ObjectiveTo investigate the clinical efficacy of low molecular weight heparin on community-acquired pneumonia (CAP). MethodsA total of 78 patients with CAP admitted to hospital between January 2013 and March 2015 were randomly assigned into a conventional treatment group and a heparin treatment group. Both groups received anti-infection and symptomatic treatment, and the patients in heparin treatment group additionally received low molecular weight heparin by abdominal subcutaneous injection once daily for a course with seven days. The age, sex and severity of the disease were recorded. White blood cell (WBC) count and the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured on and during admission. ResultsThe baseline information including age and sex, severity of illness, CRP, ESR and WBC counts on admission and the first treatment day had no difference between two groups (P > 0.05). CRP and ESR on day 3 after treatment and WBC counts on day 7 after treatment in the heparin treatment group were significantly more decreased than those in the conventional treatment group (P < 0.05). For the moderate and severe CAP patients, the level of CRP on day 3 after treatment and WBC counts on day 7 after treatment in the heparin treatment group were significant lower than those in the conventional treatment group (P < 0.05). ConclusionCombination therapy of low molecular weight heparin may improve the clinical efficacy of CAP.
ObjectiveTo explore the risk factors of stroke-associated pneumonia (SAP) in the patients with acute ischemic stroke, in order to provide effective guidance for clinical prevention and treatment.MethodsFrom November 2016 to November 2019, 330 patients with acute ischemic stroke admitted to the Department of Neurology of West China Hospital of Sichuan University and the Department of Neurology of the Sixth People’s Hospital of Chengdu were selected as the research object. The clinical data of the patients were analyzed retrospectively. According to whether SAP occurred, they were divided into infected group and non-infected group. Multivariate logistic regression model was used to analyze the risk factors of SAP.ResultsA total of 71 cases of SAP occurred in patients with acute ischemic stroke, accounting for 21.52%. Logistic regression analysis showed that age≥70 years old [odds ratio (OR)=3.677, 95% confidence interval (CI) (1.452, 9.311), P=0.006], chronic lung disease [OR=4.985, 95%CI (1.558, 15.952), P=0.007], disturbance of consciousness [OR=7.147, 95%CI (1.617, 31.587), P=0.009], bulbar palsy [OR=5.909, 95%CI (2.668, 13.089), P<0.001], the use of nasal feeding tube [OR=7.427, 95%CI (1.681, 32.812), P=0.008] were independent risk factors for SAP in patients with acute ischemic stroke.ConclusionsAge≥70 years old, chronic lung disease, disturbance of consciousness, bulbar paralysis and use of nasal feeding tube are independent risk factors for SAP. It is necessary to strengthen the management of these risk factors in order to identify high-risk patients with SAP early, and develop intervention strategies for risk factors, so as to improve the prognosis.
ObjectiveTo compare the clinical characteristics of patients with nosocomial and community infections with extended-spectrum beta-lactamase-containing Klebsiella pneumoniae (ESBL-KP) and non-ESBL-KP so as to improve clinical diagnosis and treatment outcomes.MethodsThis retrospective study determined the clinical features of patients with nosocomial and community infections with KP who were admitted to our hospital from January 1st, 2017 to June 30th, 2018. The chi-square test or Fisher's exact probability method were used to compare different groups.ResultsWe identified 334 strains of KP, and 83 (24.9%) of them strains were EBSL-KP. The percentages of ESBL-KP infections among those with nosocomial and community infections were similar (31.25% vs. 22.27%, χ2=2.955, P=0.086). Significantly more females than males had ESBL-KP infections (32.32 vs. 21.70%, χ2=4.208, P=0.040). The percentages of ESBL-KP infections were similar among <18 years-old group, 18 to 45 years-old group, 45 to 60 years-old group, and ≥60 years-old group. The three major locations of KP infections were the lower respiratory tract, urinary tract, and bloodstream (bacteremia). Among nosocomial KP infections, there were no significant differences in the percentages of ESBL-KP infections at different sites, nor in the hospital departments where patients were treated; among community KP infections, there were significant differences in the percentages of ESBLs-KP infections at different sites, and in the hospital departments where patients were treated. For community KP infections, the two most common infection sites were the urinary tract (37.74%) and the skin and soft tissue (30.77%), and most patients were treated in the urology department (40.00%) and respiratory medicine department (38.10%). ESBL-KP isolates had greater resistance than non-EBSL-KP isolates to 16 tested antibiotics (P<0.05). There were no statistically significant differences in the percentages of nosocomial infections and community infections among those with ESBL-KP and among those with non-ESBL-KP (P>0.05).ConclusionsOur population have high rates of nosocomial and community KP infections and of infections with ESBL-KP. It is necessary to strengthen the management and clinical use of antibiotics and to provide real-time surveillance of KP infections, especially for patients with ESBL-KP infections. Increased vigilance is required for KP infections of females and community KP infections to improve control of nosocomial infections and reduce the prevalence of cross-infections.
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 role of Krüppel-like factor 4 (KLF4) mediated monocyte/macrophage subtype switch in the pathological progression of pulmonary fibrosis.MethodsThirty-six patients with interstitial pneumonia were recruited from Characteristic Medical Center of the Chinese People's Armed Police Force between May 2015 and January 2017. Peripheral venous blood and bronchoalveolar lavage fluid were collected in the morning. Pulmonary function and arterial blood gas were tested after admission. Flow cytometry was used to test monocyte subtypes of peripheral blood and macrophage subtypes of bronchoalveolar lavage fluid. KLF4 of peripheral blood was detected by enzyme linked immunosorbent assay. Thirty normal subjects were selected as control group of peripheral blood mononuclear cell subtypes and KLF4 (control group A), and 10 patients without pulmonary fibrosis who needed bronchoscopy were selected as control group of macrophage subtypes in alveolar lavage fluid (control group B). The relationship between the expression of KLF4 and the differentiation of monocytes and macrophages were observed. Furthermore, the relationship between the differentiation of monocytes subtypes, macrophages subtypes and lung function were observed.ResultsMonocyte of CD14++CD16– subtype in pulmonary fibrosis group was significantly lower than that in control group A (P<0.05). Monocyte of CD14++CD16+ subtype in pulmonary fibrosis group was significantly higher than that in control group A (P<0.05). No significant difference was found between the two groups regarding CD14+CD16++. No correlation was found between three subtypes of monocyte and DLCO of patients and between three subtypes of monocyte and PaO2 of patients. M1 macrophage in pulmonary fibrosis group was significantly lower than that in control group B (P<0.05). M2 macrophage in pulmonary fibrosis group was significantly higher than that in control group B (P<0.05). Negative correlation was found between the ratio of M2 subtypes and DLCO of patients and between the ratio of M2 subtypes and PaO2 of patients (P<0.05). KLF4 protein of blood in pulmonary fibrosis group was significantly higher than that in control group A (P<0.05). Positive correlation was found between the ratio of M2 subtypes and KLF4 protein (P<0.05).ConclusionsCD16+ monocyte plays a role in the occurrence and development of pulmonary fibrosis, but no evidence is found there is a direct correlation between monocyte subtypes of peripheral blood and fibrosis degree of lung tissue. M2 macrophage subtype plays an important role in the development of interstitial pneumonia. The number of M2 macrophages is positively correlated with the severity of pulmonary fibrosis. Monocyte/macrophage subtype differentiation by KLF4 may play a role in the pathological progression of pulmonary fibrosis.
ObjectiveTo investigate the prevention and control measures and procedures for surgical operation safety during the outbreak of new coronavirus pneumonia.MethodsAfter interpreting the diagnosis and treatment plan of new coronavirus pneumonia, the prevention and control plan of new coronavirus pneumonia, and the technical guidelines for prevention and control of new coronavirus pneumonia infection in medical institutions, we formulated and improved the prevention and control measures and procedures for surgical safety in our hospital.ResultsA total of 567 patients were operated in our hospital from January 22, 2020 to February 10, 2020, including 501 were operated in the surgical center and 66 were operated in the interventional center. Among all the cases, there were 303 emergency operation and 264 scheduled or limited operation. In the emergency operation, the top three were 130 cases of caesarean section (42.9%), 63 cases of abdominal digestive system operation (20.8%) and 31 cases of skull operation (10.2%). In the scheduled or limited operation, the top four were 65 cases of benign diseases of the eye (24.6%), 57 cases of tumor (21.6%), 53 cases of orthopedic surgery (20.1%), and 25 cases of coronary angiography (9.4%). All the patients were successfully completed the operation and recovered well after the operation. No serious surgical complications or infection-related complications occurred.ConclusionDuring the outbreak of new coronavirus pneumonia, surgery and epidemic prevention and control can be carried out by adjusting and optimizing measures and procedures.
ObjectiveTo systematically review the effectiveness of Xuebijing injection combined with routine therapy versus routine therapy alone in treating severe pneumonia. MethodsDatabases including PubMed (1990-2013.4), EMbase (1990-2013.4), The Cochran Library (Issue 4, 2013), CNKI (1982-2013.4), WangFang Data (1990-2013.4), VIP (1989-2013.4) and CBM (1978-2013.4) were searched from inception to April, 2013, for randomized controlled trials (RCTs) on Xuebijing injection for severe pneumonia. Studies were screened according to the inclusion and exclusion criteria, data were extracted, and methodological quality was evaluated. Meta-analysis was then performed using RevMan 5.2 software. ResultsA total of 12 studies involving 860 patients were included. The results of meta-analysis showed that, routine therapy plus Xuebijing injection had higher total effective and excellent rates, and the combined therapy reduced the average hospitalization days, and they had better improvement in WBC, CRP, CPIS, IL-6, IL-8, TNF-α. ConclusionThis current evidence shows that Xuebijing injection has a better clinical efficacy in treating severe pneumonia. Traditional Chinese herbs with the function of "promoting blood circulation to remove blood stasis" may exert their pharmacological effects via a multi-target way in treating severe pneumonia, which have a great potential for both clinical work and scientific research. Due to the limited quality and quantity of the included studies, better designed RCTs are needed to support Xuebijing's clinical efficacy in the treatment of severe pneumonia.
ObjectiveTo predict the total hospitalization expenses of bronchopneumonia inpatients in a tertiay hospital of Sichuan Province through BP neural network and support vector machine models, and analyze the influencing factors.MethodsThe home page information of 749 cases of bronchopneumonia discharged from a tertiay hospital of Sichuan Province in 2017 was collected and compiled. The BP neural network model and the support vector machine model were simulated by SPSS 20.0 and Clementine softwares respectively to predict the total hospitalization expenses and analyze the influencing factors.ResultsThe accuracy rate of the BP neural network model in predicting the total hospitalization expenses was 81.2%, and the top three influencing factors and their importances were length of hospital stay (0.477), age (0.154), and discharge department (0.083). The accuracy rate of the support vector machine model in predicting the total hospitalization expenses was 93.4%, and the top three influencing factors and their importances were length of hospital stay (0.215), age (0.196), and marital status (0.172), but after stratified analysis by Mantel-Haenszel method, the correlation between marital status and total hospitalization expenses was not statistically significant (χ2=0.137, P=0.711).ConclusionsThe BP neural network model and the support vector machine model can be applied to predicting the total hospitalization expenses and analyzing the influencing factors of patients with bronchopneumonia. In this study, the prediction effect of the support vector machine is better than that of the BP neural network model. Length of hospital stay is an important influencing factor of total hospitalization expenses of bronchopneumonia patients, so shortening the length of hospital stay can significantly lighten the economic burden of these patients.
【Abstract】 Objective To analyze the risk factors for ventilator-associated pneumonia ( VAP) in respiratory intensive care unit ( RICU) , as well as the impact on mortality. Methods A retrospective cohort study was conducted in 105 patients who had received mechanical ventilation in RICUbetweenMay 2008 andJanuary 2010. The duration of intubation, vital signs, primary disease of respiratory failure and complications,blood biochemistry, blood routine tests, arterial blood gas analysis, APACHEⅡ score,medications, nutritional status, bronchoalveolar lavage ( BAL) , protected specimen brush ( PSB) quantitative culture, chest X-rayexamination were recorded and analyzed. Results The incidence rate of VAP was 32. 4% . Mortality in the VAP patients were significantly higher than those without VAP( 58. 8% vs. 28. 2% , P = 0. 007) . The duration of intubation, hypotension induced by intubation, cerebrovascular disease, and hypoalbuminemiawererisk factors for VAP in RICU. Conclusions Mortality of the patients with VAP increased obviously. The risk factors for VAP in RICU were the duration of intubation, hypotension after intubation, cerebrovascular disease, and hypoalbuminemia.
ObjectivesTo identify the clinical characteristics and prognosis for CRKP (Carbapenem-resistant Klebsiella pneumonia, CRKP) infection among ICU patients in the Second Affiliated Hospital of Anhui Medical University. MethodsWe conducted a retrospectively analysis in which 19 patients infected by CRKP with another 21 CSKP (Carbapenem-sensitive Klebsiella pneumoniae, CSKP) infected patients from January 2017 to April 2018. Risk factors for CRKP infection were assessed. ResultsThe lower respiratory tract is the most common site of CRKP infection in our department. CRKP infection was associated with several clinical symptoms, particularly a higher incidence of sepsis shock (χ2=8.338, P=0.004), more application of the combined medicine (χ2=26.3, P<0.001), prolonged hospital stays (χ2=–2.217, P=0.027) and more expenses on antibiotics (χ2=12.855, P=0.005), and the declined survival rates in 14 days (χ2=4.269, P=0.039) and 21 days (χ2 =5.647, P=0.017). The resistance rate of CRKP strains was high, however no resistance to tegafycline was found. The risk factors of CRKP infection included three generations of cephalosporin and/or hydrocarbonase antibiotics exposure (χ2 =6.388, P=0.041), exposure time of three generations of cephalosporin (U=–2.187, P=0.029), exposure time of hydrocarbonase antibiotics (U=–2.103, P=0.035), tracheal intubation (χ2=6.352, P=0.012), tracheotomy (χ2 =4.821, P=0.028), SOFA score (t=4.505, P<0.001) and Charlson comorbidity index (t=3.041, P=0.004). The SOFA score was the only factor independently associated with CRKP bacteremia (P=0.02). ConclusionsCRKP infections in ICU directly affect the course of disease, survival time and treatment expenses of patients. Therefore, monitoring bacterial resistance, rational use of antibiotics, and protection of the immune function are of great significance for prevention and treatment of CRKP infection.