Objective To investigate changes of TLR2 mRNA expression in lung of a mouse model of Chlamydia Pneumoniae pneumonitis, and to explore the possible mechanism of signal transduction. Methods Ninety-six male C3H/HeJ mice were randomly divided into four groups as follows: a control group, a model group, a SB203580 intervened group, and a pyrrolidine dithiocarbamate( PDTC) intervened group. Chlamydia Pneumoniae pneumonitis was induced by intranasally inoculated with 4. 0 ×106 IFU/mL of C. Pneumoniae per mouse in the model group and two intervened groups. Then the intervened groups were intraperitoneally injected with the p38MAPK inhibitor SB203580 and nuclear factor kappa B ( NF-κB)inhibitor PDTC, respectively. Six mice in each group were randomly killed in 1st, 4th, 7th and 14th day. The expressional changes of TLR2 mRNA in the mice lung tissue were measured by semi-quantitative RT-PCR. The concentrations of TNF-α in the lung homogenate were measured by ELISA. Results TLR2 mRNA expression in the lung tissue significantly increased after C. Pneumoniae infection, peaking at 4th and 7th days, then decreased after 14th day. Tumor necrosis factor-α( TNF-α) was also elevated in the lung tissue after C. Pneumoniae challenging. Both SB203580 and PDTC treatment effectively inhibited TNF-αand TLR2 mRNA expressions in lung. The inhibitory effect was more obvious by SB203580 treatment. Conclusion C. Pneumoniae can upregulate the expressions of TLR2 and TNF-α in lung, and TLR2/MAPK and TLR2 /NF-κB signal pathways may be involved in Chlamydia Pneumoniae pneumonitis.
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 analyze the clinical characteristics of coronavirus disease 2019 (COVID-19), identify the high-risk factors which promoted the disease progression into severe or critical cases, and provide clinical guidance.MethodsNinety-six cases of clinically diagnosed coronavirus disease 2019 were collected and analyzed from General Hospital of the Yangtse River Shipping from January 20 to February 14, 2020. According to clinical classification, those cases were divided into two groups: mild group, including common and mild cases, and severe group including severe and critical cases.ResultsThere were more than half of patients ages>60 years old and severe or critical illness (61.5%, 56.3%), and obese patients accounts for 45.8%, the complication of hypertension accounts for 52.1%. The average time from onset to hospitalization was (6.1±2.6) days, and the average hospitalization days were (15.7±6.3) days. Compared with the mild group, the number of male patients in the severe group was more (57.4% vs. 35.7%, P<0.05), the numbers of elderly patients were larger (77.8% vs. 40.5%, P<0.01), and more obese peoples (55.6% vs. 33.3%, P<0.05). Cough symptom was more common in clinical presentation in the severe group (81.5% vs. 61.9%, P< 0.05). Patients with the complication of hypertension or diabetes occupied a higher proportion in the severe group, which were 64.8% vs. 35.7% and 35.2% vs. 14.3% (P< 0.05), respectively. And the rate of hypoxemia in admission of the severe group was significantly higher (79.6% vs. 9.5%, P< 0.01).ConclusionsThe cases of ages>60 years old and severe or critical illness in coronavirus disease 2019 occupy a higher proportion, and the complication of hypertension accounts for high proportion. Men, ages>60 years old, obese, coughing symptoms, with hypertension and / or diabetes, hypoxemia upon admission are high risk factors for progression into severe and critical cases.
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 investigate the high-resolution computed tomography (HRCT) signs of patients diagnosed with the coronavirus disease 2019 (COVID-19) and explore its evolution features during hospitalization.MethodsFrom January 17, 2020 to February 26, 2020, HRCT images from 15 COVID-19 patients were analyzed. All the patients had positive nucleic acid test results of SARS-CoV-2. The imaging features of initial and follow-up of each patient were reviewed and graded based on the severity of lung lesions.ResultsAmong the 15 COVID-19 patients, ground-glass opacity (GGO) was found in 14 cases. Six patients presented with consolidation and 3 with fibrosis. Five patients had multi-lobe involvement. Subpleural distribution pattern was present in 12 patients (80.0%) and peribronchovascular distribution pattern was present in 2 patients (13.3%). The severity score on HRCT images at the follow-up was significantly higher than that at the initial (4.6±3.4 vs. 3.5±2.5, P=0.018 2). Increase of random distribution pattern (5 cases) were also noted at the follow-up.ConclusionsChest HRCT of COVID-19 patients is characterized with GGO mainly distributed in subpleural areas and a rapid progression within a short time interval. HRCT could provide a sensitive monitor to observe disease progression for COVID-19 patients.
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.
呼吸機相關性肺炎( VAP) 是指患者接受機械通氣治療48 h 后至停用機械通氣、拔除人工氣道后48 h 內發生的肺實質的感染性炎癥。為接受機械通氣患者最常見的院內感染。VAP的發生率和病死率由于診斷手段不同, 報道不一。國外報道, VAP 發生率為9% ～70% [ 1] , 病死率高達20% ～71% [ 2, 3] ; 國內醫院調查, VAP發生率為48. 5% , 病死率為37. 5% [ 4] 。患者一旦發生VAP, 易造成撤機困難, 并可導致患者在ICU的停留時間及住院時間延長, 增加相關的醫療費用, 嚴重者可導致患者死亡。因此, VAP的早期預防、早期診斷和治療就顯得非常重要, 本文就近年來VAP 的診治現狀做一概述, 以供同道參考。
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 investigate the values of pneumonia severity index ( PSI) , CURB-65,plasma procalcitonin ( PCT) , C-reactive protein ( CRP) measurements for evaluation the severity of healthcare-associated pneumonia ( HCAP) .Methods A retrospective observational study was conducted on 92 hospitalized patients with HCAP admitted between June 2010 and December 2011. They were divided into different groups according to different severity assessment criteria. The variance and correlation of PCT,CRP,WBC and percent of neutrophil ( Neu% ) levels were compared among different groups. ROC curvewas established to analyze PSI, CURB-65, PCT and CRP levels for predicting the motality of HCAP patients.Results In the severe HCAP group, PSI and CURB-65 scoring and serum PCT, CRP, WBC, Neu% levels were significantly higher than those in the non-severe HCAP group( P lt; 0. 05) . In the high-risk HCAP group, PCT, CRP, WBC and Neu% levels were significantly higher than those in the low-risk HCAP group according to the PSI and CURB-65 scoring criteria( P lt;0. 05) .WBC and Neu% levels were also significantly higher than those in the moderate-risk group. PSI and CURB-65 scoring were positively correlated with PCT and CRP levels. PSI scoring gt;120 points or CURB-65 scoring gt;2 points on admission were predictors of mortality. Conclusions PSI and CURB-65 scoring are correlated with severity of HCAP. Combining serum PCT and CRP levels can improve the predictive accuracy of the severity of HCAP.
ObjectiveTo summarize the clinical, radiological and pathological characteristics of acquired immune deficiency syndrome (AIDS) combined with Pneumocystis carinii pneumonia (PCP), so as to improve the clinicians' understanding of the disease. MethodsThe clinical data of 50 AIDS patients combined with PCP admitted between February 2006 and May 2015 were retrospectively analyzed, including medical history, physical signs, laboratory examination, chest high resolution CT (HRCT), pathological characteristics, treatment and prognosis, etc. ResultsThe clinical features of AIDS patients combined with PCP included cough, dyspnea and fever, without obvious positive signs in the lung.The patients were divided as a mild group, a moderate group and a severe group according to the levels of PaO2.There was significant difference among three groups in serum albumin level [(23±3) g/L vs. (30±5) g/L and (28±6) g/L, P < 0.01].There were no significant differences among three groups in CD4+ T lymphocyte and lactate dehydrogenase (LDH) (P > 0.05).The typical chest radiograph feature of HRCT was ground-glass shadows in both lungs, and may be associated with reticular shadows or "gravel sign" and cyst.Of 50 patients, 16 patients were diagnosed via pathology of transbronchial lung biopsy(TBLB) and only 5 patients were diagnosed via silver staining of the bronchoalveolar lavage fluid (BALF).The other patients were clinically diagnosed.100% of the patients were treated with sulfamethoxazole (SMZco), 64%with caspofungin, and 72% with glucocorticoid.All the patients relieved with no death in hospital. ConclusionWhen a patient got cough, dyspnea and fever, especially ground glass on HRCT in both lungs, AIDS combined with PCP should be highly considered, and diagnostic treatment with SMZco and CD4+ T lymphocyte measurement should be conducted as soon as possible, so as to reduce misdiagnosis and mortality.