软管喉镜吞咽功能评估对脑卒中患者临床功能结局的影响

目的 观察软管喉镜吞咽功能评估（FEES）对亚急性期脑卒中患者临床功能结局的影响。 方法 对52例行FEES评估和51例未行FEES评估的脑卒中患者（分别纳入FEES组和对照组）进行回顾性病例对照研究,2组患者分别在FEES评估后或改良容积-黏度吞咽测试（V-VST）评估后根据结果进行吞咽功能训练和摄食训练。首要结局观察指标为肺炎发生率,次要结局观察指标包括鼻饲管拔除率、留置鼻饲管时间、功能性经口摄食评估（FOIS）分级、出院时饮食方式、住院时间等。 结果 与对照组比较,FEES组肺炎发生率明显降低（7.7% vs. 39.2%,P<0.001）,鼻饲管拔除率明显升高（75.0% vs. 41.0%,P=0.002）,FOIS分级明显改善（χ2=9.868,P=0.001）,出院时可尝试部分经口进食和完全经口进食患者百分比均明显增加（15.4% vs. 13.7%,P=0.030;78.8% vs. 54.9%, P=0.001）。通过多元Logistic回归分析发现,FEES组患者发病后到首次FEES检查间隔时间越长,其患肺炎的风险越大（P=0.023）。 结论 脑卒中亚急性期患者及早进行FEES检查能降低肺炎发生率,提高鼻饲管拔除率及吞咽功能,改善患者临床功能结局。     

Bivalent vaccination against pneumonic pasteurellosis in domestic sheep and goats with modified-live in-frame lktA deletion mutants of Mannheimia haemolytica

A temperature-sensitive shuttle vector, pBB80C, was utilized to generate in-frame deletion mutants of the leukotoxin structural gene (lktA) of Mannheimia haemolytica serotypes 1, 2, 5, 6, 7, 8, 9, and 12. Culture supernatants from the mutants contained a truncated protein with an approximate molecular weight of 66 kDa which was reactive to anti-leukotoxin monoclonal antibody. No protein reactive to anti-LktA monoclonal antibody was detected at the molecular weight 100–105 kDa of native LktA. Sheep and goats vaccinated intramuscularly with a mixture of serotypes 5 and 6 mutants were resistant to virulent challenge with a mixture of the wild-type parent strains. These vaccinates responded serologically to both vaccine serotypes and exhibited markedly-reduced lung lesion volume and pulmonary infectious load compared to control animals. Control animals yielded a mixture of serotypes from lung lobes, but the proportion even within an individual animal varied widely from 95% serotype 5–95% serotype 6. Cultures recovered from liver were homogeneous, but two animals yielded serotype 5 and the other two yielded serotype 6 in pure culture.     

Triple therapy with hydroxychloroquine,azithromycin, and ciclesonide for COVID-19 pneumonia

No specific therapy is available for COVID-19. We report the effectiveness and adverse effects of triple therapy with hydroxychloroquine, azithromycin, and ciclesonide in patients with COVID-19 pneumonia. The clinical condition of the patients improved within 5 days in response to the therapy.     

抗击新冠肺炎的临床一线医务人员心理韧性与焦虑抑郁现状及相关性研究

目的调查抗击新冠肺炎临床一线医务人员心理韧性与焦虑、抑郁的状况,并了解疫情中临床一线医务人员心理韧性与焦虑、抑郁相关性。方法采用心理韧性量表(CD-RISC)、焦虑自评量表(SAS)、抑郁自评量表(SDS)对抗击新冠肺炎临床一线医务人员进行问卷调查,并用Pearson分析其相关性。结果90名抗击新冠肺炎临床一线医务人员的心理韧性总分为(87.178±16.639)分,坚韧性、自强性、乐观性三个维度得分为(44.022±9.236)分、(29.800±5.773)分和(13.356±3.014)分,在性别、年龄、学历、婚姻状况、工作年限、职称、月收入上无统计学意义(P>0.05);焦虑自评量表得分为(45.333±10.539)分,抑郁自评量表得分为(51.956±11.777)分,未达到焦虑、抑郁水平,但略高于全国常模,但在性别、年龄、学历、婚姻状况、工作年限、职称、月收入上均无统计学意义(P>0.05);Pearson相关分析显示:心理韧性与焦虑、抑郁呈负相关,相关性具有统计学意义(P<0.05)。结论抗击新冠肺炎临床一线医务人员心理韧性与焦虑、抑郁呈负相关,心理韧性水平越高,焦虑、抑郁程度越低。     

Analysis of risk factors for multidrug-resistant pathogens and appropriate treatment indications for pneumonia in children with neurologic impairment

IntroductionThe features of pneumonia in children with neurologic impairment (NI) resemble those of healthcare-associated pneumonia is defined as pneumonia occurring in the community associated with healthcare risk factors. There are currently no guidelines for the treatment of pneumonia in children with NI. Here, we assessed whether the guidelines applicable for treating pneumonia in adults could be applied to children with NI.MethodsBetween 2008 and 2019, we enrolled children with NI who developed pneumonia and were treated in the pediatric ward of Kawasaki Medical School Hospital. We evaluated patient characteristics, the frequency of isolation of multidrug-resistant (MDR) pathogens, and clinical outcomes.ResultsMDR pathogens were more frequently isolated from patients receiving tube feeding (TF) and/or with tracheostomy than from patients without these risk factors. Other risk factors, including a history of antibiotic therapy and methicillin-resistant Staphylococcus aureus isolation, recent hospitalization, residence in a nursing home or extended care facility, and low-dose, long-term macrolide therapy, did not significantly affect the frequency of MDR pathogen isolation. In patients receiving TF and/or with tracheostomy, treatment success was achieved in all cases treated with broad-spectrum antibiotics and 72.2% of cases treated with non-broad-spectrum antibiotics (P = 0.007). Conversely, among patients without these risk factors, no such difference was observed.ConclusionsOur findings indicate that the guideline to select antibiotics for treating pneumonia in children with NI should be simpler and more useful than the current guidelines for adult pneumonia, based on risk factor assessment for MDR pathogens.     

Serum Total Cholesterol Levels Would Predict Nosocomial Infections After Gastrointestinal Surgery

It has been suggested that total cholesterol levels and the use of statin medications are associated with the incidence of complications after gastrointestinal surgery. The aim of this study was to determine if preoperative total cholesterol levels are associated with a higher risk of postoperative infections and mortality. A total of 2211 patients undergoing general surgical procedures between December 2006 and November 2008 at Iizuka Hospital and between January 2010 and March 2012 at Jichi Medical University Hospital were reviewed. Multiple logistic regression models were used to evaluate serum total cholesterol and other variables as predictors of postoperative nosocomial infections. Serum total cholesterol concentrations lower than 160 mg/dl were associated with an increased incidence of superficial and deep incisional surgical site infections. Serum total cholesterol levels showed a reverse J-shaped relationship with the development of organ space surgical site infection and pneumonia. There was no discernible effect of serum cholesterol levels on the postoperative mortality observed in this cohort of patients. Decreased serum albumin was one of the strongest risk factors for the development of nosocomial infection after surgery. Postoperative pneumonia was not observed in patients taking statin medications whose cholesterol levels were <200 mg/dl. Serum total cholesterol may be a valid predictor of surgical outcome. Preoperative statin use may affect the development of postoperative pneumonia in patients with total cholesterol levels below 200 mg/dl.     

婴幼儿肺炎IL-2R和细胞体液免疫功能的检测

对 32例轻症和 44例重症婴幼儿肺炎检测外周血中可溶性白细胞介素 2受体 (s IL- 2 R)、白细胞介素 2膜受体 (m IL- 2 R)、T淋巴细胞亚群、血清 Ig、Ig A、Ig M和补体 C3的变化。结果 :重症婴幼儿肺炎 s IL- 2 R显著高于轻症婴幼儿肺炎 ,轻症高于对照组 (P<0 .0 5 ) ,而 m IL- 2 R则重症低于轻症、轻症低于对照组 (P<0 .0 5 ) ;婴幼儿肺炎 T细胞亚群 CD8显著低于对照组 (P<0 .0 5 ) ,CD4/ CD8高于对照组 (P<0 .0 5 ) ;Ig G、Ig A、Ig M和补体 C3重症低于轻症、轻症低于对照组 (P<0 .0 5 )。结果提示 s I1- 2 R和 m I1- 2 R表达异常和细胞免疫紊乱及体液免疫不足是婴幼儿肺炎的易患因素 ,且与病情严重程度有相关性。     

比较社区获得性肺炎严重程度的评判指数

社区获得性肺炎在人群中的发病率较高,对社区获得性肺炎严重程度的准确评估有助于临床医生决定有关治疗方面的问题.本文就国内外多种评估社区获得性肺炎严重程度的方法 发及应用作一综述.     

Therapeutic temperature modulation is associated with pulmonary complications in patients with severe traumatic brain injury

AIM: To examine complications associated with the use of therapeutic temperature modulation(mild hypothermia and normothermia) in patients with severe traumatic brain injury(TBI). METHODS: One hundred and fourteen charts were reviewed. Inclusion criteria were: severe TBI with Glasgow Coma Scale(GCS) 9, intensive care unit(ICU) stay 24 h and non-penetrating TBI. Patients were divided into two cohorts: the treatment group received therapeutic temperature modulation(TTM) with continuous surface cooling and indwelling bladder temperature probes. The control group received standard treatment with intermittent acetaminophen for fever. Information regarding complications during the time in the ICU was collected as follows: Pneumonia was identified using a combination of clinical and laboratory data. Pulmonary embolism, pneumothorax and deep venous thrombosis were identified based onimaging results. Cardiac arrhythmias and renal failure were extracted from the clinical documentation. acute respiratory distress syndrome and acute lung injury were determined based on chest imaging and arterial blood gas results. A logistic regression was conducted to predict hospital mortality and a multiple regression was used to assess number and type of clinical complications. RESULTS: One hundred and fourteen patients were included in the analysis(mean age = 41.4, SD = 19.1, 93 males), admitted to the Jackson Memorial Hospital Neuroscience ICU and Ryder Trauma Center(mean GCS = 4.67, range 3-9), were identified and included in the analysis. Method of injury included motor vehicle accident(n = 29), motor cycle crash(n = 220), blunt head trauma(n = 212), fall(n = 229), pedestrian hit by car(n = 216), and gunshot wound to the head(n = 27). Ethnicity was primarily Caucasian(n = 260), as well as Hispanic(n = 227) and African American(n = 223); four patients had unknown ethnicity. Patients received either TTM(43) or standard therapy(71). Within the TTM group eight patients were treated with normothermia after TBI and 35 patients were treated with hypothermia. A logistic regression predicting in hospital mortality with age, GCS, and TM demonstrated that GCS(Beta = 0.572, P 0.01) and age(Beta =-0.029) but not temperature modulation(Beta = 0.797, ns) were significant predictors of in-hospital mortality [χ2(3) = 22.27, P 0.01] A multiple regression predicting number of complications demonstrated that receiving TTM was the main contributor and was associated with a higher number of pulmonary complications(t =-3.425, P = 0.001). CONCLUSION: Exposure to TTM is associated with an increase in pulmonary complications. These findings support more attention to these complications in studies of TTM in TBI patients.     

Ultrasound of the Pleurae and Lungs

The value of ultrasound techniques in examination of the pleurae and lungs has been underestimated over recent decades. One explanation for this is the assumption that the ventilated lungs and the bones of the rib cage constitute impermeable obstacles to ultrasound. However, a variety of pathologies of the chest wall, pleurae and lungs result in altered tissue composition, providing substantially increased access and visibility for ultrasound examination. It is a great benefit that the pleurae and lungs can be non-invasively imaged repeatedly without discomfort or radiation exposure for the patient. Ultrasound is thus particularly valuable in follow-up of disease, differential diagnosis and detection of complications. Diagnostic and therapeutic interventions in patients with pathologic pleural and pulmonary findings can tolerably be performed under real-time ultrasound guidance. In this article, an updated overview is given presenting not only the benefits and indications, but also the limitations of pleural and pulmonary ultrasound.