Objective To investigate the risk factors for secondary pulmonary fungal infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). And a visual tool using nomogram was developed and validated to assist in the clinical prediction of the probability of pulmonary fungal infection occurrence in AECOPD patients. Methods A retrospective cohort study method was used to collect AECOPD patients hospitalized in the Department of Respiratory, The First Affiliated Hospital of Chengdu Medical College from January 2021 to December 2021 as a training set. And AECOPD patients between January 2020 and December 2020 were collected as a validation set. Independent risk factors were determined through univariate, Lasso regression analyses. and multivariable logistic, A nomogram prediction model was constructed with these independent risk factors, and the nomogram was evaluated by receiver operating characteristic area under the curve (AUC), calibration curve, and decision curve analysis (DCA). Results The use of glucocorticoid, combined use of antibiotics, duration of antibiotic use and hypoalbuminemia were independent risk factors for secondary pulmonary fungal infection in AECOPD patients (all P<0.05). The training set and validation set of the constructed prediction model had an AUC value of 0.915 [95%CI: 0.891 - 0.940] and 0.830 [95%CI: 0.790 - 0.871], respectively. The calibration curve showed that the predicted probability was in good agreement with the actual observed probability of pulmonary fungal infection in AECOPD patients. The corresponding decision curve analysis (DCA) indicated the nomogram had relatively ideal clinical utility. Conclusions The result showed that the use of glucocorticoid, combined use of antibiotics, prolonged antibiotic therapy and hypoalbuminemia was independent risk factors for pulmonary fungal infection in AECOPD patients. The clinical prediction model for secondary pulmonary fungal infection in AECOPD patients constructed in this study has strong predictive power and clinical practicability.
目的 探討肺郎格罕細胞組織細胞增多癥（pulmonary Langerhans cell histiocytosis, PLCH）的臨床特征、診斷和治療。 方法 回顧性分析1999年-2008年4例病理確診的PLCH。 結果 4例患者均為男性；13～56歲；2例吸煙。臨床特征是活動后氣短、氣胸。胸部CT表現為網格狀、囊狀或結節狀影像。肺活檢病理結果：光學顯微鏡下可見病理性郎格罕細胞，免疫組織化學法檢測發現4例S-100均為陽性，2例CD1a陽性，1例CD68陽性。 結論 PLCH胸部CT表現為網結節或囊性變，病理檢查見病理性郎格罕細胞浸潤細支氣管壁和上皮細胞的間質，免疫組織化學CD1a抗原、S-100蛋白陽性可明確診斷。
ObjectivesTo systematically review the efficacy of telemedicine on blood glucose level and pregnancy outcomes in patients with gestational diabetes mellitus.MethodsThe Cochrane Library, PubMed, Web of Science, CINAHL, Scopus, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on efficacy of telemedicine on blood glucose and pregnancy outcomes in patients with gestational diabetes from inception to January 1st, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, and then meta-analysis was performed by RevMan 5.3 software.ResultsA total of 10 RCTs involving 1 267 patients were included. The results of meta-analysis showed that there were no statistical significances in fasting blood glucose (MD=?0.34, 95%CI ?1.62 to 0.93, P=0.60), HbA1c (MD=?0.22, 95%CI ?0.61 to 0.17, P=0.27), gestational age at delivery (MD=0.03, 95%CI ?0.13 to 0.19, P=0.72), premature rate (OR=0.52, 95%CI 0.26 to 1.01, P=0.05), caesarean delivery rate (OR=0.87, 95%CI 0.57 to 1.31, P=0.51), infant birth weight (MD=13.01, 95%CI ?45.75 to 71.78, P=0.66), large for gestational age rate (OR=1.16, 95%CI 0.83 to 1.62, P=0.40), pre- eclampsia/pregnancy induced hypertension rate (OR=1.04, 95%CI 0.52 to 2.09, P=0.91), neonatal hypoglycaemia rate (OR=1.21, 95%CI 0.75 to 1.95, P=0.44) and neonatal jaundice rate (OR=1.09, 95%CI 0.59 to 2.00, P=0.78) between telemedicine management and outpatient follow-up of gestational diabetes mellitus. However, the telemedicine management group had lower 2h postprandial blood glucose (MD=?3.45, 95%CI ?5.53 to ?1.37, P=0.001).ConclusionsThe current evidence shows that telemedicine management of gestational diabetes mellitus achieves similar efficacy and safety in blood glucose level and pregnancy outcomes as outpatient follow-up. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.
ObjectiveTo explore the effectiveness of modified rhomboid flap for repairing facial skin and soft tissue defect.MethodsBetween January 2016 and May 2018, 23 patients with facial skin and soft defect were repaired by the modified rhomboid flap. There were 10 males and 13 females with the median age of 27 years (range, 11-72 years). The primary tumor included pigmented nevus in 18 cases, basal cell carcinoma in 4 cases, and squamous cell carcinoma in 1 case. The defect location was nose in 8 cases, cheek in 4 cases, malar in 6 cases, forehead in 2 cases, and upper lip in 3 cases. The defect ranged from 0.8 cm×0.8 cm to 3.9 cm×3.9 cm. According to the location and size of facial tumors, the resection area of square lesions was designed. According to the mobility of surrounding tissues and the direction of dermatoglyphic lines, the rhomboid flaps with an angle of 45–60° was designed to repair the defect by tension-free rotation.ResultsAll the flaps survived and the incision healed by first intension. All patients were followed up 3-15 months (mean, 7.3 months). During follow-up, no tumor reoccurred; the color and texture of the flaps were similar with surrounding tissue. There was no obvious scar hyperplasia, nor traction of adjacent normal tissues, and patients were satisfied with the appearance.ConclusionThe application of modified rhomboid flaps in repairing facial skin and soft tissue defects caused by resection of round facial tumor has the advantages of flexible design, simple manipulation, and less trauma.