Background: Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) has regarded as a biological marker of infection. We aimed to evaluate the diagnostic value of bronchoalveolar lavage (BAL)-sTREM-1 concentration in neonatal ventilator-associated pneumonia (NVAP). Methods: In this multicenter, controlled clinical trial of 60 preterm and 33 full-term neonates on mechanical ventilators, we measured concentrations of BAL-fluid and serum sTREM-1, serum C-reactive protein, and serum procalcitonin, as well as white blood cell count. We initially divided cases into eight groups, based on three categories: preterm of full-term; NVAP or non-NVAP; and extrapulmonary infection present or absent. Groups were compared, and logistic regression analysis and receiver operating characteristic (ROC) analysis was performed to determine diagnostic value. Results: The mean gestational age (± standard deviation) of preterm and full-term neonates was 28.9±2.2 weeks and 39.5±1.7 weeks, respectively, and 32/60 were male. The BAL-fluid sTREM-1 concentration was higher in NVAP cases than in non-NVAP cases, irrespective of extrapulmonary infection. ROC analysis revealed that BAL-fluid sTREM-1 concentration had an area under the curve (AUC) of 0.986 and a cutoff value of 228.0 pg/ml (sensitivity, 94.3%; specificity, 96%) in preterm neonates; the same values in full-term neonates were 0.938 and 245.5 pg/ml (sensitivity, 100%; specificity, 93.7%), respectively. The optimal combination of indicators was BAL-fluid sTREM-1 and serum C-reactive protein concentration. All indicators were present at lower levels on days 8 and 10 of ventilation in neonates who ultimately recovered than in those who did not. Conclusion: BAL-fluid sTREM-1 and serum C-reactive protein concentrations may be useful for the diagnosis of NVAP.
Background: This report describes one case of anesthetic management about surgical resection of a malignant phaeochromocytoma with tumor extension into vena cava and right atrium in a patient. Report for anesthetic management is limited in these patients under surgical resection until now. Case presentation: In September 2015, a 24-year-old male presented to the department of cardiology with right flank pain and hypertensive urgency in our hospital. Contrast-enhanced CT abdomen and MRI abdomen revealed right adrenal mass suspicious of malignancy with invasion and compression to the right IVC wall along with IVC thrombus extending from the level of renal veins to the level of confluence with hepatic veins. Echocardiography shown no abnormal detection. Finally, this patient gave up the surgical resection of phaeochromocytoma and chose the expectant treatment. In April 2018, this patient once again presented to the emergence department with a persistent cough and intermittent wheezing character for 5 hour. Contrast-enhanced CT and echocardiography shown existing IVC thrombus had extended into the right atrium. After the careful preoperative preparation, adrenalectomy with complete thrombus excision by inferior vena cava exploration and right atriotomy were performed successfully by a multidisciplinary team. After one month post-operation care, the patient healthily leave our hospital. Conclusion: To the best of our knowledge, the occurrence of pheochromocytoma in IVC and right atrium thrombosis has not been reported so far from mainland China. This clinical case may supply a rare reference experience for surgical treatment and anesthetic management in the group of phaeochromocytoma patient with distance vascular extension. Keywords: Adrenal tumor; Malignant phaeochromocytoma; Inferior vena cava; Right atrium; Tumor thrombus.
Objectives: The early diagnosis of pertussis is a public health issue, and there is a lack of sufficient lab testing. sTREM-1 has been found to be a potential specific marker for infectious diseases. This study aimed to evaluate the early diagnostic value of serum sTREM-1 to pertussis in infants. Methods: In patients with suspected pertussis, various potential indicators were evaluated, including serum sTREM-1, white blood cells, serum C reactive protein, and serum procalcitonin. Multiplex PCR of nasopharyngeal secretion was employed to identify B. pertussis, and bacterial cultures and viral antigen detection were performed. Cases in which the pathogen and various indicators were present were considered as pertussis. Cases were divided into two groups, the pertussis and non-pertussis groups, and then the indicator results were analyzed. Results: Seventy-eight infants with pertussis and 42 infants without pertussis were analyzed; there were no significant differences in terms of sex, age, onset time, feeding patterns, and location of residence. The difference in serum sTREM-1 levels between the pertussis group (238.99±71.95 pg/ml) and non-pertussis group (104.04±49.38 pg/ml) was statistically significant (t = 10.8482, P<0.05). Serum sTREM-1 had an AUC of 0.930, cutoff value of 142.5 pg/ml, sensitivity of 85.9%, and specificity of 83.3% (95% CI: 0.886-0.973, P<0.05). Lymphocyte proportion had an AUC of 0.871; however, white blood cells, C reactive protein, and procalcitonin had AUC values below 0.7. Conclusion: The detection of serum sTREM-1 may be useful for the early diagnosis of pertussis.
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