ObjectiveTo evaluate the value of blood urea nitrogen to creatinine ratio (UCR) in predicting the condition and prognosis of severe pneumonia patients.MethodsA total of 408 patients with severe pneumonia hospitalized in the intensive care unit (ICU) of Fangcun branch of Guangdong Provincial Hospital of traditional Chinese medicine from January 1, 2017 to August 1, 2020 were retrospectively collected. The patients were divided into a survival group (320 cases) and a death group (88 cases) according to the outcome of hospitalization. This study analyzed the relationship between UCR level and general information, condition, and treatment needs of severe pneumonia patients; and compared UCR, the value of neutrophil to lymphocyte ratio, the levels of hematocrit, C-reactive protein, procalcitonin and D-dimer, and the scores of Acute Physiology and Chronic Health EvaluationⅡ and Pneumonia Severity Index between the survival group and the death group. Receiver operating characteristic (ROC) curve was used to analyze the prognostic value of the above indicators. Logistic regression was used to analyze the risk factors of death of severe pneumonia.ResultsThe age of the patients died of severe pneumonia was higher than that of the survival patients (P<0.05); The mortality rate of severe hospital acquired pneumonia was higher than that of severe community acquired pneumonia (P<0.05); The level of UCR was higher in the patients over 70 years old (P<0.05); UCR level of the severe pneumonia patients with acute exacerbation of chronic obstructive pulmonary disease or multiple organ dysfunction syndrome during hospitalization was higher (P<0.05); The UCR level was higher in the patients with severe pneumonia whose ICU stay was more than 10 days (P<0.05); The UCR level of the severe pneumonia patients with mechanical ventilation longer than 180 hours was higher (P<0.05); UCR level of the severe pneumonia patients who died during hospitalization was higher than that of the survival group (P<0.05); The area under ROC curve of UCR for predicting death in the patients with severe pneumonia was 0.648 (95%CI 0.576 - 0.719), the cut-off value was 108.74, the sensitivity was 47.7%, and the specificity was 77.8% (P<0.05). PSI > level 3 (OR=4.297, 95%CI 2.777 - 6.651) and UCR > 108.74 (OR=0.545, 95%CI 0.332 - 0.896) were independent risk factors for death in the patients with severe pneumonia (P<0.05).ConclusionUCR has certain value in evaluating the condition and prognosis of severe pneumonia patients.
ObjectiveTo introduce implantation methods of different types of congenital heart disease occluder for the treatment of bronchopleural fistula (BPF) and its preliminary efficacy.MethodsThree patients who diagnosed with BPF and treated by congenital heart disease occluder were reviewed. The clinical data was analyzed after comprehensively reviewing of relevant literature.ResultsAll the three patients were treated with postoperative BPF and empyema. The diameter of the fistula ranged from 3 to 8 mm. We used occlusive devices for congenital heart diseases such as atrial septum (ASD), ventricular septum (VSD) defect or patent ductus arteriosus (PDA), respectively. After treatment, all three patients were cured of BPF and empyema caused by BPF in a short time, and the thoracic drainage tube was successfully removed. During the follow-up period from 7 to 25 months, no significant long-term complications were observed.ConclusionThe use of ASD, VSD and PDA occluder for the treatment of BPF with a fistula more than 3 mm is effective and safe.
ObjectiveTo investigate the efficacy of vagus nerve stimulation (VNS) in the treatment of refractory epilepsy in children and the key factors affecting its efficacy. MethodsThe clinical data of 22 children with drug-resistant epilepsy who received VNS treatment in the Second People's Hospital of Hunan Province from January 2016 to April 2023 were analyzed. The average seizure reduction rate, effective rate and McHugh grade were used to evaluate the efficacy of VNS after at least 1 year follow-up. Patients with an attack reduction rate of ≥50% were defined as respondents, and Mann-Witney U test and χ2 test were used, respectively, to conduct univariate and multifactor Logistics regression analysis with statistically significant indicators (P<0.05). ResultsAmong the 22 patients, the average attack reduction rate was 12.66% at 1 month, 26.10% at 3 months, 37.47% at 6 months, 48.18% at 9 months and 54.38% at 12 months. The effective rate was 5.00%, 9.00%, 36.00%, 50.00% and 68.00%, respectively. 12 months after operation, there were 3 cases of grade I, 12 cases of grade II, 7 cases of grade III, and 0 cases of grade V. Unifactorial and multivariate Logistic regression analysis showed that the curative effect of epilepsy in children was related to the seizure type, among which the curative effect of general seizure was better than that of focal seizure (OR=0.062, P=0.014), and the curative effect of myoclonic seizure and tonic seizure was better than that of other types in general seizure. ConclusionThe clinical effect of VNS in the treatment of refractory epilepsy in children is time cumulative, and the surgical effect of myoclonic seizures and tonic seizures in general seizures is better.
Objective To invesitgate the clinical characteristics, radiology, diagnosis and treatment of pulmonary cryptococcosis ( PC) . Methods The patients with PC diagnosed form January 2000 to January 2009 from three hospitals of Shanghai and Nanjing were retrospectively analyzed. Results A total of 34 patients were diagnosed, with 24 males and 10 females, and an average age of ( 40. 6 ±13. 5) years old ( ranged from 3 to 72 years) . Twelve patients had underlying diseases and 28 patients had symptoms. The main symptoms were pyrexia ( 20 cases) , cough and expectoration ( 22 cases) , chest pain ( 8 cases) , chest tightness ( 5 cases) , and hemoptysis ( 4 cases) . Seven cases were diagnosed as systemic pulmonary cryptococcosis, in which 3 cases were complicated with cryptococcal meningitis ( CM) , and 3 cases with CM and cryptococcal septicemia, and 1 cases with third dorsal vertebra Busse-Buschke disease. Radiologic manifestations showed multiformand nonspecific lesion such as nodus or nodules in 17 cases, pneumonia in 10 cases, mixed appearance in 6 cases, and diffused military nodes in 1 case. The diagnosis was confirmed by pathological study in 27 cases, including 12 cases by thoracotomy, 10 cases by percutaneous lung biopsy, 1 cases by thoracic vertebra biopsy, and 4 cases by bronchoscope. Ten cases were confirmed with culture positive or smear positive. Six cases were treated by surgery alone, 21 cases by antimycotic drug therapy alone, and 6 cases by drug therapy after surgery. One case quitted after the diagnosis. The duration of treatment varied from 2 weeks to 2 years. One case died in the hospital, 25 cases recovered after discharge, and 8 cases were lost to follow-up. Conclusions PC is likely to be misdiagnosed due to atypical clinical and image manifestations. The diagnosis is always comfirmed on the pathological and microbiological study.
