Financial impact of nosocomial infections on surgical patients in an eastern Chinese hospital: a propensity score matching study

This study, conducted at Zhejiang Taizhou Hospital, China, aimed to examine the financial impact of nosocomial infections on surgical patients. A retrospective case-control study using propensity score matching was conducted over a 9-month period from January to September 2022. The study included 729 surgical patients with nosocomial infections and 2187 matched controls without infections. Medical expenses, length of hospitalization and total economic burden were compared between the two groups. The rate of nosocomial infections in surgical cases was 2.66%. The median hospitalization cost for patients with nosocomial infections was US$8220, compared with US$3294 for controls. The overall additional medical expenditure attributable to nosocomial infections amounted to US$4908. Notable median differences were observed between cases with nosocomial infections and controls in terms of total hospitalization cost, nursing services, medication, treatment, materials, test fees and blood transfusion fees. In each age group, medical costs for patients with nosocomial infections were more than twice those of controls. Additionally, hospital stays for surgical patients with nosocomial infections were, on average, 13 days longer compared with controls. These findings highlight the importance of implementing effective infection control measures in hospitals to reduce the financial burden on patients and the healthcare system.

[The role of CT coronary angiography in improving the positive rate of coronary angiography in patients with low-or moderate-risk non-ST segment elevation myocardial infarction]

Objective: To investigate whether CT coronary angiography (CTA) can safely and effectively reduce the number of invasive coronary angiography (ICA) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) whose Grace score is low-or moderate-risk, and increase ICA positive rate. Methods: One hundred and two NSTEMI patients, including 61 males and 41 females, aged 38-80 (58±12) years, were prospectively included and treated in Henan Provincial People's Hospital from February 2017 to February 2018. By using random number method, the patients were divided into control group (51 cases) and experimental group (51 cases). Patients in the control group were arranged for elective ICA examination according to the risk stratification. If further intervention or surgical treatment was required, the ICA examination was positive; in the experimental group, the CTA examination was completed through the green channel first. If the CTA showed that the main coronary artery and its main branches were severe or extreme stenosis, further ICA examination was arranged; otherwise, a secondary prophylactic drug treatment was developed and the patients were then discharged and followed up for 1 year. ICA number, ICA positive rate, length of hospital stay, hospital cost, hospital anxiety and depression score (HADS), major cardiovascular events (MACE) within 1 year, and other serious adverse events related to examination or surgery were compared between the two groups. Results: A total of 37 patients in the experimental group underwent ICA, and the positive rate of ICA was 94.59% (35/37), which was significantly higher than that of the control group [62.75% (32/51)] (P<0.05). The average length of hospital stay and the HADS score before ICA in the experimental group were significantly lower than those in the control group [(3.8±2.2) d vs (4.8±2.4) d; 8.8±4.5 vs 11.4±6.8] (all P<0.05). There was no significant difference in the cumulative incidence of MACE (3 cases vs 5 cases, P=0.423) and other serious adverse events (8 cases vs 10 cases, P=0.548) within 1 year between the two groups. Conclusion: CTA significantly reduces the number of ICA and the average length of hospital stay, and increases the positive rate of ICA in NSTEMI patients whose Grace score is low-or moderate-risk. There is no increase in cardiovascular risks within 1 year.

[Biomarkers screening for viral myocarditis through proteomics analysis of plasma exosomes]

Objective: To compare and analyze the differentially expressed plasma exosomic proteome between healthy control group (Control group) and viral myocarditis group (VMC group) to search for biomarkers that maybe used for early diagnosis of VMC. Methods: Fifty plasma samples of Control group and VMC group were collected respectively from Henan Provincial People's Hospital (from January 2016 to December 2017), and then 5 samples (1 ml) of each group were selected randomly, after exosomes extraction with ultra-centrifugation, difference gel electrophoresis (DIGE) was used to isolate the total proteins, and then the protein spots with more than 2-fold changes between VMC and Control group were picked up after the software analysis, afterward, the varied proteins were identified by MALDI-TOF/TOF mass spectrometry. Finally, the specifically related protein was selected to be verified by ELISA with the plasma exosomic samples of Control (n=40) and VMC (n=40). Results: A total of 10 varied protein spots were found including 8 up-regulated proteins and 2 down-regulated proteins between VMC and Control group. After MS analysis, the up-regulated proteins in VMC group contained KRT2, KRT5, KRT9, KRT77, KRT78, AZGP1, HP and RBP4, whereas the down-regulated ones were CD5L and C1QB. RBP4 was selected to validate by ELISA analysis, and the corresponding results showed that RBP4 was increased specifically in plasma exosomes of VMC group (P<0.05) after comparing with Control group, which was consistent with DIGE. Conclusion: Ten proteins related to VMC are detected in total, and RBP4 might serve as a potential specific biomarker for early screening and diagnosis of VMC.

[The effect of inadequate Vitamin D on sperm quality]

Objective: To analyze the effect of insufficient intake of vitamin D (VD) on sperm quality and male fertility and to discuss the mechanism of the effect. Methods: VD deficiency mice were fed with VD-deficient diet and light-sheltered. The sperm motility, morphology, ultrastructure, testicular pathology, sex hormones and fertility of normal and VD-deficient mice were analyzed to investigate the effects of VD deficiency on male reproduction. Results: Compared with the normal group, the mice with VD deficiency had lower sperm concentration[(128±53) ×10(6)/ml vs( 58±15) ×10(6)/ml, P<0.05], less sperm in the epididymis, slightly less mature spermatozoa.The serum testosterone[(328±65 )nmol/L vs(255±58 )nmol/L]and estradiol levels[(60±115) pmol/L vs(384±104) pmol/L]were significantly lower (P<0.05), and the FSH[(296±177)ng/L vs(219±105 )ng/L]and LH[(393±129) ng/L vs(364±108) ng/L]levels were significantly higher (P<0.05). The other tests did not show any significant difference (P>0.05). Conclusion: The impact of insufficient intake of VD on sperm quality is not prominent, the specific impact of VD on male reproductive needs to be further studied.

[Morphological characteristics and phenotypic analysis of multiple morphological abnormalities in sperm flagella]

Objective: To analyze the sperm morphological characteristics of multiple morphological abnormalities of the sperm flagella (MMAF), and to analyze their common features and subtypes. Methods: Twenty-eight patients with abnormal morphology of flagella were analyzed by semen analysis. The morphological characteristics were analyzed by scanning electron microscopy and transmission electron microscopy. Histological observation of one case of testicular tissue was performed. Results: Of the 28 patients, only 13 patients (46.4%) had motile spermatozoa, 12 of which had a sperm motility rate of <10% and a sperm survival rate of 9.0%-80.0%. Under light and scanning electron microscope, sperm with absent, short, coiled, bent and irregular width flagella or their combinations were observed. Transmission electron microscopy showed structural abnormalities of sperm fibrous sheath, mitochondrial sheath. Loss rate of central microtubule was 41.4%-84.6%. The semen of the 2 patients with the absence or presence of the kinetic protein arm and both the inner and lateral motilin arms missing had no motile spermatozoa. There was no statistically significant difference in the proportion of flagellar malformations between the two groups of patients (without motile sperm vs with motile spermatozoa). Conclusion: MMAF is a kind of sperm flagella specific abnormalities. Initially diagnosis can be carried out using light microscopy. Clear diagnosis could be conduct using transmission electron microscopy, and the central microtubule loss of the sperm could be seen as the main feature of the flagella abnormalities. Through the morphological analysis and research, MMAF could be precisely classified, which provide a strong basis for the diagnosis.

[Influence of trabecular microstructure modeling on finite element analysis of dental implant]

OBJECTIVE

To analyze the influence of trabecular microstructure modeling on the biomechanical distribution of implant-bone interface with a three-dimensional finite element mandible model of trabecular structure.

METHODS

Dental implants were embeded in the mandibles of a beagle dog. After three months of the implant installation, the mandibles with dental implants were harvested and scaned by micro-CT and cone-beam CT. Two three-dimensional finite element mandible models, trabecular microstructure(precise model) and macrostructure(simplified model), were built. The values of stress and strain of implant-bone interface were calculated using the software of Ansys 14.0.

RESULTS

Compared with the simplified model, the precise models' average values of the implant bone interface stress increased obviously and its maximum values did not change greatly. The maximum values of quivalent stress of the precise models were 80% and 110% of the simplified model and the average values were 170% and 290% of simplified model. The maximum and average values of equivalent strain of precise models were obviously decreased, and the maximum values of the equivalent effect strain were 17% and 26% of simplified model and the average ones were 21% and 16% of simplified model respectively. Stress and strain concentrations at implant-bone interface were obvious in the simplified model. However, the distributions of stress and strain were uniform in the precise model.

CONCLUSIONS

The precise model has significant effect on the distribution of stress and strain at implant-bone interface.

Sphingosine kinase 1 participates in insulin signalling and regulates glucose metabolism and homeostasis in KK/Ay diabetic mice

AIMS/HYPOTHESIS

The aim of this study was to determine the potential role of sphingosine kinase 1 (SPHK1), a key sphingolipid metabolic enzyme, in glucose metabolism and homeostasis.

METHODS

SMMC-7721 hepatoma cells and C2C12 myotube cells were used to explore the role of SPHK1 in glucose uptake in vitro. KK/Ay type 2 diabetic mice, which were transfected with adenovirus harbouring the human SPHK1 gene by i.v. injection, were used to investigate the glucose-lowering effects of SPHK1 in vivo.

RESULTS

The basal glucose uptake and the insulin-stimulated glucose uptake in both 7721 cells and C2C12 cells were markedly enhanced when SPHK1 was overexpressed by adenovirus-mediated gene transfer, whereas they were substantially reduced when the expression of SPHK1 was inhibited or the activity of SPHK1 was blocked. Insulin could activate SPHK1 of both cell lines in a dose-dependent manner. SPHK1 gene delivery significantly reduced the blood glucose level of KK/Ay diabetic mice, but had no effect on that of normal animals. It also attenuated elevated levels of plasma insulin, NEFA, triacylglycerol, cholesterol and LDL, significantly ameliorated hyperglycaemia-induced injury of liver, heart and kidney, and enhanced phosphorylation of insulin-signalling kinases such as Akt and glycogen synthase kinase 3beta in livers of the diabetic animals.

CONCLUSIONS/INTERPRETATION

SPHK1 is involved in insulin signalling and plays an important role in the regulation of glucose and fat metabolism; adenovirus-mediated SPHK1 gene transfer might provide a novel strategy in the treatment of type 2 diabetes mellitus.

Pheochromocytoma of the urinary bladder: a case report

A 61-year-old female was admitted who had had symptoms of hematuria and a tumor mass in the urinary bladder for six months. Hypertension and headache after micturition had been noted for one year. Plasma norepinephrine before and after voiding were elevated. Increased I-131 metaiodobenzylguanidine (I-131 MIBG) uptake in the urinary bladder was also found. The plasma norepinephrine level and blood pressure returned to normal after partial cystectomy. Diagnosis of pheochromocytoma was confirmed by histology.

Growth of Thuja plicata seedlings along a light gradient

To improve understanding of light – growth response relationships in western red cedar, seedlings were grown on three environmentally comparable sites representing nearly optimum growth conditions for the species in coastal British Columbia. On each site, the seedlings were planted on transects extending from a clearcut to the interior of an adjacent old-growth stand. After three growing seasons, seedling mortality, vigour, growth characters, and foliar nutrients were compared across five light classes and between study sites using analysis of variance and related to the percentage of above-canopy light available to each seedling using regression analysis. Three-year mortality was ≤ 27%, and most mortality (≥ 85%) occurred at ≤ 20% of above-canopy light. Seedling growth improved consistently with increasing light; however, the actual growth response at > 40% of above-canopy light varied with study site. The pattern of variation in the growth characters suggested that planted seedlings were able to acclimate morphologically to varying light conditions in three structural traits typically associated with shade adaptation: specific leaf area, height to caliper ratio, and aboveground to root biomass ratio. Specific leaf area and height to caliper ratio decreased and aboveground to root biomass ratio increased with increasing light. This study does not support the contention that under optimal moisture and nutrient conditions carbohydrate deficiency increases the allocation of net biomass production to aboveground structures. We consider western red cedar in the study area to be a. very shade-and exposure-tolerant species but not one that is specifically adapted to an understory environment. Key words: Thuja plicata seedlings, light – growth response relationships, specific leaf area, height to caliper ratio, aboveground to root biomass ratio, shade tolerance.

Aldosterone-producing adenoma--variable serum aldosterone response to postural change: a case report

A 25-year-old female was admitted for evaluation of hypertension and hypokalemia. Plasma renin activity was suppressed and plasma aldosterone level was higher than normal. The CT scan of adrenal gland revealed a 2.5cm in size low density tumor mass over right adrenal area, and NP-59 adrenal scan showed early and persistent uptake of radioactivity in the right adrenal gland. Interestingly, the plasma aldosterone level was elevated, decreased and unchanged to postural change on three different occasions. After right adrenalectomy, the plasma aldosterone level decreased to 4.77ng/dl, blood pressure, serum potassium, and plasma aldosterone returned to normal response to postural change. Histologically, it was compatible with the picture of cortical adenoma. However, the tumor cell may not have reached autonomous function yet, since different responses of plasma aldosterone to postural change were observed clinically.

Change of circulating thyroid autoantibody titers in Graves' hyperthyroidism after antithyroid drugs therapy

Parallel measurements of circulating thyroglobulin (Tg), microsomal [TPO(mic)] and TSH-receptor antibodies [TSH-R(rr)] were performed in 30 cases of Graves' hyperthyroid patients who received antithyroid drug (ATD) therapy for 2.8 +/- 1.7 years (range: 0.5-5.0 years). Before ATD therapy, positive Tg, TPO(mic) and TSH-R(rr) antibodies were found in 33.3%, 83.3% and 86.7% of our patients with Graves' disease, respectively. The titers of Tg and TPO(mic) antibodies remained unchanged in most patients after ATD treatment. However, the TSH-R(rr) antibody titers decreased in 46.7%, elevated in 26.7% and unchanged in 26.7% after ATD therapy. Six cases got long-term remission. Measurements of Tg and TPO antibodies have no value in forecasting the outcome of the disease. The change of circulating TSH-R(rr) antibody from positive to negative is more predictive of remission after ATD therapy than the decrease of thyrotropin-binding inhibiting immunoglobulin index only. However, the former change indicating a persistent remission is not certain.

Silent corticotropic adenoma of pituitary gland--a case report

A 79-year-old man complained progressive visual impairment and Diplopia for 2 weeks. A big pituitary tumor was found and partially removed by the surgeon eventually. The tumor cells were chromophobic with H&E stain and exhibited focal positive staining with PAS. Immunoperoxidase method demonstrated moderate positivity for adrenocorticotrophic hormone (ACTH), while staining for growth hormone (G.H) and prolactin were negative. The patient was eucorticoid clinically and biochemically. Since silent corticotropic adenoma of the human pituitary gland is rarely encountered clinically, a review of the literature is included in this article.

[Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic coma--a reappraisal after seven years]

In treating DKA and HHNK, low dose insulin therapy has been confirmed to be efficient and with less complications than traditional high dose insulin therapy. In 1981, we have reported 157 cases of DKA and HHNK at VGH. Between January 1986 and December 1987, 98 cases of DKA and HHNK were encountered at VGH. 40 patients had 48 episodes of DKA their mean age were 56 years. Comparing with the previous report, we found that the main precipitating factors were infection (41.6% vs 38.8%), omission of insulin (27.1% vs 34.7%) and there were cases without any precipitating factors (18.7% vs 24.8%). 3 cases died (6.2% vs 7.3%) in three days. During treatment, hypoglycemia were found in 4 cases (8.3% vs 5.2%) and hypokalemia were noted in 30 cases (62.5% vs 42.3%). 47 patients had 50 episodes of HHNK, their mean age were 68.7 years. Comparing with the previous experience, the main precipitating factors were infection (44% vs 45.7%), omission of insulin (16% vs 20%) and cardiovascular disorder (12% vs 31.4%), there were some episodes without any precipitating factors (20% vs 8.6%). 10 cases died (20% vs 20%) in three days, hypoglycemia were noted in 2 cases (4% vs 3%) and hypokalemia in 20 cases (42% vs 27.3%). It seems, even with better knowledge, facilities and increased experience in the management of diabetic emergencies, no dramatic change in morbidity and mortality was noted over the past 7 years.

[Cost-effectiveness analysis of two-dimensional/Doppler echocardiography, cardiac catheterization and angiography in the diagnosis of congenital heart disease]

To compare the costs and effectivenesses of 2-dimensional/Doppler echocardiography (2D/DE), cardiac catheterization (CC) and angiography (CA) in the evaluation of cardiac anatomy in patients with congenital heart disease, these three kinds of examinations were performed in 100 patients before operation. The 100 patients had 120 separate cardiovascular abnormalities, of which 100 (83.3%) were prospectively identified by 2D/DE. The sensitivity and specificity of 2D/DE were: ASD, 87.9% and 100%; VSD, 97.9% and 96.1%; PDA, 86.7% and 98.2%, Tetralogy of Fallot, 6 of 6 patients; the overall sensitivity and specificity of the less common defects, 31.6% and 95.8%. Ninety-seven (80.8%) were prospectively identified by catheterization. The sensitivity and specificity of catheterization were: ASD, 87.9% and 100.0%; VSD, 80.9% and 94.6%; PDA 93.3% and 96.6%; Tetralogy of Fallot, 6 of 6 patients, the less common defects, 52.6% and 95.5%. Forty-five (81.8%) were prospectively identified by angiography in 55 patients. The sensitivity and specificity of angiography: ASD, 5 of 7 patients, VSD, 88.0% and 94.3%; PDA, 2 of 2 patients; Tetralogy of Fallot, 5 of 5 patients; the less common defects, 68.8% and 100.0%. The economic evaluations were performed. The costs of the depreciation (including equipments and houses), hospital bed, water and electricity, management and staffs' wage were: 2D/DE, RMB 46.09 per patient; catheterization, RMB 314.17 per patient; angiography, RMB 314.17. The ratios of cost to outcome (cost per correct diagnosis) of 2D/DE, CC and CA were: 55.33, 388.82 and 384.07 respectively.(ABSTRACT TRUNCATED AT 250 WORDS)