, and this did not significantly change in those with persistent infection after Hpylori eradication （n = 11）. HE was more frequently observed in patients with H pylori infection than in those without （58.5% vs 30.6%, P 〈 0.01）. HE rate significantly dropped to 34.1% after H pylori eradiation （P 〈 0.01）. H pylori prevalence significantly differed among cirrhotic patients with HE （74.4%）, SHE （69.1%）, and those without HE （53.2%） （P 〈 0.05）. Blood ammonia level was significantly different among cirrhotic patients with HE （94.5 ± 75.6 μmol/L）, SHE （59.9 ± 49.2 μmol/L）, and without HE （47.3 ± 33.5 μmol/L） （P 〈 0.05）. Logistic regression analysis showed that blood ammonia concentration, Child-Pugh stage, upper gastrointestinal bleeding, electrolyte disturbance, and urea nitrogen were risk factors for HE. CONCLUSION： H pylori infection is an important factor for inducing high blood ammonia concentration and HE in cirrhotic patients. H pylori eradication may be helpful for treatment and prevention of HE.展开更多
AIM： To investigate the quality of care for a hospital based-cohort of patients with inflammatory bowel disease （IBD） from East China according to the current practice guidelines, METHODS： A retrospective review w...AIM： To investigate the quality of care for a hospital based-cohort of patients with inflammatory bowel disease （IBD） from East China according to the current practice guidelines, METHODS： A retrospective review was conducted, involving 177 patients with IBD admitted to Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University between June 2000 and June 2006. Data regarding demographic and clinical characteristics as well as medical therapy including use of oral aminosalisylates, topical therapy, corticosteroid agents, immunomodulatory agents （such as azathioprine） at admission and outpatient clinic visit were analyzed. RESULTS： A total of 177 eligible patients were evaluated in this study, including 71 patients with Crohn＇s disease （CD） and 106 with ulcerative colitis （UC）. All were the Han nationality Chinese with active disease at baseline. All the 106 patients with ulcerative colitis received optimal doses of aminosalisylate while 27 of 68 （39.7%） patients with ileal or colonic CD received the suboptimal doses of aminosalisylate. The incidence of suboptimal dose of aminosalisylate was significantly higher in CD patients with small intestine involvement only （52.8% vs 25.0%, P = 0.019）. Thirty-one （54.4%） patients with active distal or left-sided ulcerative colitis received topical therapy, and 27.8% of patients suffering from severe inflammatory bowel disease did not receive oral or intravenous steroid therapy. Among the 51 patients for whom thiopurine was indicated, only 10 （19.6%） received immunomodulatory agents, and more thanhalf of the 8 patients received a suboptimal dose of azathiopurine with no attempt to increase its dosage. CONCLUSION： The quality of care for IBD patients can be further improved. A suboptimal dose of aminosalicylate is used in treatment of patients with CD, especially in those with small intestine involved only. Topical mesalazine is inadequately used in patients with distal or left-sided colitis. Oral or intravenous steroid therapy is not used in some patients with severe IBD. Use of immunomodulatory medication is limited. Larger prospective studies are needed to investigate the quality of care for patients with IBD to establish our own evidence-based guidelines.展开更多
Carbon stars are excellent kinematic tracers of galaxies and can serve as a viable standard candle, so it is worthwhile to automatically search for them in a large amount of spectra. In this paper, we apply the effici...Carbon stars are excellent kinematic tracers of galaxies and can serve as a viable standard candle, so it is worthwhile to automatically search for them in a large amount of spectra. In this paper, we apply the efficient manifold ranking algorithm to search for carbon stars from the Large Sky Area Multi-Object Fiber Spectroscopic Telescope （LAMOST） pilot survey, whose performance and robustness are verified comprehensively with four test experiments. Using this algorithm, we find a total of 183 carbon stars, and 158 of them are new findings. According to different spectral features, our carbon stars are classified as 58 C-H stars, 11 C-H star candidates, 56 C-R stars, ten C-R star candidates, 30 C-N stars, three C-N star candidates, and four C-J stars. There are also ten objects which have no spectral type because of low spec- tral quality, and a composite spectrum consisting of a white dwarf and a carbon star. Applying the support vector machine algorithm, we obtain the linear optimum clas- sification plane in the J - H versus/-/- Ks color diagram which can be used to distinguish C-H from C-N stars with their J - H and H - Ks colors. In addition, we identify 18 dwarf carbon stars with their relatively high proper motions, and find three carbon stars with FUV detections likely have optical invisible companions by cross matching with data from the Galaxy Evolution Explorer. In the end, we detect four variable carbon stars with the Northern Sky Variability Survey, the Catalina Sky Survey and the LINEAR variability databases. According to their periods and ampli- tudes derived by fitting light curves with a sinusoidal function, three of them are likely semiregular variable stars and one is likely a Mira variable star.展开更多
基金Supported by the National Natural Science Foundation of China,No.81372623the Zhejiang Province Key Science and Technology Innovation Team,No.2013TD13
文摘We present a rare case of invasive liver abscess syndrome due to Klebsiella pneumoniae (K. pneumoniae) with metastatic meningitis and septic shock. A previously healthy, 55-year-old female patient developed fever, liver abscess, septic shock, purulent meningitis and metastatic hydrocephalus. Upon admission, the clinical manifestations, laboratory and imaging examinations were compatible with a diagnosis of K. pneumoniae primary liver abscess. Her distal metastasis infection involved meningitis and hydrocephalus, which could flare abruptly and be life threatening. Even with early adequate drainage and antibiotic therapy, the patient’s condition deteriorated and she ultimately died. To the best of our knowledge, this is the first case of K. pneumoniae invasive liver abscess syndrome with septic meningitis reported in China's Mainland. Our findings reflect the need for a better understanding of the epidemiology, risk factors, complications, comorbid medical conditions and treatment of this disease.
基金Supported by the Zhejiang Science and Technology Project,No.LGF18H160012
文摘AIM To evaluate the outcomes of furazolidone-and amoxicillin-based quadruple therapy for treatment of Helicobacter pylori(H. pylori) infection and identify predictors of failed eradication.METHODS Patients with H. pylori infection treated with furazolidone, amoxicillin, bismuth, and proton pump inhibitor therapy(January 2015 to December 2015) who received the ^(13)C-urea breath test > 4 wk after treatment were evaluated. Demographic and clinical data including prior H. pylori treatment attempts, medication adherence, alcohol and cigarette consumption during therapy, and treatment-related adverse events were recorded by reviewing medical records and telephone surveys. H. pylori eradication rates for overall and subgroups were evaluated. Multivariate analysis was performed to identify independent predictors of failed H. pylori eradication.RESULTS Of the 992 patients treated and retested for H. pylori infection, the overall eradication rate was 94.5% [95% confidence interval(CI): 94.1%-95.9%]. H. pylori eradication rate of primary therapy was 95.0%(95%CI: 93.5%-96.5%), while that of rescue therapy was 91.3%(95%CI: 86.8%-95.8%). Among the 859 patients who completed the study protocol, 144(17%) reported treatment-related adverse events including 24(3%) leading to premature discontinuation. On multivariate analysis, poor medication adherence [adjusted odds ratio(AOR) = 6.7, 95%CI: 2.8-15.8], two or more previous H. pylori treatments(AOR = 7.4, 95%CI: 2.2-24.9), alcohol consumption during therapy(AOR = 4.4, 95%CI: 1.5-12.3), and possibly smoking during therapy(AOR = 1.9, 95%CI: 0.9-4.3) were associated with failed H. pylori eradication. CONCLUSION Furazolidone-and amoxicillin-based quadruple therapy for H. pylori infection in an area with a high prevalence of clarithromycin resistance demonstrated high eradication rates as primary and rescue therapies with a favorable safety profile. Patient education targeting abstinence from alcohol during therapy and strict medication adherence may further optimize H. pylori eradication.
文摘AIM： To investigate the relationship between H pylori infection, blood ammonia concentration and hepatic encephalopathy （HE）, and the effect of Hpylori eradication in cirrhotic patients. METHODS： From July 2003 to January 2005, 457 cirrhotic patients in five regions of Zhejiang Province were enrolled. Patients were evaluated for demographics, number connection test, Hpylori infection, liver impairment, blood ammonia concentration and HE. Patients with Hpylori infection were given I wk therapy with omeprazole plus clarithromycin and tinidazole. ^14C urea breath test was performed and mental symptoms and blood ammonia level were reassessed after RESULTS： Overall H pylori infection rate was 60.6%, and HE occurred in 47.5% of cirrhotic patients. Subclinical HE （SHE） was detected in 55 of 117 cirrhotic patients. Blood ammonia concentration in H pylori negative （n = 180） and positive （n = 277） cirrhotic patients was 53.8 ± 51.4 and 78.4 ± 63.6 μmol/L, respectively （P 〈 0.01）, which was significantly reduced to 53.5 ± 37.7 μmol/L after bacterium eradication （n = 126） （P 〈 0.01）. Blood ammonia was 97.5 ± 81.0 μmol/L in H pylori-positive cirrhotic patients, and this did not significantly change in those with persistent infection after Hpylori eradication （n = 11）. HE was more frequently observed in patients with H pylori infection than in those without （58.5% vs 30.6%, P 〈 0.01）. HE rate significantly dropped to 34.1% after H pylori eradiation （P 〈 0.01）. H pylori prevalence significantly differed among cirrhotic patients with HE （74.4%）, SHE （69.1%）, and those without HE （53.2%） （P 〈 0.05）. Blood ammonia level was significantly different among cirrhotic patients with HE （94.5 ± 75.6 μmol/L）, SHE （59.9 ± 49.2 μmol/L）, and without HE （47.3 ± 33.5 μmol/L） （P 〈 0.05）. Logistic regression analysis showed that blood ammonia concentration, Child-Pugh stage, upper gastrointestinal bleeding, electrolyte disturbance, and urea nitrogen were risk factors for HE. CONCLUSION： H pylori infection is an important factor for inducing high blood ammonia concentration and HE in cirrhotic patients. H pylori eradication may be helpful for treatment and prevention of HE.
基金National Natural Science Foundation of China (No. 30500244)Funtional study of two new allele variants of NOD2 in Han nationality
文摘AIM： To investigate the quality of care for a hospital based-cohort of patients with inflammatory bowel disease （IBD） from East China according to the current practice guidelines, METHODS： A retrospective review was conducted, involving 177 patients with IBD admitted to Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University between June 2000 and June 2006. Data regarding demographic and clinical characteristics as well as medical therapy including use of oral aminosalisylates, topical therapy, corticosteroid agents, immunomodulatory agents （such as azathioprine） at admission and outpatient clinic visit were analyzed. RESULTS： A total of 177 eligible patients were evaluated in this study, including 71 patients with Crohn＇s disease （CD） and 106 with ulcerative colitis （UC）. All were the Han nationality Chinese with active disease at baseline. All the 106 patients with ulcerative colitis received optimal doses of aminosalisylate while 27 of 68 （39.7%） patients with ileal or colonic CD received the suboptimal doses of aminosalisylate. The incidence of suboptimal dose of aminosalisylate was significantly higher in CD patients with small intestine involvement only （52.8% vs 25.0%, P = 0.019）. Thirty-one （54.4%） patients with active distal or left-sided ulcerative colitis received topical therapy, and 27.8% of patients suffering from severe inflammatory bowel disease did not receive oral or intravenous steroid therapy. Among the 51 patients for whom thiopurine was indicated, only 10 （19.6%） received immunomodulatory agents, and more thanhalf of the 8 patients received a suboptimal dose of azathiopurine with no attempt to increase its dosage. CONCLUSION： The quality of care for IBD patients can be further improved. A suboptimal dose of aminosalicylate is used in treatment of patients with CD, especially in those with small intestine involved only. Topical mesalazine is inadequately used in patients with distal or left-sided colitis. Oral or intravenous steroid therapy is not used in some patients with severe IBD. Use of immunomodulatory medication is limited. Larger prospective studies are needed to investigate the quality of care for patients with IBD to establish our own evidence-based guidelines.
基金funded by the National Natural Science Foundation of China(Grant Nos.11390371,11303036,11390374,11233004 and 61202315)The Guo Shou Jing Telescope(the Large Sky Area Multi-Object Fiber Spectroscopic Telescope,LAMOST) is a National Major Scientific Project built by the Chinese Academy of Sciences+6 种基金Funding for the project has been provided by the National Development and Reform CommissionFunding for SDSS-Ⅲ has been provided by the Alfred P.Sloan Foundationthe Participating Institutionsthe National Science Foundationthe U.S.Department of Energy Office of Sciencefunded by NASANSF
文摘Carbon stars are excellent kinematic tracers of galaxies and can serve as a viable standard candle, so it is worthwhile to automatically search for them in a large amount of spectra. In this paper, we apply the efficient manifold ranking algorithm to search for carbon stars from the Large Sky Area Multi-Object Fiber Spectroscopic Telescope （LAMOST） pilot survey, whose performance and robustness are verified comprehensively with four test experiments. Using this algorithm, we find a total of 183 carbon stars, and 158 of them are new findings. According to different spectral features, our carbon stars are classified as 58 C-H stars, 11 C-H star candidates, 56 C-R stars, ten C-R star candidates, 30 C-N stars, three C-N star candidates, and four C-J stars. There are also ten objects which have no spectral type because of low spec- tral quality, and a composite spectrum consisting of a white dwarf and a carbon star. Applying the support vector machine algorithm, we obtain the linear optimum clas- sification plane in the J - H versus/-/- Ks color diagram which can be used to distinguish C-H from C-N stars with their J - H and H - Ks colors. In addition, we identify 18 dwarf carbon stars with their relatively high proper motions, and find three carbon stars with FUV detections likely have optical invisible companions by cross matching with data from the Galaxy Evolution Explorer. In the end, we detect four variable carbon stars with the Northern Sky Variability Survey, the Catalina Sky Survey and the LINEAR variability databases. According to their periods and ampli- tudes derived by fitting light curves with a sinusoidal function, three of them are likely semiregular variable stars and one is likely a Mira variable star.
