ObjectiveTo analyze the risk factors for post-thymectomy myasthenic crisis (PTMC) and prolonged mechanical ventilation, in myasthenia gravis patients who underwent extended thymectomy.
MethodsWe retrospectively analyzed the clinical data of 79 patients including 38 males and 41 females who experienced PTMC and required mechanical ventilation in Daping Hospital between June 2008 and November 2014. Single factor analysis and multivariate analysis were conducted.
ResultsMorbidity of PTMC was 20.6% (79/384). Result of single-factor analysis showed that postoperative pneumonia was one of the main reasons of prolonged mechanical ventilation (P < 0.05). Result of multiple-factor analysis showed that the operation time was positively correlated with mechanical ventilation time (P < 0.05). The risk factor of prolonged mechanical ventilation time in PTMC was not associated with sex, age, disease history, myasthenic crisis history, Osserman classification, dosage of pyridostigmine before and after the operation, surgical approach, bleeding volume, other therapies besides mechanical ventilation (P > 0.05).
ConclusionMechanical ventilation is one the main therapy of PTMC, operation time, and postoperative pneumonia are the main factors to prolong mechanical ventilation time. In order to decrease morbidity of PTMC and shorten mechanical ventilation time, the operation time should be controlled and pulmonary infection should be avoided.
ObjectiveTo investigate the clinical and CT findings in patients with coronavirus disease 2019 (COVID-19).MethodsThe epidemiological data and clinical manifestations of 83 COVID-19 patients admitted to Chongqing Public Health Medical Center from January 24, 2020 to February 4, 2020 were analyzed retrospectively. According to the clinical classification, they were divided into four groups: mild group 8 patients, common group 62 patients, severe group 10 patients, and critically severe group 3 patients. The CT characteristics and their relationship with clinical classification were analyzed.ResultsThe average age of 70 mild patients was (43.7±15.0) years, 13 severe patients was (57.4±11.8) years. The average age of mild patients was lower than that of severe patients (Z=–3.185, P=0.001). The average course of mild disease was (5.5±4.2) days, lower than that of severe disease (11.8±5.0) days (Z=–3.978, P=0.000). The clinical manifestations were fever in 72 patients, cough in 60 patients, expectoration in 34 patients, asthenia in 25 patients and shortness of breath in 19 patients. Basic diseases were complicated in 16 patients. CT findings: Both lung lobes were affected in 70 patients (93.3%), pure right lung lobe was affected in 3 patients (4.0%), pure left lung lobe was affected in 2 patients (2.7%), and there was no focus in 8 patients. The total number of affected lung segments was 203 in severe type, with an average of 15.6±5.4 and 530 in the common type, with an average of 9.6±5.3. The number of the severe type was more than that in the common type (Z=–3.456, P=0.001). The focus was mainly in the posterior part, 62 in the dorsal and 65 in the posterior basal segments, 41 in the anterior part of the upper lobe, and less in the common type (P<0.05). The main lesions were ground-glass opacities in 74 patients, patchy shadow in 72 patients, piece shadow in 46 patients, strip shadows in 51 patients and consolidation in 34 patients. Among them, the common CT showed patchy shadow in 34 patients (54.8%), less than severe patients in 12 patients (92.3%) (χ2=4.880, P=0.027). There was no significant difference between the mild CT and the severe patients (P>0.05).ConclusionsThere are some radiographic characteristics in COVID-19. Chest CT is helpful for the diagnosis and the judgement of the disease.
ObjectiveTo discuss the risk factors of acute respiratory distress syndrome (ARDS) in patients with severe pneumonia.MethodsData of 80 patients with severe pneumonia admitted in our ICU were analyzed retrospectively, and they were divided into two groups according to development of ARDS, which was defined according to the Berlin new definition. The age, gender, weight, Acute Physiology and Chronic Health EvaluationⅡscore, lactate, PSI score and LIPS score, etc. were collected. Statistical significance results were evaluated by multivariate logistic regression analysis after univariate analysis. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of the parameter for ARDS after severe pneumonia.ResultsForty patients with severe pneumonia progressed to ARDS, there were 4 moderate cases and 36 severe cases according to diagnostic criteria. Univariate analysis showed that procalcitonin (t=4.08, P<0.001), PSI score (t=10.67, P<0.001), LIPS score (t=5.14, P<0.001), shock (χ2=11.11, P<0.001), albumin level (t=3.34, P=0.001) were related to ARDS. Multivariate logistic regression analysis showed that LIPS ［odds ratio (OR) 0.226, 95%CI=4.62-5.53, P=0.013］ and PSI (OR=0.854, 95%CI=132.2-145.5, P=0.014) were independent risk factors for ARDS. The predictive value of LIPS and PSI in ARDS occurrence was significant. The area under ROC curve (AUC) of LIPS was 0.901, the cut-off value was 7.2, when LIPS ≥7.2, the sensitivity and specificity were both 85.0%. AUC of PSI was 0.947, the cut-off value was 150.5, when PSI score ≥150.5, the sensitivity and specificity were 87.5% and 90.0% respectively.ConclusionsPSI and LIPS are independent risk factors of ARDS in patients with severe pneumonia, which may be references for guiding clinicians to make an early diagnosis and treatment plan.
Objective To assess the effectiveness and safety of an aerosol inhalation of ambroxol in accessory treatment of pneumonia. Methods Biomedical databases, including MEDLINE, EMbase, The Cochrane Central Register of Controlled Trials (CENTRAL), CBM-disk and CNKI were searched. Randomized controlled trials (RCTs) and quasi-RCTs that compare aerosol inhalation of ambroxol with placebo or other aerosol inhalation regimens were collected. A critical quality assessment and Meta-analysis were performed for included studies. Results Thirteen RCTs were included and all of them were carried out in China. None of the trials described the method of randomization, allocation concealment, blind, and follow-up. With Juni scales, 13 trials scored C degree. Compared with the control group, aerosol inhalation of ambroxol improved total improvement rate and symptoms, and shortened hospital stay. Although statistical difference was not found in some comparisons, all trials showed beneficial tendency. We didn’t find any RCTs describing the safety of ambroxol aerosol inhalation. Conclusion Because of the low quality of RCTs on ambroxol aerosol inhalation for pneumonia, no reliable conclusion can be drawn from our Meta-analysis. Well-designed RCTs and economic evaluation are urgently needed to evaluate the value and safety of aerosol inhalation of ambroxol in treating pneumonia.
ObjectiveTo compare the value of the acute physiology and chronic health evaluationⅡ (APACHEⅡ) scores, the pneumonia severity index (PSI) scores), the CURB-65 scores, and serum procalcitonin (PCT) concentration in prediction of prognosis for inpatients with community-acquired pneumonia (CAP) and discuss the influence factors.MethodsRetrospective analysis was conducted based on the APACHEⅡ scores, the CURB-65 scores, the PSI scores and PCT concentration of hospitalized CAP patients admitted in the Department of Respiratory Medicine of First Hospital of Shanxi Medical University between January 2015 and December 2016, and within 24 hours of their admission. The end point of this study was the clinical outcome of hospitalization (recovery, improvement, exacerbation or death). Receiver operating characteristic (ROC) curve analysis and binary logistic regression models were used to assess the ability of prognostic evaluation and determine the boundary value, to screen risk factors that influence deterioration and death in CAP patients.ResultsTwo hundred and thirty-five CAP patients were enrolled with 146 males and 89 females at an average age of (60.4±18.1) years old. All patients were divided into 2 groups: improving recovery group had 205 cases, and deteriorating group had 30 cases. The rank of areas under the ROC curve for predicting the deterioration and death risk of CAP, from big to small were APACHEⅡ(0.889), PSI (0.850), CURB-65 (0.789), and PCT (0.720). APACHEⅡ score over 11 points and PSI score over 91 points were optimal cut-off values for the prognostic assessment. Moreover, the logistic regression analysis revealed that APACHEⅡ score and PCT were independent risk factors of deterioration and death in CAP patients.ConclusionsThe better predictability of clinic outcome of CAP is APACHEⅡ score, PSI score, CURB-65 score, and PCT respectively in order, while the APACHEⅡ score and PCT concentration were independent risk factors for exacerbation and mortality in CAP patients. The predictive ability of a single PCT measurement is limited. The combination of APACHEⅡ score and PCT may increase specificity, but reduce sensitivity.
ObjectiveTo explore the clinical value of next-generation sequencing (NGS) in the diagnosis of Pneumocystis jirovecii pneumonia (PCP).MethodsTwo patients with Pneumocystis jirovecii pneumonia after lung transplantation were detected by NGS in the sputum and bronchoalveolar lavage fluid. The clinical data, imaging features, laboratory examination and treatment of the two patients were reported. A systematic literature review was performed for similar published cases in PubMed database, using the keywords "lung transplantation/solid organ transplantation" and "Pneumocystis jirovecii".ResultsThere were six references based on the keywords of "lung transplantation " and " Pneumocystis jirovecii ", of which three were case report. Sixty-six lung transplant patients were complicated with Pneumocystis jirovecii in total. The clinical manifestations of Pneumocystis jirovecii pneumonia were fever and dyspnea of different degrees. The diffuse "ground glass" infiltration could be shown on imaging. Computer tomography scan of chest was a sensitive method to detect PCP. Combined immunofluorescence microscope/PCR/serum 3-β-D-glucan could effectively improve the accuracy of microbiology detection. In addition, NGS could quickly and accurately identify pathogenic bacteria, give guidance for treatment and improve prognosis so as to benefit patients well. Trimethoprim/sulfamethoxazole (TMP/SMZ) was the preferred choice for the treatment of PCP patients.ConclusionsPneumocystis jirovecii pneumonia is more common in patients with immunodeficiency or immunosuppression. NGS can help rapid and accurate diagnosis, and the treatment should be early and sufficient.
Objective To analyze morbility，risk factors，etiology，treatment and outcome of nosocomial pulmonary fungal infections in respiratory intensive care unit（RICU）.Methods Forty-seven respiratory RICU patients with nosocomial pulmonary fungal infections between July 2000 and June 2005 were retrospectively analyzed.Results All of the 47 cases were clinically diagnosed as probable nosocomial pulmonary fungal infections，with the morbidity of 10.8% significantly higher than general wards（1.8%，Plt;0.005）.COPD and bacterial pneumonia were the major underlying diseases of respiratory system with a percent of 38.30% and 36.17%，respectively.Forty-one patients (87.2%) had risk factors for fungal infections.Compared with general wards，the proportion of Aspergillosis was higher in RICU without significant difference (Pgt;0.1)；the proportions of Candida glabrata and Candida tropicalis were higher too，but that of Candida krusei was relatively low.The effective rate of antifungal treatment was 79.1% and fluconazol was the most common used antifungal agents.The mortality of fungal infection in RICU was higher than that of general wards but without significant difference（Pgt;0.1）.Conclusion The morbidity of nosocomial pulmonary fungal infection in respiratory RICU is higher than that in general wards.The proportions of infection caused by Aspergilli and some Candida resistant to fluconazol is relatively high.Early and effective treatment is needed in these patients considering the poor prognosis.
ObjectiveThis study aimed to construct a Nomogram predictive model to assess the prognosis of patients with viral pneumonia complicated by diabetes mellitus.MethodsWe retrospectively collected data from patients with viral pneumonia who visited our hospital from January 2023 to February 2024 and divided them into diabetes and non-diabetes groups based on the presence of diabetes. Clinical data were collected and intergroup differences were analyzed. Subsequently, factors with statistical significance (P<0.05) were selected for univariate and multivariate Logistic regression analysis in the diabetes group to identify risk factors affecting patient survival. Based on the regression analysis results, a linear model was constructed to predict the survival risk of patients. Additionally, calibration curves and decision curve analysis (DCA) were plotted to assess the predictive accuracy and clinical net benefit of the model.ResultsThe study found significant intergroup differences in age (age), cough, dyspnea, respiratory rate at admission, heart rate, body temperature, and laboratory test results (including blood glucose Glu, glycated hemoglobin HbA1c, neutrophil ratio Neu, C-reactive protein Crp, etc.). Multivariate Logistic regression analysis confirmed that age (age), B-type natriuretic peptide (Bnp), neutrophil ratio (Neu), and lactate (Lac) are independent risk factors affecting the survival of patients with viral pneumonia and diabetes.The constructed nomogram prediction model was evaluated. The calibration curve demonstrated a high degree of consistency between the predicted probabilities and actual outcomes, with a non-significant Hosmer-Lemeshow test result (P>0.05). Decision curve analysis further showed that the model yielded no significant clinical net benefit at extreme probability thresholds, whereas it provided substantial clinical net benefit across all other threshold ranges. Collectively, these findings indicate that the model exhibits high predictive accuracy and holds significant value for clinical application. ConclusionsAge, serum B-type natriuretic peptide, neutrophil ratio, and lactate are independent risk factors for the survival of patients with viral pneumonia complicated by diabetes. The Nomogram predictive model constructed based on these factors has clinical value for prognosis assessment.
ObjectiveTo analyze the clinical characteristics and related prognostic factors of post-renal transplantation pneumonia.MethodsThe clinical data of 89 patients with post-renal transplantation pneumonia in Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital from 1st January 2014 to 31st December 2015 were collected in the study. Kaplan-Meier method was used to calculate overall survival. Cox analysis was used to analyze the related prognostic factors.ResultsPost-renal transplantation pneumonia occurred mainly within 6 months after renal transplantation. The prominent clinical manifestations were cough (95.5%), fever (56.1%), and dyspnea (12.3%). The mortality of post-renal transplantation pneumonia was 11.2% and all death occurred within 5 months after transplantation. The overall survival rate significantly decreased in the patients with C-reactive protein (CRP) ≥40 mg/L (P<0.001), procalcitonin ≥1 ng/ml (P=0.002), brain natriuretic peptide >100 pg/ml (P<0.001), platelet ≤100×109/L (P<0.001), or those with occurrence time of pneumonia <180 days (P=0.013). Platelet ≤100×109/L could increase the risk of death by 66.6 times (RR=0.015, P=0.006), and CRP ≥ 40 mg/L could increase the risk of death by 20 times (RR=0.05, P=0.029).ConclusionsPost-renal transplantation pneumonia has prominent clinical characteristics. Platelet ≤100×109/L or CRP ≥40 mg/L can increase the risk of death and can be used as an independent prognoctic factor of post-renal transplatation pneumonia.
ObjectiveTo describe the imaging and clinical features of vaccinia virus induced pneumonia by long-term follow-up.MethodsThe clinical data, imaging features and long-term follow-up of 5 patients with vaccinia virus pneumonia admitted to Wuxi People's Hospital Affiliated to Nanjing Medical University were analyzed.ResultsAll the 5 patients were male, aged between 21 and 54 years. The latent period of the disease was 2 to 5 days. All the patients had fever and pneumonia, while 3 of them had herpes. Two patients with severe pneumonia showed extensive patchy and nodular shadows in both lungs. Chest CT findings of the other three patients showed scattered small nodules in both lungs. All patients were followed up by telephone every half a year for 3 years. The prognosis of all patients was good. The patients reported in the English literature were clinically clustered, with fever, vomiting and rash as the main symptoms.ConclusionsVaccinia virus may cause different clinical symptoms through different transmission routes, and its infectivity is strong. Biological protection should be strengthened in laboratory and working environment.
