ObjectiveTo observe and analyze the clinical features and prognosis of endogenous klebsiella pneumoniae endophthalmitis (EKPE).MethodsThis is a retrospective case series study. Seven patients (8 eyes) with EKPE were enrolled in this study. There were 3 males (4 eyes) and 4 females (4 eyes). The ages were from 39 to 76 years, the mean age was 57.29 years. All these cases had no history of trauma and surgery. Meanwhile, they all had some risk factors, such as infection, diabetes mellitus, systemic lupus erythematosus, liver abscess, renal insufficiency undergoing dialysis treatment, Hodgkin lymphoma and so on. All the eyes were undertaken visual acuity, slit lamp and fundus examination to observe the eye conditions. Seven eyes were undertaken pars plana vitrectomy with intravitreal injection of antibiotics from 2 days to 2 weeks after onset. And only one eye was undertaken intravitreal injection of antibiotics without surgery. Microbial stains and culture were performed for 7 eyes using vitreous and aqueous fluid samples from the procedures of vitrectomy. Meanwhile, culture and drug sensitive tests were performed from blood samples. According to the result of the drug sensitive tests, carbapenems such as imipenem and meropenem were used in each patient through intravenous injection from 1 to 2 weeks. During the follow up period from 3 days to 1 year, prognosis was observed at each office visit.ResultsFrom these eight eyes, presenting visual acuity was light perception (4 eyes), hand motion (3 eyes), 0.1 (1 eye). Hypopyon (6 eyes), aqueous fluid opacity (2 eyes) and diffuse vitreous opacity (8 eyes) were found. Changes in fundus like optic disc, macular edema and retinal vascular occlusion could be observed. Cultures of the vitreous and aqueous fluid samples from vitrectomy were all point out to klebsiella pneumoniae. At last office visit, the visual acuity of patients with hypopyon was no light perception (1 eye), light perception (1 eye), hand motion (1 eye). The visual acuity of patients without hypopyon was 0.05 (1 eye) and 0.5(1 eye). Finally, 1 eye was underwent enucleation and one patient with binocular disease was died of multiple organ failure.ConclusionsEKPE is almost unilateral attacked. Changes in fundus like optic disc, macular edema and retinal vascular occlusion can be observed. EKPE is commonly associated with poor visual outcomes. It is useful to save patients’ visual acuity by performing vitrectomy before hypopyon happened.
ObjectiveTo investigate the characteristics and prognostic value of cellular immune function in severe patients with coronavirus disease 2019 (COVID-19).MethodsA cohort study was conducted to collect the clinical data of 119 severe patients admitted to the Renmin Hospital of Wuhan University (Eastern District) including 60 males (50.4%) and 59 females (49.6%), with an average age of 60.9±14.2 years. The primary endpoint of follow-up was death in the hospital, and the disease outcome classification was the secondary endpoint of follow-up within 30 days after admission. We analyzed the correlation between cellular immune function and COVID-19 prognosis.Results A total of 22 patients died during this process, and 47 patients were severe/critical during the follow-up period. The counts of CD3+, CD4+, CD8+, and CD19+ in the primary endpoint events were significantly different between the survival group and the death group (all P<0.05). The counts of CD3+, CD4+, CD8+, CD19+ in the secondary endpoint events were significantly different between the normal group and the severe/critical group (all P<0.05). The results of the receiver operating characteristic (ROC) curve showed that the area under the cellular immune function curve of dead patients and severe/critical patients had good predictive value (all P<0.05).ConclusionCell immune function has good clinical and prognostic value for COVID-19.
ObjectiveTo systematically review the risk factors of refractory mycoplasma pneumoniae pneumonia (RMPP) in children. MethodsPubMed, The Cochrane Library, EMbase, CNKI, CBM, VIP, and WanFang Data databases were electronically searched for case-control studies and cohort studies on the risk factors of RMPP in children from inception to March 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 27 case-control studies involving 3 967 children with RMPP and 11 613 children with common MPP were included. The results of meta-analysis showed that heat course (OR=2.07, 95%CI 1.98 to 2.16, P<0.000 01), length of hospital stay (OR=1.42, 95%CI 1.14 to 1.69, P<0.000 01), recurrent respiratory tract infection (OR=8.51, 95%CI 6.15 to 11.77, P<0.000 01), level of IL-6 (OR=21.95, 95%CI 20.85 to 23.06, P<0.000 01), level of CRP (OR=2.41, 95%CI 1.94 to 2.87, P<0.000 01), level of LDH (OR=0.79, 95%CI 0.53 to 1.06, P<0.000 01), level of ESR (OR=2.65, 95%CI 1.13 to 4.18, P=0.000 6), combined pleural effusion (OR=9.42, 95%CI 3.65 to 24.31, P<0.000 01), combined with extrapulmonary complications (OR=3.33, 95%CI 2.42 to 4.58, P<0.000 01), large lung consolidation (OR=12.31, 95%CI 5.42 to 27.99, P<0.000 01) were the risk factors for RMPP. ConclusionsCurrent evidence indicates that heat course, length of hospital stay, repeated respiratory tract infection, high level of IL-6, high level of CRP, high level of LDH, high level of ESR, combined pleural effusion, combined extrapulmonary complications, and large lung consolidation are risk factors for children with RMPP. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectivesTo explore a reliable and simple predictive tool for 30-day mortality of influenza A community-acquired pneumonia (CAP).MethodsA multicenter retrospective study was conducted on 178 patients hospitalized with influenza A CAP, including 144 alive patients and 34 dead patients. Receiver operating characteristic (ROC) curves were performed to verify the accuracy of severity scores as 30-day mortality predictors in the study patients.ResultsThe 30-day mortality of influenza A CAP was 19.1%. The actual mortality of PSI risk class Ⅰ-Ⅱ and CURB-65 score 0-1 were 14.5% and 15.7%, respectively, which were much higher than the predicted mortality. Logistic regression confirmed blood urea nitrogen >7 mmol/L (U), albumin <35 g/L (A) and peripheral blood lymphocyte count <0.7×10 9/L (L) were independent risk factors for 30-day mortality of influenza A CAP. The area under the ROC curve (AUC) of UAL (blood urea nitrogen >7 mmol/L+ albumin <35 g/L+ peripheral blood lymphocyte count <0.7×10 9/L) was 0.891, which was higher than CURB-65 score (AUC=0.777, P=0.008 3), CRB-65 score (AUC=0.590, P<0.000 1), and PSI risk class (AUC=0.568,P=0.000 1).ConclusionUAL is a reliable and simple predictive tool for 30-day mortality of influenza A CAP.
ObjectiveTo explore the differential diagnosis value of airspace consolidation in thoracic CT between organizing pneumonia (OP) and acquired community pneumonia (CAP).MethodsA retrospective study was taken by retrieving the patients CT database from October 2010 to August 2016. Fifty-six consecutive patients with OP and 99 consecutive patients with CAP whose CT showed airspace consolidation were enrolled and their clinical characteristics and radiological characteristics were analyzed.ResultsThe percentage of patients whose CT image showed various amount of air bronchogram (ABG) with different shapes is higher in OP group than that in CAP group (87.5% and 72.7% respectively, χ2=4.558, P=0.033). The median and interquartile range amount of ABG in the OP patients were significantly higher than those in CAP group [4 (ranged from 2 to 8) and 2 (ranged from 0 to 4) respectively, z=3.640, P=0.000]. Morphologically, 58.9% of the OP patients showed entire air bronchogram (EABG) on the thoracic CT, significantly higher than that in CAP group (21.2%) (χ2=22.413, P=0.000). Interrupted ABG was found in 26.3% of CAP patients, while 16.1% of OP patients shared same features and the difference was not statistically significant (χ2=2.125, P=0.148). Traction bronchiectasis and ground glass opacity (GGO) were more likely to be found in the OP patients rather than CAP patients with 26.8% and 39.3% respectively, while they were found in 1.0% and 11.1% in the CAP patients (P<0.05). Reversed halo sign was found only 1.0% of the CAP patients, significantly lower than that in OP group, 26.8% (χ2=25.671, P=0.000). Pleural effusion and bronchial wall thickening were more commonly found in the CAP group with 56.6% and 35.4% respectively. By multivariate logistic analysis, EABG (OR=5.526, P=0.000), traction bronchiectasis (OR=21.564, P=0.010), GGO (OR=4.657, P=0.007) and reversed halo sign (OR=13.304, P=0.023) were significantly associated with OP, while pleural effusion (OR=0.380, P=0.049) and bronchial wall thickening (OR=0.073, P=0.008) were significantly associated with CAP. Other features in thoracic CT coexisting with ABG all reach significance statistically between the OP and CAP group (all P<0.05).ConclusionsAirspace consolidation in thoracic CT may be valuable for the differential diagnosis between OP and CAP. EABG is more commonly found in OP patients than in CAP patients. When EABG exists or ABG coexists with traction bronchiectasis, GGO and reversed halo sign, a diagnose of OP should be considered.
Coronavirus disease 2019 that started in Wuhan, Hubei Province in December 2019, has spread rapidly across China. Radiography provides an important basis for clinical diagnosis of coronavirus disease 2019 and plays a crucial role in fighting against the epidemic. In the face of public health emergencies, how to quickly set up a team for accurate prevention and control in the first time and how to carry out radiological examination and diagnosis ina scientific, orderly, safe and efficient manner are the key measures to support the hospital in effectively responding to the epidemic. This paper summarized the innovative management experience of the radiology department of West China Hospital of Sichuan University in the prevention and control of nosocomial infection and discipline construction in the fight against the outbreak of coronavirus disease 2019.
