双黄连对肺炎支原体感染大鼠组织中PDGF—BB影响的免疫组织化学研究

为探讨中药制剂双黄连粉针剂(双黄连)对反复肺炎支原体肺部感染大鼠肺组织中血小板衍生生长因子-BB(PDGF-BB)蛋白质水平表达的影响,给大鼠于24周内反复9次经超声雾化吸入肺炎支原体以复制其慢性肺部感染模型,并应用双黄连腹腔注射进行治疗干预;随后用PDGF-BB单克隆抗体按SABc法行免疫组织化学染色,定量图像分析。结果(1)感染组动物(n=4)支气管肺泡灌洗液肺炎支原体-PCR检测均为阳性,而对照组(n=4)和感染加双黄连治疗组(n=4)均为阴性(均为P<0．05);三组动物的支气管和肺组织常规细菌培养结果均为阴性;感染组动物透射电镜检查见肺泡间隔增宽,其中有较多胶原纤维堆积,其余两组则未见明显异常。(2)感染组动物肺间质结缔组织中以及小气道和小血管的壁上可见较强的细颗粒状或细丝网状棕黄色PDGF-BB免疫组化染色阳性表达产物,其积分光密度为23．26±3．87(n=4),显著高于正常对照组者(1．52±0．61,n=4,P<0．05)和感染加双黄连治疗组者(3．49±0．63,n=4,P<0．05)。提示双黄连可抑制反复肺炎支原体肺部感染大鼠肺组织中PDGF-BB蛋白质水平的表达,对于防止肺炎支原体肺部感染所引起的肺间质纤维化可能具有一定的作用。     

Clinical characteristics of patients with chronic eosinophilic pneumonia in a Chinese tertiary‐care hospital: A 6‐year retrospective study

IntroductionChronic eosinophilic pneumonia (CEP) is a rare disease with unknown etiology. Due to lack of specificity of CEP symptoms, clinicians are not experienced in establishing its diagnosis.ObjectivesTo summarize the clinical data of CEP patients to improve the understanding of CEP and reduce misdiagnosis.MethodsData of patients pathologically diagnosed with CEP in the PLA General Hospital between May 2013 and May 2019 were collected, and clinical manifestations, imaging characteristics, pathological features, and treatment were retrospectively analyzed.ResultsTwenty patients, including 6 males and 14 females, were diagnosed with CEP. The average age was 47.0 ± 10.2 years. The main clinical manifestations were cough and dyspnea. The average duration of CEP was 15.5 ± 11.5 months. The average proportion of eosinophils in the peripheral blood was 18.9 ± 17.8%, and the average proportion of eosinophils in the bronchoalveolar lavage fluid was 41.5 ± 19.4%. The main imaging features were patchy shadows and consolidation shadows. The most common manifestations on bronchoscopic examination were congestion and edema of the bronchial mucosa. Two patients had granular protrusions of the endotracheal membrane. Histological examination indicated infiltration of numerous eosinophils. All patients improved after prednisone therapy.ConclusionCEP onset is insidious, and clinical manifestations lack specificity. Typical imaging features are peripheral and subpleural distribution of lung infiltrates. Some patients have a normal proportion of eosinophils in the peripheral blood, but most have an increased number of eosinophils in the BALF, which contributes to CEP diagnosis. A biopsy is necessary when differential diagnosis is difficult. A systemic glucocorticoid is effective.     

Emergence of Klebsiella pneumoniae carbapenemase-producing Proteus mirabilis in Hangzhou, China

Background Carbapenems are used to treat severe infections caused by multi-drug-resistant organisms, however, the emergence of carbapenem-resistant bacterial isolates is becoming an increasing therapeutic challenge. Since the first Klebsiella （K.） pneumoniae carbapenemase （KPC）-producing K. pneumoniae was reported in 2001, KPC-producing isolates have been found increasingly, specially in Enterobacteriaceae. The aim of this study was to characterize the mechanisms of a carbapenem-resistant Proteus （P.） mirabilis. Methods A carbapenem-resistant P. mirabilis isolate was recovered from pleural drainage fluid of a patient admitted to surgical intensive care unit. Antimicrobial susceptibility testing of the isolate was performed by disk diffusion according to Clinical and Laboratory Standards Institute guidelines, and subsequent minimal inhibitory concentrations were determined with the E-test. Amplification of the blaKPC gene generated a positive band and the PCR products were sequenced subsequently. The plasmid of the isolate was extracted and was successfully transformed into Escherichia （E.） coli DH5a. Results The P. mirabilis isolate was resistant to all detected antimicrobial agents except tigecycline. KPC-2 was confirmed by DNA sequence analysis. The transformant E. coil was resistant to carbapenems. Further study demonstrated that upstream and downstream regions of b/aKPC-2 were identical to that observed in K. pneumoniae submitted to GenBank from China in 2007. Conclusion Carbapenem resistance in the P. mirabilis isolate in this study is mainly due to production of KPC-2.     

Predictive model of postoperative pneumonia after neoadjuvant immunochemotherapy for esophageal cancer

BackgroundPostoperative pneumonia (PP) is the most common pulmonary complication of esophagectomy. It is of great importance to identify any high-risk factors and prevent pulmonary complications to improve the prognosis of patients with esophageal cancer undergoing esophagectomy. Thus, we established a predictive model of PP in patients with neoadjuvant immunochemotherapy for resectable esophageal squamous cell carcinoma (ESCC), and provide suggestions for the best strategy for the perioperative period of the patients.MethodWe retrospectively analyzed 78 patients who underwent esophagectomy for squamous cell carcinoma after neoadjuvant immunochemotherapy between September 2019 and August 2021.We used the “glmnet” language package in R to perform least absolute shrinkage and selection operator (LASSO) regression to screen the best predictors of PP, and nomograms predicting PP were constructed utilizing screened factors. The performance of nomograms was internally validated by calibration curves, concordance index (C-index), and the Brier score for overall performance.ResultsTwenty-six patients (33.3%) had postoperative pneumonia. After LASSO regression, the factors that were independently associated with PP were diffusing capacity of the lungs for carbon monoxide (DLCO) (P=0.0002), white blood cell (WBC) difference before vs. after neoadjuvant immunochemotherapy (P=0.0133). We constructed a prediction model, plotted the nomogram, and verified its accuracy. Its Brier score was 0.147, its calibration slope was 0.98, and its C-index was 0.85 (95% CI: 0.75–0.95). Internal validation demonstrated a good discrimination power that the actual probability corresponds closely with the predicted probability.ConclusionsOur prediction model can predict the possibility of PP in patients with neoadjuvant immunochemotherapy for resectable esophageal squamous cell carcinoma and may facilitate physicians’ efforts to reduce the incidence of postoperative pneumonia.     

甲氰咪胍与硫糖铝对老年食管癌术后院内感染性肺炎的观察

目的观察甲氰咪胍与硫糖铝对老年食管癌术后院内感染性肺炎的影响.方法将60岁以上食管癌病人分为甲氰咪胍组、硫糖铝组、对照组,术后观察院内感染性肺炎情况.结果院内感染性肺炎发生率:甲氰咪胍组30.6%,硫糖铝组8.6%,对照组10.7%,甲氰咪胍组分别与硫糖铝组、对照组相比,差别有统计学意义.硫糖铝组与对照组相比,差別无统计学意义.结论甲氰咪胍组与硫糖铝组相比,可引起较高的院内感染肺炎的发生率,硫糖铝在老年食管癌病人术后可替代甲氰咪胍应用.     

传染性非典型肺炎17例临床分析

目的 分析四川地区传染性非典型肺炎(非典)的流行病学和临床特点。方法 对2003年2月以来四川省已临床诊断的非典患进行回顾性分析。结果 迄今四川省已临床诊断非典患17例，均为来自广东和北京疫区的输入性病例，发病年龄以青壮年为主，起病较急骤，88％(15／17)的患体温超过38℃，咳嗽较常见，部分有血丝痰，周围血白细胞计数减少或正常居多，X线片显示多叶多段病变特点，初期进展较快而后期恢复较慢。4例作血清学试验，2例阳性。1例尸检标本在电镜下检出冠状病毒颗粒和衣原体样颗粒，RT-PCR扩增出冠状病毒RNA聚合酶基因片段。死亡2例，已痊愈出院7例。结论 四川地区非典型肺炎均为输入性病例，临床表现与其他地区报道相似，但病情相对较轻，传染性较弱．未造成继发件感染。     

后疫情时代的肺移植临床研究发展和未来展望

肺移植技术在全球经历了近半个世纪的发展,在中国也高速发展了二十余年,中国肺移植逐渐融入国际肺移植大家庭。2020年新型冠状病毒肺炎(新冠肺炎)疫情暴发,既是对中国肺移植发展的挑战,也使得全球同行关注中国肺移植发展,加速了国际间的交流与合作。随着对新冠肺炎重症患者肺移植的临床和基础研究逐步深入,移植科医师对于未来中国肺移植在供者的维护、高龄和儿童受者的选择、围手术期管理等方面有了更多的认知和思考。对于肺移植相关学科交叉领域的研究,需要开展设计优良、多方协作的临床试验,不断推进学科理论和实践的创新。     

The SMART‐COP score performs well for pneumonia risk stratification in Australia’s Tropical Northern Territory: a prospective cohort study

Objective To prospectively compare a modified pneumonia severity scoring system, SMARTACOP, with other severity scores in patients presenting with pneumonia to the emergency department (ED) of a tertiary referral hospital in tropical Australia. Methods We conducted a prospective observational study of adult patients presenting with radiologically confirmed pneumonia over a 12‐month period. The sensitivity of risk stratification scores were assessed against the need for intensive respiratory or vasopressor support (IRVS). Results There were 367 ED attendances for pneumonia of whom 77.1% were admitted to hospital, 10% required intensive respiratory or vasopressor support and 2.8% died. Mean age was 50.0 years, 52% were men and 59% were Indigenous. The sensitivity of a SMART‐COP score ≥3, a SMARTACOP score ≥3 and a pneumonia severity index (PSI) class ≥3 for predicting IRVS was 97%, 97% and 78% respectively. Conclusions We found no significant advantage of the SMARTACOP over the SMART‐COP score for the prediction of intensive respiratory or vasopressor support, but both scores significantly outperformed PSI. The SMART‐COP score should replace the PSI in tropical Australia and should be assessed in other tropical areas for pneumonia risk stratification in emergency departments.     

A case with life-threatening interstitial pneumonia associated with bucillamine treatment

Abstract

We report a case of bucillamine-induced interstitial pneumonia accompanied by severe hypoxemia in an 83-year-old woman who had rheumatoid arthritis. Respiratory failure worsened even after withdrawal of bucillamine and administration of high-dose corticosteroids, and mechanical ventilation was required. A review of 15 cases with bucillamine-induced pulmonary injury suggests that advanced age may be associated with the development of severe interstitial pneumonia. Bucillamine can cause corticosteroid-resistant and life-threatening lung injury, especially in the elderly.