Primary tracheobronchial amyloidosis in China: Analysis of 64 cases and a review of literature

Primary tracheobronchial amyloidosis (TBA) is a rare pulmonary disease.A systematic review was performed on 64 cases of primary TBA in China and progress in the diagnosis and treatment of this disease is discussed.The Chinese biological and medical databases from 1970 to 2010 were searched and 75 cases of complete clinical and pathological data were identified.The clinical characteristics of the disease were summarized and longitudinal comparisons were made of diagnostic and treatment methods over time.The results showed that the morbidity associated with primary TBA has increased over recent years.The clinical manifestations were non-specific.Progressive dyspnea, cough and sputum were the most common symptoms.The percentage of patients undergoing computed tomography (CT) scan has increased over the years.The bronchoscopy and transbrochial lung biopsy (TBLB) were usually sufficient to establish the diagnosis.Treatment was reported for a total of 44 cases.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration such as steroids and colchicines were reported to be effective in some patients.It is concluded that the demographic characteristics and clinical manifestations of primary TBA patients in China are largely consistent with findings reported in other countries.Dramatically more cases were reported in recent years, mainly due to the extensive application of bronchoscopy since 1990s.Chest CT scan provides important clues for the diagnosis of the disease.The definite diagnosis was confirmed by bronchoscopic findings and Congo red staining of biopsy specimen.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration, such as steroids and colchicines were reported to be effective in some patients.     

Epidemiology of acute kidney injury in intensive care septic patients based on the KDIGO guidelines

Background Acute kidney injury （AKI） is a common complication of sepsis,which is associated with higher risks of adverse outcomes.Recently,kidney disease：improving global outcomes （KDIGO） recommended a new guideline forAKI,including a little modification on the AKI staging criteria.Methods This retrospective study included 211 septic patients admitted to the intensive care unit （ICU） at Xiangya Hospital,Central South University from January 2008 to January 2011.AKI was diagnosed and classified according to the KDIGO or acute kidney injury network （AKIN） criteria.Differences between the AKI and non-AKI groups for baseline characteristics,laboratory examinations,etiology,outcomes,as well as the risk factors for AKI and 28-day mortality were analyzed.The reliability of the KDIGO criteria was also evaluated by comparing it with the AKIN criteria.Results The overall incidence of AKI in septic patients was 47.9％,and the 28-day mortality was 32.7％.The incidence of AKI was significantly higher in patients with more severe sepsis.Indicators of hepatic and respiratory function were significantly worse in the AKI group.Furthermore,a higher proportion of patients were infected with Enterobacter cloacae in the AKI group.The independent risk factors for AKI were shock,the number of organ failures,blood urea nitrogen （BUN）levels,and the use of vasopressors.The independent risk factors for mortality were BUN and creatine kinase-MB （CK-MB）levels.Both the KDIGO criteria and the AKIN criteria were significantly associated with 28-day mortality.Conclusions The incidence and 28-day mortality of AKI were very high in ICU septic patients.Greater attention should be paid to AKI-induced hepatic and respiratory dysfunction in clinical practice.Patients with an intra-abdominal source of infection were more likely to develop AKI.KDIGO criteria are reliable in AKI staging.     

Contrasting treatment and outcomes of septic shock: presentation on hospital floors versus emergency department

Background Patients with septic shock have a high mortality. This study used the Surviving Sepsis Campaign （SSC）database to compare characteristics, treatments and outcomes of septic shock patients diagnosed in the emergency department （ED） to patients developing septic shock on hospital floors （HF）.Methods The studied population included patients admitted to the intensive care unit （ICU） of an urban tertiary care medical center over an 18-month period. Acute physiology and chronic health evaluation （APACHE Ⅱ） scores, need for mechanical ventilation （MV）, performance on four of the SSC resuscitation bundle indicators, ICU length of stay （LOS）,hospital LOS and in-hospital mortality were ascertained.Results Sixty-six ED and 27 HF septic shock patients were included in this study. Urinary tract infections （UTI） and pneumonia were the two most common sites of infection in the ED patients. The sources of infection for HF septic shock patients were fairly well distributed across etiologies. The time to achieve superior vena cava oxygen saturation （ScvO2）＞ 70% in HF patients （（10.8±9.1） hours） was longer when compared to the ED patients （（6.6±-6.1） hours） （P ＜0.05）.Hospital mortality for the ED and HF patients were 25.8% and 59.3%, respectively （P ＜0.05）. Use of MV during the first 24 hours of shock was 44% in the ED patients and 70% in the HF patients （P ＜0.05） and was linked to mortality.Conclusions When compared to HF patients, ED septic shock patients have lower in-hospital mortality, there was less use of MV during the first 24 hours following onset of septic shock and the HF patients required a longer time to achieve target ScvO2. The need for mechanical ventilation is independently associated with increased mortality.     

DIAGNOSTIC BEHAVIOR OF COMMUNITY-ACQUIRED PNEUMONIA： SURVEY CONDUCTED IN SOME REGIONS OF CHINA

Objective To analyze the spectrum of microbiological agents causing community-acquired pneumonia （CAP） in recent years. We also investigated the procedure of diagnosis us well as the empirical treatment for this disease in OPD （ outpatient department） of pulmonary disease. Methods A total of 7097 patients from 150 hospitals in 24 provinces in China were enrolled in the study from Nov. 2002 to Mar. 2003. Every patient was diagnosed, treated and registered at the same time. Diagnostic behavior for doctors include chest radiograph and/or CT examination of the lung, as well as collecting sputum samples at the time of diagnosis for bacteria culture to identify the pathogen. Appointed staff fulfiUed the questionnaires and information sheets in each center. After that, data were computerized and analyzed. Results There were 7404 valid information sheets and 7097 questionnaires taken into count. The majority CAP patients were from cities （ 77. 3% ）, most of those who had medical insurance. Most CAP patients had productive cough （81.1% ）, and 76. 7% and 18. 2 % CAP patients received chest film and CT examination respectively for diagnosis. Only 24% patients received sputum sample tested and with 36% got positive results. Streptococcus pneumoniae remained the main pathogen of CAP （43. 2% ）. Most doctors used to prescribe β-lactam antibiotics as the first line of empirical therapy of CAP （ 51.1% ） with oral taken as the main method for drug using （66. 3% ）. Conclusion This survey provides a key point of empirical therapy in China. The procedure for diagnosing us well as the empirical treatment of CAP in OPD of pulmonary disease in China still to be improved, especially in accessing the pathogen. Guidelines developed to recognize and evaluate CAP should base on epidemiological information of the pathogen prevalence, then could offer a rational approach to the initial management of the CAP patients.     

Respiratory and Cardiac Characteristics of ICU Patients Aged 90 Years and Older：A Report of 12 Cases

Objective To investigate the respiratory and cardiac characteristics of elderly Intensive Care Unit (ICU) patients.
Methods Twelve senior ICU patients aged 90 years and older were enrolled in this study. We retrospectively collected all patients’ clinical data through medical record review. The basic demographics, primary cause for admission, the condition of respiratory and circulatory support, as well as prognosis were recorded. Shock patients and pneumonia patients were specifically analyzed in terms of clinical manifestations, laboratory variables, echocardiography, and lung ultrasound results.
Results The mean age of the included patients was 95 years with a male predominance (8 to 4, 66.7%). Regarding the reasons for admission, 6 (50.0%) patients had respiratory failure, 1 (8.3%) patient had shock, while 5 (41.7%) patients had both respiratory failure and shock. Of the 6 patients who suffered from shock, only 1 was diagnosed with distributive shock, 5 with cardiogenic shock. Of the 5 cardiogenic shock patients, 1 was diagnosed with acute coronary syndrome. The rest 4 cardiogenic shock patients were diagnosed with Takotsubo cardiomyopathy. The patient with ST-segment elevation myocardial infarction died within 24 hours. Of the 4 Takotsubo patients, 1 died on day-6 and the other 3 patients were transferred to ward after heart function recovered in 1 to 2 weeks. Of the 10 pneumonia patients, 3 were diagnosed as community acquired pneumonia, and 7 as hospital acquired pneumonia. Only 3 patients were successfully weaned from ventilator. The others required long-term ventilation complicated with heart failure, mostly with diastolic heart failure. Lung ultrasound of 6 patients with diastolic dysfunction showed bilateral B-lines during spontaneous breathing trial.
Conclusions Elderly patients in shock tend to develop Takotsubo cardiomyopathy. Diastolic heart dysfunction might be a major contributor to difficult weaning from ventilator in elderly patients. Bedside lung ultrasonography and echocardiography could help decide the actual cause of respiratory failure and shock more accurately and effectively.     

Changes of the proportion and mortality of pulmonary thromboembolism in hospitalized patients from 1974 to 2005

Background Pulmonary thromboembolism （PTE） has become a common disease that severely endangers people＇s health. This study analysed the changes in proportion and mortality of PTE in hospitalized patients to provide data for prevention and management of the disease. Methods The data of 763 hospitalized patients with PTE from 1974 to 2005 in Fuwai Hospital were analysed. Results During the 1970s, 0.27% of patients in a cardiovascular hospital had PTE （〈 5 cases per year）; while so far this century the proportion is 0.94% （48 to 113 per year）. The mortality of hospitalized PTE patients fell from 20.00% in the 1970s to 4.10% this century. Prior to 1990, the mortality of hospitalized PTE patients was 12.50%, and in the years after 1990 only 3.40%. The difference was statistically significant （P〈0.005）. People with this disease were mostly between the ages of 30 and 69 years. Men were most susceptible between the ages of 30 and 69 years, while women between the ages of 40 and 69 years. Men contracted PTE 10 years earlier than women. The mortality of male PTE patients was 4.70%, not significantly different from female patients, 5.06% （0.50〈P〈0.75）. There were not any significant differences between the mortality of patients in the different age groups overall （≤39, 40-49, 50-59, and ≥60 years, P〉0.1）. More people contracted the disease in winter than in other seasons （P〈0.05）. There was no obvious difference between the mortality in different seasons overall （0.75〈P〈0.90）. Conclusion PTE is an increasingly significant disease and deserves adequate attention.     

Analysis and Comparison of the Tongue Picture of 34 Patients with Severe Acute Respiratory Syndrome

Objective: To explore the changes of tongue pictures in the developing process of disease in patients with severe acute respiratory syndrome (SARS), and to compare the tongue pictures of SARS patients with those of suspected SARS patients. Methods: Materials of tongue picture were dynamically collected from 34 SARS patients and 35 suspected SARS patients, and the difference and similarity between them were analyzed. Meanwhile, the changes in clinic symptoms and tongue picture after integrative medicinal treatment were observed. Results: Characteristics of tongue picture in SARS patients were changed along with the progress of the disease, showing that there existed a tendency of the pathogen invading from exterior to interior, from surface to the deep. Also the tongue pictures were varied due to the coexistence of dampness pathogen; the time of the early stage was generally 1 - 1.5 days, shorter than that of other stages. While in the patients with suspected SARS, the tongue picture was mostly red with     

Acute Myocardial Infarction in Chinese Medicine Hospitals in China from 2006 to 2013: An Analysis of 2311 Patients from Hospital Data

Objective: To assess the trends in characteristics, treatments, and outcomes of acute myocardial infarction (AMI) patients in tertiary Chinese medicine (CM) hospitals in China between 2006 and 2013. Methods: This retrospective study was based on two nationwide epidemiological surveys of AMI in tertiary CM hospitals during 2 years (2006 and 2013). Patients admitted to the hospital for AMI were enrolled. Hospital records were used as the data source. Case data were derived regarding baseline characteristics, treatments, and outcomes of patients to assess changes from 2006 to 2013. Logistic regression was used to analyze the relationship between prognosis, general influencing factors of disease, and various treatment measures. Results: Totally 26 tertiary CM hospitals in 2006 and 29 tertiary CM hospitals in 2013 (18 were repetitive) were surveyed. A total of 2,311 patients with AMI were enrolled (1,094 cases in 2006 and 1,217 cases in 2013). From 2006 to 2013, the mean age did not significantly change, but the proportion of patients younger than 65 years increased. The prevalence of risk factors such as hypertension, diabetes, and hyperlipidemia also increased. Significant increases were observed in primary percutaneous coronary intervention [20.48% (2006) vs. 24.90% (2013)] and revascularization [36.11% (2006) vs. 52.42% (2013)]. In-hospital mortality decreased from 11.15% in 2006 to 10.60% in 2013. A mortality logistic regression analysis identified reperfusion therapy [odds ratio (OR), 0.222; 95% confidence interval (CI), 0.106–0.464], Chinese patent medicines (OR, 0.394; 95% CI, 0.213–0.727), and CM decoctions (OR, 0.196; 95% CI, 0.109–0.353) as protective factors. Conclusion: Reperfusion and revascularization capabilities of tertiary CM hospitals have improved significantly, but in-hospital mortality has not significantly decreased. Efforts are needed to improve medical awareness of AMI and expand the use of CM to reduce in-hospital mortality in China.     

Experience in Management of Fournier’s Gangrene: A Report of 24 Cases

Fournier’s gangrene (FG) is an extremely aggressive and rapidly progressive polymicrobial soft tissue infection of the perineum,anal area or genitalial regions with a high mortality rate.The objectives of this study were to share our experience with the management of this serious infectious disease over the last 15 years.This retrospective study examined 24 patients diagnosed as having FG who were admitted to our hospital between March 1996 and December 2011.The gender,age,etiology,predisposing factors,laboratory findings,treatment modality,hospitalization time and spread of gangrene of the subjects were all recorded and analyzed.The results showed that the mean age of the patients was 48.33 years,the male-to-female ratio was 5:1 and the mortality rate was 20.8% (5/24).The most common predisposing factor was diabetes mellitus in 10 patients (41.6%),followed by alcohol abuse,obesity,neoplasms and immunosuppression.The most common etiology was peri-anal and peri-rectal abscesses (45.8%),followed by lesions of urogenital origin (33.3%) and cutaneous (8.3%) origin.No local pathologies could be identified in 3 (12.5%) patients.The most commonly isolated microorganisms were Escherichia coli (62.5%),followed by Enterococcus,Pseudomonas aeruginosa and Staphylococcus aureus.The median admission Fournier’s gangrene severity index (FGSI) score for survivors was 5.63±1.89 against 13.6±3.64 for non-survivors which was designed for predicting the disease severity in the series.Early diagnosis and immediate extensive surgical debridement were significant prognostic factors in the management of Fournier gangrene.Individualized reconstructive modalities for wound coverage were useful in that they repaired the tissue defect and improved the quality of life.We are led to conclude that Fournier’s gangrene is a severe condition with a high mortality.The Fournier’s gangrene severity index (FGSI) score at admission serves as a good predictor for the disease severity.Early diagnosis,surgical debridement and aggressive fluid t     

Clinical and microbiological features of community acquired and nosocomial bloodstream infections in the surgical department of a tertiary care hospital in Beijing

Background Bloodstream infections （BSls） remain a major cause of morbidity and mortality in patients undergoing surgery. This study aimed at elucidating the clinical characteristics of community-acquired BSIs （CABs） and nosocomial BSIs （nBSIs） in patients admitted to the surgical wards of a teaching hospital in Beijing, China. Methods This cross-sectional study compared 191 episodes of BSIs in 4074 patients admitted to the surgical wards between January 2008 and December 2011. Cases of BSIs were classified as CABs or nBSIs, and the characteristics, relevant treatments, and outcomes of CABs and nBSIs were compared. Results Of the 191 BSIs, 52 （27.2%） and 139 （72.8%）were CABs and nBSIs, respectively. Escherichia coli, coagulasenegative staphylococci, and Klebsiella spp, were the most frequently isolated microorganisms. There were significant differences between CABs and nBSIs with respect to the use of hormonal drugs, ventilation, acute physiology and chronic health evaluation （APACHE） Ⅱand American Society of Anesthesiologists scores, and prevalence of cancer （P 〈0.05）. Empirical antibacterial therapy did not decrease the crude mortality, but multivariate analysis showed that high APACHE Ⅱwas independently associated with a risk of mortality （odds ratio =0.97, 95% confidence interval： 0.93-1.02 for APACHE Ⅱ）. Conclusions We found significant differences in the clinical characteristics of surgical patients with CABs and nBSIs. The outcome of patients seems to be related to hiah APACHE Ⅱ scores.     

A Streptococcus suis serotype 2 caused streptococcal toxic shock syndrome（STSS） in a patient

Streptococcus suis(S.suis)is a Gram-positive,facultatively anaerobic coccus that has been implicated as the cause of a wide range of clinical disease syndromes in swine and other domestic animals.S.suis has also been implicated in disease in humans,especially among abattoir workers,swine and pork handlers.Here we report a case of streptococcal toxic shock syndrome(STSS)caused by S.suis in a 59-year-old man.Despite of intensive treatment,the patient died of shock with multiple organ failure 14 h after admission.One bacterial isolate obtained from blood culture was identified to the species level by biochemical tests and serological tests as S.suis serotype 2.Identification was confirmed by PCR amplification of genes encoding 16sRNA of S.suis and the capsule of S.suis serotype 2(cps 2J).Genes encoding virulence factors were also detected.An investigation to identify the source of S.suis revealed that several days before admission the affected man had been handling sick pigs or their meat.Transmission may occur through breaks in the skin of feet with tinea due to that no measures for personal protection was taken.This case should highten awareness of the potential for occupational exposure and human infection with S.suis.     

ICU院内获得性真菌性败血症的临床特点和防治策略

目的　探讨ICU重症病人院内获得性真菌性败血症的临床特点和防治对策。方法　收集近 8年本院ICU危重病人中院内获得性真菌性败血症 71例进行回顾性调查。结果　 71例院内获得性感染患者中血培养共获得真菌菌株 75株 ,其中念珠菌是主要病原菌 (占 83.35 % )。感染途径以中心静脉导管较多 (占 2 8.2 2 % ) ,总病死率为 4 4 .4 2 %。出现感染性休克和多脏器功能不全综合征 (MODS)常提示预后不良。结论　真菌性败血症是ICU危重病患者主要的死亡原因之一。去除易患因素、加强病原学监测、注意无菌原则 ,提倡早期经验性治疗等措施是降低死亡率的有效手段     

基于中医临床证候探讨新型冠状病毒肺炎在岭南地区的疫性特点

目的:通过分析广东省第二人民医院收治的新型冠状病毒肺炎(以下简称新冠肺炎)患者的临床资料,从中医临床证候探讨该病在岭南地区的疫性特点,更好地指导临床辨证治疗。方法:收集广东省第二人民医院收治的36例新冠肺炎患者的临床资料,其中输入病例20例,本地病例16例,分析全部病例、输入病例和本地病例的临床资料和证候特点。结果:新冠肺炎患者年龄分布较广,平均年龄45岁,以男性居多,55.56%的患者为外地输入病例,44.44%的患者为本地感染病例。全部病例证型以湿邪郁肺型和邪热壅肺型为主,分别占44.44%和38.89%;91.67%的患者呈现“湿”的病理特点,72.22%的患者呈现“热”的病理特点。其中输入病例证型以湿邪郁肺型为主,占65.00%,100%的患者呈现“湿”的病理特点,55.00%呈现“热”的病理特点;本地病例证型以邪热壅肺为主,占56.25%,93.75%的患者呈现“热”的病理特点,81.25%呈现“湿”的病理特点。结论:本次疫病在岭南地区的疫性属于以湿邪和热邪为主导的“湿热疫”,病机特点为湿热并重;输入性病例多表现为以湿邪为患的“湿疫”,有化热的趋势和倾向,病机特点为湿重于热;本地病例多表现为以热邪为主的“温热疫”,病机特点为热重于湿。此次新冠肺炎不同地区存在不同疫性的可能,辨证和治疗要遵守三因制宜的原则。     

重症医学科内系统性红斑狼疮合并脓毒症患者临床表现和预后分析

目的 讨论重症医学科（ICU）内系统性红斑狼疮（SLE）合并脓毒症患者的临床特点和预后的影响因素。方法 回顾分析2010~2014年入住ICU的SLE合并脓毒症的临床及实验室数据包括主要器官受累情况,SLE疾病活动指数(systemic lupus erythematosus disease activity index,SLEDAI),急性生理和慢性健康状况评分(acute physiology and chronic health evaluation,APACHEⅡ),感染部位及病原体检查结果等,并采用多因素logistic回归分析预后相关的危险因素。结果 共纳入50例患者,以女性为主（86%）,SLEDAI （15.8±6.3）分, APACHEⅡ （25.8±6.5）分,ICU内死亡率为46.0%,最常见的死亡原因为多器官衰竭,进入ICU 的最常见原因是呼吸衰竭。感染以G-菌为主。多变量logistic回归提示ICU内消化道出血、感染性休克及较高的急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）与预后相关。结论 消化道出血、感染性休克和较高的APACHEⅡ评分是ICU内SLE合并脓毒症患者预后的不良因素。     

肉鸡鹦鹉热衣原体的分离和鉴定

目的 确定鹦鹉热衣原体是否为导致肉鸡发生严重呼吸道疾病的主要病原。方法 对2001～2002间北京、天津地区肉鸡流行的严重呼吸道疾病的鸡群进行血清学测定。取发病鸡的心、肺、肾脏组织固定、切片、染色：发病鸡肺脏组织液接种7dSPF鸡胚，收集4～9d死亡鸡胚的卵黄囊膜，分别用碘染色、衣原体荧光染色；青霉素、磺胺嘧啶钠抑制分离的病原，观察SPF鸡胚发育。分离病原注射15d商品肉鸡，复制病变。结果发病肉鸡血清抗体出现10％-30％阳性，分离病原荧光染色阳性，人工感染肉鸡后可以复制病变。结论 从肉鸡分离的病原可能是鹦鹉热衣原体，与大肠埃希菌混合感染是造成肉鸡呼吸困难、死亡升高的主要因素。     

Characteristics of patients with diabetic foot in Mombasa, Kenya

OBJECTIVE: To study the causes of perceived high mortality in patients with diabetic foot in Mombasa, Kenya. DESIGN: A retrospective study. SETTING: The Mombasa Hospital Private Clinics, from January 2001 to December 2005. An urban set up. SUBJECTS: Ninety five patients with diabetic foot disease out of 830 in-hospital patients admitted with diabetes mellitus, aged between 40 and 90 years, treated mainly at The Mombasa Hospital. INTERVENTION: Patients were managed conservatively and operatively. The operations were incision and drainage, debridement and amputation. RESULTS: The majority of the males were between 50-70 years (76%) while the majority of the females were between 60-80 years (69%), with the mean age for males of 58 years and 65 years for the females. Overall mortality was 13%. Post-amputation mortality was 28%. The mortality was found to be associated with high co-morbidity, mainly uncontrolled diabetes mellitus (100%), Sepsis (75%), ischaemic heart disease (42%), uncontrolled hypertension (25%) and renal insufficiency (25%). The measurable characteristics included high blood sugars, raised WBC count, high creatinine, high serum lipids, abnormal ECG and abnormal arterial Doppler scans. CONCLUSION: The mortality associated with diabetic foot ulcer disease may be predicted by measurable characteristics. These parameters point to conditions that are themselves complications of diabetes mellitus and whose management will reduce mortality. The management of diabetic foot is therefore, multidisciplinary. Amputation appears to carry an added risk and should not be rushed until the patient is fully resuscitated.     

The epidemiology of invasive group A streptococcal disease in Victoria, Australia

OBJECTIVE: To estimate the incidence and severity of invasive group A streptococcal infection in Victoria, Australia. DESIGN: Prospective active surveillance study. SETTING: Public and private laboratories, hospitals and general practitioners throughout Victoria. PATIENTS: People in Victoria diagnosed with group A streptococcal disease notified to the surveillance system between 1 March 2002 and 31 August 2004. MAIN OUTCOME MEASURE: Confirmed invasive group A streptococcal disease. RESULTS: We identified 333 confirmed cases: an average annual incidence rate of 2.7 (95% CI, 2.3-3.2) per 100,000 population per year. Rates were highest in people aged 65 years and older and those younger than 5 years. The case-fatality rate was 7.8%. Streptococcal toxic shock syndrome occurred in 48 patients (14.4%), with a case-fatality rate of 23%. Thirty cases of necrotising fasciitis were reported; five (17%) of these patients died. Type 1 (23%) was the most frequently identified emm sequence type in all age groups. All tested isolates were susceptible to penicillin and clindamycin. Two isolates (4%) were resistant to erythromycin. CONCLUSION: The incidence of invasive group A streptococcal disease in temperate Australia is greater than previously appreciated and warrants greater public health attention, including its designation as a notifiable disease.     

严重急性呼吸综合征134例死亡病例特征分析

目的:分析严重急性呼吸综合征死亡病例的特征,为早期诊断和治疗该疾病提供参考.方法:收集某市SARS死亡病例134例和同期临床诊断病例2 522例的资料,如发病-死亡时间、性别、年龄、临床症状等进行计算和比较.结果:死亡病例中男性74例,女性60例.患者从发病到死亡的时间中位数为11 d.随着年龄的增大,病死率增高.死亡病例中,31～50岁者占28.36%,51岁以上者占66.41%.死亡病例早期症状中咳痰、胸闷、呼吸困难和气促出现比例较高.结论:发病后11 d是SARS病例死亡的高峰;51岁以上人群是患者死亡的高危人群;早期呼吸道症状在死亡病例中的出现比例较高.     

急诊监护室脓毒症并发ARDS患者的临床特点及预后因素分析

目的探讨急诊监护室（Emergency Care Unit,ECU）收住的脓毒症（Sepsis）并发ARDS患者的临床特点及预后影响因素。方法调查2003年1月-2011年9月之间入住ECU的107例脓毒症并发ARDS患者临床资料,总结其临床特点,采用单因素分析以及多因素逐步Logistic回归,分析其死亡相关危险因素。结果107例脓毒症并发ARDS患者中,男性71例（66．4％）,女性36例（33．6％）,年龄（59．5±16．0）岁,器官衰竭数目（2．8±1．0）个,呼吸道是最常见感染源（49．5％,53／107）,心血管疾病（34．6％,37／107）是最常见的基础疾病;总病死率75．7％（81／107）;多因素逐步Logistic回归显示：凝血功能障碍和多器官功能不全（MODS）是脓毒症并发ARDS患者死亡的独立危险因素,血液净化和早期预防是其保护因素。结论脓毒症并发ARDS的患者预后差,病死率极高,早期运用血液净化等多种抢救措施,防止发生多器官功能衰竭及凝血功能障碍有益于降低脓毒症并发ARDS患者病死率。     

人猪链球菌病的研究现状

人猪链球菌病是由人感染猪链球菌而引起的新发传染病，荚膜2型猪链球菌为主要病原。病猪和带菌猪是人猪链球菌病的主要传染源，夏秋季多发。人猪链球菌病的自然病程可分为潜伏期、前驱期、进展期和恢复期，人猪链球菌病可分为普通型、休克型、脑膜炎型和混合型。抗菌药物治疗有效，休克型的病死率高。