Acquired Immunodeficiency Syndrome (AIDS)

The Acquired Immunodeficiency Syndrome (AIDS), caused by the human immunodeficiency virus (HIV), also called the human T-lymphotropic virus type III/lymphadenopathy-associated virus [HTLV-III/LAV], has affected over 23,000 people; more than half of those with the disease have died. The actual case fatality rate approaches 100%. AIDS affects all groups and classes of people, although some are at special risk. Distribution of the disease is worldwide. The illness' effects on the body are widespread; of special interest are the ophthalmologic manifestations. The eye may be infected by various viruses (cytomegalovirus, varicella-zoster virus, herpes simples virus or HIV itself), toxoplasma gondii, candida sp, cryptococcus neoformans, M. tuberculosis, or M. avium-intracellulare. Kaposi's sarcoma may affect the eye as well. Retinal vascular abnormalities (e.g., cotton-wool spots, vasculitis) are not uncommon in AIDS. The syndrome may present with neuro-ophthalmologic manifestations. No effective treatment for the illness is currently available, although several hold promise and there is hope for an AIDS vaccine. Prevention of infection through reduction of risks appears to be the only defense against AIDS at this time.     

重证肺炎中医证候分布规律及症状特点研究

目的:基于文献,分析重症肺炎证候分布规律及主要证型的症状特点。方法:采用计算机检索和人工检索相结合方法,检索1981—2008年6月重症肺炎的相关文献,运用频数描述、logistic回归分析和聚类分析方法进行分析。结果:共收集合格文献29篇,55条记录。结果显示,频率较高的证型依次为亡阳证(28.1%)、气阴两虚证(21.8%)、亡阴证(18.75%)、肺热腑实证(18.75%)、厥证(15.62%)、脱证(12.5%)、痰热壅肺证(12.5%)。结合专业知识和聚类结果,筛选痰热壅肺证、阴竭阳脱证、肺热腑实证、热入心包证作为重症肺炎的主要证型,并对证型的主、次症进行了筛选。结论:文献分析总结出了重症肺炎证型分布规律及主要证型症状特点,为进一步研究提供了参考。     

Unmasking Myocardial Dysfunction in Patients Hospitalized for Community-Acquired Pneumonia Using a 4-Chamber 3-Dimensional Volume/Strain Analysis

Lower respiratory infection was reported as the most common fatal infectious disease. Community-acquired pneumonia (CAP) and myocardial injury are associated; yet, true prevalence of myocardial injury is probably underestimated. We assessed the rate and severity of myocardial dysfunction in patients with CAP. Admitted patients diagnosed with CAP were prospectively recruited. All the patients had C-reactive protein (CRP), brain natriuretic peptide (BNP), and high-sensitivity cardiac troponin (hs-cTnl) tests added to their routine workup. 2D/3D Doppler echocardiography was done on a Siemens Acuson SC2000 machine ≤ 24 h of diagnosis. 3D datasets were blindly analyzed for 4-chamber volumes/strains using EchobuildR 3D-Volume Analysis prototype software, v3.0 2019, Siemens-Medical Solutions. Volume/strain parameters were correlated with admission clinical and laboratory findings. The cohort included 34 patients, median age 60 years (95% CI 55–72). The cohort included 18 (53%) patients had hypertension, 9 (25%) had diabetes mellitus, 7 (21%) were smokers, 7 (21%) had previous myocardial infarction, 4 (12%) had chronic renal failure, and 1 (3%) was on hemodialysis treatment. 2D/Doppler echocardiography findings showed normal ventricular size/function (LVEF 63 ± 9%), mild LV hypertrophy (104 ± 36 g/m²), and LA enlargement (41 ± 6 mm). 3D volumes/strains suggested bi-atrial and right ventricular dysfunction (global longitudinal strain RVGLS =  − 8 ± 4%). Left ventricular strain was normal (LVGLS =  − 18 ± 5%) and correlated with BNP (r = 0.40, p = 0.024). The patients with LVGLS >  − 17% had higher admission blood pressure and lower SaO₂ (144 ± 33 vs. 121 ± 20, systolic, mmHg, p = 0.02, and 89 ± 4 vs. 94 ± 4%, p = 0.006, respectively). hs-cTnl and CRP were not different. Using novel 3D volume/strain software in CAP patients, we demonstrated diffuse global myocardial dysfunction involving several chambers. The patients with worse LV GLS had lower SaO₂ and higher blood pressure at presentation. LV GLS correlated with maximal BNP level and did not correlate with inflammation or myocardial damage markers.     

肺炎支原体感染的致病机制及实验室检测

肺炎支原体对呼吸道上皮细胞的黏附以及在其上面滑动是导致肺炎发生的先决条件,机体通过抗体和补体调理吞噬并最终引起细胞毒作用和炎症反应,其中过氧化氢和社区获得性呼吸窘迫综合征毒素是肺炎支原体的重要毒力因子。肺炎支原体实验室检测包括培养、血清学实验和核酸扩增检测技术（NAATs）,由于NAATs具有高灵敏度和短周转时间,被认...     

临床拟诊机化性肺炎31例诊疗的回顾性分析

目的 探讨临床拟诊机化性肺炎的诊断与治疗.方法 回顾性分析31例临床拟诊为机化性肺炎患者的临床资料、影像资料和治疗方法.结果 31例经抗生素治疗无效的患者,通过支气管镜肺活检病理或经皮肺穿刺病理除外结核、真菌、化脓性炎、肺癌而拟诊机化性肺炎24例,无病理检查结果而经激素治疗有效拟诊7例.21例患者具有典型机化性肺炎CT表现,所有病例均经短期（6～14d）激素治疗后影像学结果明显改善.随访6～25个月,复发6例,均发生在激素减量过快或停药患者中.结论 临床上经抗生素治疗无效、结合临床影像学特点、病理检查除外其他疾病是拟诊机化性肺炎的重要指标;对于无病理检查患者短期激素治疗有效有助于诊断.过早激素减量容易导致复发.     

Significant accumulation of KRAS mutations in bronchiolar metaplasia-associated honeycomb lesions of interstitial pneumonia

Interstitial pneumonia (IP) is a major risk factor for lung adenocarcinoma (LADC). IP-related LADC predominantly develops in the bronchiolar metaplasia lining in honeycomb lesions. Kirsten rat sarcoma virus (KRAS) is the most common oncogene mutated in IP-related LADC. The present study examined the metaplastic epithelia in honeycomb lesions for KRAS mutations using digital droplet polymerase chain reaction (ddPCR), a sensitive method used to detect infrequent mutations. Significantly higher KRAS mutation variant allele frequencies (VAFs) were detected in the metaplastic lung epithelia from 13 patients with IP compared with those in 46 non-lesioned lung samples from patients without IP (G12V, P=0.0004, G12C, P=0.0181, and G12A, P=0.0234; Mann Whitney U test). Multivariate analyses revealed that higher KRAS G12V (logistic regression model; P=0.0133, odds ratio=7.11) and G12C (P=0.0191, odds ratio=5.81) VAFs in patients with IP were independent of confounding variables, such as smoking and age. In patients with IP, metaplastic epithelia exhibited significantly higher KRAS G12V and G12C VAFs compared with the non-lesioned counterparts (paired t-test; G12V, P=0.0158, G12C, P=0.0465). These results suggested that IP could increase KRAS mutations and supported the hypothesis that bronchiolar metaplasia could be a precursor for IP-related LADC.     

A retrospective study of physiotherapy management for patients with pneumonia requiring invasive ventilation in a single-center Australian ICU

Background:Pneumonia is a frequent diagnosis for patients admitted to Australian intensive care units (ICUs) for invasive ventilation. Physiotherapists in ICU provide interventions to enhance respiratory function and physical recovery.Objective:This retrospective cohort study aimed to describe physiotherapy management of adults with pneumonia who require invasive mechanical ventilation in a single Level 3 ICU in a quaternary teaching hospital.Methods:All adults admitted with a medical diagnosis of pneumonia requiring invasive mechanical ventilation over a two-year period were included. Demographic and clinical data, including APACHE II score, ventilator-free days (VFDs) to day 28, ICU length of stay (LOS), and type and frequency of physiotherapy episodes of care delivered in ICU, were collected from electronic medical records. Correlations between VFDs to day 28 and the frequency of physiotherapy interventions delivered per subject were examined using Spearman’s rho analysis.Results:From 208 records screened, 66 subjects with an ICU admission diagnosis of pneumonia, who required invasive mechanical ventilation, were included. Median (IQR) ICU LOS was 10 (5–17) days, and mortality rate was 15.2% (n=10). The cohort had a median of 20.5 (IQR 2–25) VFDs to day 28. Community-acquired pneumonia (66.7%, n=44) was the most frequent type of pneumonia diagnosis. There were 1110 episodes of physiotherapy care, with patients receiving a median of 13.5 (IQR 6.8–21.3) episodes during their ICU stay, with a median rate of 1.2 (IQR 1.0–1.6) episodes per day. Over 96.7% of patients with pneumonia received physiotherapy treatment during their ICU stay. Overall, physiotherapy treatments consisting only of respiratory techniques were most commonly provided (55.1%, n=612). Airway suctioning (92.4%, n=61), patient positioning (72.7%, n=48) or positioning advice to nurses (77.3%, n=51), and hyperinflation techniques (63.6%, n=42) were among the respiratory techniques most delivered.Conclusion:This study described the current intensive care physiotherapy management in a single center for adults with pneumonia who required invasive mechanical ventilation, demonstrating that respiratory physiotherapy interventions are often provided for this ICU patient cohort. Further research is warranted to determine the efficacy of respiratory physiotherapy interventions to justify their use for ICU patients with pneumonia receiving invasive mechanical ventilation.     

重症肺炎后闭塞性细支气管炎的危险因素分析

目的 探讨引起感染后闭塞性细支气管炎（postinfectious bronchiolitis obliterans,PIBO）的重症肺炎的临床特征及危险因素。方法 回顾性分析2014年4月—2019年4月在深圳市儿童医院因重症肺炎住院治疗并最终诊断为PIBO的病例为观察组,并随机抽取同期诊断为重症肺炎未发生PIBO的病例为对照组。分析观察组重症肺炎的临床特征,并分析发生PIBO的危险因素。结果 观察组49例,对照组98例。观察组男33例,女16例;发病年龄≤2岁45例（91.8%）,患者发热、咳嗽49例（100%）,热程（12.898±5.818）d,喘息22例（44.9%）、气促19例（38.8%）。出院时肺部仍有啰音28例（57.1%）。胸部影像病初表现为间质性改变11例（78.6%,11/14）,病程中主要表现为实变19例（57.6%,19/33）。病原腺病毒26例（53.1%）,肺炎支原体17例（34.7%）。入住PICU 31例（63.3%）,使用有创呼吸机19例（38.8%）,使用激素25例（51.0%）,使用人免疫球蛋白28例（57.1%）。多因素Logistic回归结...     

盐酸氨溴索对老年肺炎祛痰作用疗效分析

目的评价盐酸氨溴索注射液对老年肺炎患者祛痰作用的临床疗效及安全性。方法将124例老年肺炎住院患者随机分成治疗组64例和对照组60例，治疗组使用左氧氟沙星注射液0．2g＋10％葡萄糖液（糖尿病患者用生理盐水）100mL，静脉滴注，2次／d；加用盐酸氨溴索注射液45mg，静脉注射，2次／d。对照组用左氧氟沙星注射液（用法同治疗组），加用必嗽平片16mg，口服，3次／d。疗程7～14d，2组均不同时使用其他抗生素，有基础疾病者按相应疾病常规治疗。结果治疗组对咳嗽的临床控制率＋显效率（31％＋38％）明显高于对照组（15％＋20％），有极显著性差异（P〈0．01）；对痰性状的改变及肺部哆音的改变2组间无显著性差异（P〉0．05）。治疗组盐酸氨溴索注射液的主要不良反应为胃部灼热，治疗过程中有6例出现，发生率为9％，患者能耐受，未作特殊处理。对照组必嗽平片治疗过程中有7例出现胃部不适，表现为上腹胀痛，恶心、欲呕，发生率为12％，经服用西咪替丁片后好转，未中断治疗。结论盐酸氨溴索注射液对老年肺炎患者祛痰效果显著，是一种安全、经济、有效的祛痰药物。