Clinical and bacteriological outcomes in hospitalised patients with community-acquired pneumonia treated with azithromycin plus ceftriaxone, or ceftriaxone plus clarithromycin or erythromycin: a prospective, randomised, multicentre study

This study compared patients with moderate-to-severe community-acquired pneumonia (CAP) requiring hospitalisation, who received initial therapy with either intravenous ceftriaxone plus intravenous azithromycin, followed by step-down to oral azithromycin (n = 135), with patients who received intravenous ceftriaxone combined with either intravenous clarithromycin or erythromycin, followed by step-down to either oral clarithromycin or erythromycin (n = 143). Clinical and bacteriological outcomes were evaluated at the end of therapy (EOT; day 12-16) or at the end of study (EOS; day 28-35). At baseline, mean APACHE II scores were 13.3 and 12.6, respectively, with >50% of patients classified as Fine Pneumonia Severity Index (PSI) category IV or V. Clinical success rates (cure or improvement) in the modified intent-to-treat (MITT) population at EOT were 84.3% in the ceftriaxone/azithromycin group and 82.7% in the ceftriaxone/clarithromycin or erythromycin group. At EOS, MITT success rates (cure only) were 81.7% and 75.0%, respectively. Equivalent success rates in the clinically evaluable population were 83% and 87%, respectively, at EOT, and 79% and 78%, respectively, at EOS. MITT bacteriological eradication rates were 73.2% and 67.4%, respectively, at EOT, and 68.3% vs. 60.9%, respectively, at EOS. Mean length of hospital stay (LOS) was 10.7 and 12.6 days, and the mean duration of therapy was 9.5 and 10.5 days, respectively. The incidence of infusion-related adverse events was 16.3% and 25.2% (p 0.04), respectively. An intravenous-to-oral regimen of ceftriaxone/azithromycin was at least equivalent in efficacy and safety to the comparator regimen and appeared to be a suitable treatment option for hospitalised patients with CAP.     

DNA content and expression of tumour markers in germ cells adjacent to germ cell tumours in childhood: Probably A different origin for infantile and adolescent germ cell tumours

The origin of testicular germ cell tumours occurring during childhood is poorly understood. In adults, the classical seminomas and non-seminomas originate from carcinoma in situ of the testis, which can usually also be detected in seminiferous tubules adjacent to the tumours. In order to contribute with information regarding a possible association between carcinoma in situ and the childhood group of germ cell tumours, we investigated seminiferous tubules adjacent to 13 infantile yolk sac tumours, five infantile teratomas, and six adolescent germ cell tumours of various types, using morphological evaluation, immunohistochemical staining with markers for carcinoma in situ cells, and densitometric DNA measurement of the germ cells. We detected clear differences between the germ cell populations adjacent to adolescent and infantile germ cell tumours. The former were associated with both normal germ cells and carcinoma in situ cells. The presence of carcinoma in situ cells strongly suggested that the adolescent tumours arose from carcinoma in situ cells, like germ cell tumours occurring in adult men. Although we were in doubt in two cases, the infantile germ cell tumours were in general not associated with carcinoma in situ cells. The aetiology of infantile yolk sac tumours and teratomas may therefore be fundamentally different from that of adolescent and adult germ cell tumours. The origin of yolk sac tumours and teratomas remains to be elucidated.     

Elevated interleukin-18 levels in bronchoalveolar lavage fluid of patients with eosinophilic pneumonia

BACKGROUND: Interleukin (IL)-18 can induce Th2 cytokine production particularly in collaboration with IL-2. Accumulation of Th2 cells and increased levels of Th2 cytokines are found in bronchoalveolar lavage fluid (BALF) from patients with eosinophilic pneumonia (EP). To evaluate the role of IL-18 in the pathogenesis of EP, we measured the concentration of IL-2, IL-12, IL-18, and Th2 cytokines in BALF from patients with EP. METHODS: The concentrations of interferon (IFN)-gamma, IL-2, IL-5, IL-10, IL-12, IL-13, and IL-18 in BALF were measured in patients with idiopathic acute eosinophilic pneumonia (AEP), with idiopathic chronic eosinophilic pneumonia (CEP), with sarcoidosis and healthy volunteers (HV). RESULTS: The BALF concentrations of Th2 cytokines, IL-5, IL-10, and IL-13, were higher in patients with EP than in sarcoidosis and control. The IL-2 level in BALF was higher in EP than in sarcoidosis and control. The IL-18 and IL-12 (p40 + p70) levels were higher in patients with EP than sarcoidosis, while the level of IL-12 (p70) was below the detection limit in patients with EP. There was a significant correlation between IL-2 level and both IL-5 and IL-13 in BALF of patients with EP. CONCLUSIONS: Our findings suggest that IL-18 may contribute to Th2 cytokine-dominant responses in patients with EP in collaboration with IL-2.     

Idiopathic pulmonary fibrosis/cryptogenic fibrosing alveolitis

Abstract. Idiopathic pulmonary fibrosis (IPF), synonymous with cryptogenic fibrosing alveolitis (CFA), is a progressive and usually fatal disease of unknown cause characterized by sequential acute lung injury with subsequent scarring and end-stage lung disease. Historically, IPF/CFA encompassed a heterogeneous group of different histological and clinical entities arising in an idiopathic setting. Recently, the American Thoracic Society (ATS) and European Respiratory Society (ERS) core committee has redefined diagnostic criteria for both IPF/CFAand idiopathic interstitial pneumonias confining the term IPF/CFA to patients with a histological pattern of usual interstitial pneumonia on lung biopsy. This review attempts to refine the clinico-radiological-pathological features that together define IPF/CFA as it is understood today, and to summarize the rationale of new therapeutic approaches based on the current understanding of the pathogenetic mechanisms.     

In vivo efficacy of cefotaxime and amoxicillin against penicillin-susceptible, penicillin-resistant and penicillin-cephalosporin-resistant strains of Streptococcus pneumoniae in a mouse pneumonia model

Objective: To compare cefotaxime (CTX) to amoxicillin (AMO) (usually considered the definitive therapy for penicillinsusceptible Streptococcus pneumoniae infections) in an immunocompromised mouse pneumonia model.
Methods: Three S. pneumoniae clinical isolates were used: two serotype 19 strains, a penicillin-susceptible (P^s) strain (penicillin MIC = 0.03 μ/mL) and a highly penicillin-resistant (P^r) strain (penicillin MIC = 4 μ/mL), and one serotype 23F strain, a penicillin-cephalosporin-resistant (CFTR) strain (CTX MIC = 4 μ/mL).
Results: CTX activity in this mouse model of pneumonia induced by the highly penicillin-resistant strain of S. pneumoniae was lower than expected from its low MIC against this organism. Furthermore, AMO had greater efficacy than CTX against a CFTR S. pneumoniae strain.
Conclusion: Our data suggest that there is no major difference in the in vivo efficacy of the two agents, cefotaxime and amoxicillin, against penicillin-resistant and penicillin-cephalosporin-resistant S. pneumoniae.     

Plasticity of the central nervous system—a neurosurgeon's experience of cerebral compensation and decompensation

Summary Cerebral plasticity constitutes one of the most decisive factors in recovery and readaptation after cerebral lesions. In contrast to the considerable progress in current studies on normal neuronal plasticity including the idea of l'homme neuronal, the concept of plasticity postulated by Albrecht Bethe in 1929 received little attention. The author, as a neurosurgeon, has tried to describe cranial morphological plasticity, morphological and functional plasticity in infantile encephalopathies and especially in hemiatrophic lesions. It is supposed that a true morphological substrate exists due to compensatory hyperplasia of the uninvolved hemisphere.Modern neurosurgical techniques have demonstrated that the functional plastic capacity is much larger than has been supposed, even in the elderly. Some aspects of the mechanisms of compensation and decompensation of cortical and subcortical structures as well as of the central regulation systems are discussed. The full extent of the amazing recovery and functional reorganization is reached by plastic capacity, personal motivation, adequate training and sufficient time.The contribution ends with an exposition of a personal philosophy concerning psycho-somatic dualism, the body-mind problem, the future of the human brain and the ethical outlook, based on the progressive biological evolution of the basal neocortex and the immanent functional development (H. Spatz).In grateful memory of my paternal friends, the great German brain researchers Julius Hallervorden (1882–1965) and Hugo Spatz (1888–1969).     

缺血性卒中相关性肺炎危险因素的病例对照研究

目的 探讨缺血性卒中相关性肺炎的危险因素。方法 回顾性纳入2018年1月—2020年12月期间唐山市协和医院神经内科住院的急性缺血性卒中(acute ischemic stroke, AIS)患者,收集人口统计学及临床资料。根据是否发生卒中相关性肺炎(stroke - associated pneumonia, SAP)分为非SAP组和SAP组,比较两组的各项临床资料,并采用多因素logistic回归分析SAP的独立影响因素。结果 共纳入721例患者,平均年龄(65.63±12.07)岁;SAP组年龄、入院美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分,冠心病、心房颤动、卒中史、吞咽障碍和入院格拉斯哥昏迷评分≤10分的比例、同型半胱氨酸、纤维蛋白原和白细胞计数均高于非SAP组,而SAP组入院舒张压、高密度脂蛋白胆固醇、白蛋白、白蛋白与球蛋白比值、血红蛋白和红细胞计数均低于非SAP组,差异均有统计学意义;多因素logistic回归分析显示,年龄增高(OR = 1.055,95%CI:1.009～1.103)、入院NIHSS评分增加(OR = 1.290,95%CI:1.154～1.444)、白细胞计数升高(OR = 1.267,95%CI:1.101～1.457)是SAP发生的危险因素。结论 缺血性卒中相关性肺炎与高龄、入院NIHSS评分增加和白细胞计数升高相关。     

加味瓜蒌枳实汤联合哌拉西林钠他唑巴坦钠对痰热蕴肺型卒中相关性肺炎患者的免疫功能和血清炎症因子水平的影响

目的：探究加味瓜蒌枳实汤联合哌拉西林钠他唑巴坦钠对痰热蕴肺型卒中相关性肺炎(SAP)患者的免疫功能和血清炎症因子水平的影响。方法：将80例痰热蕴肺型SAP患者随机分为对照组与观察组,各40例,对照组SAP患者在基础治疗上加用哌拉西林钠他唑巴坦钠,观察组患者在对照组治疗基础上加用加味瓜蒌枳实汤,连续治疗2周,并比较两组SAP患者治疗前后的临床治疗效果、免疫指标、炎症指标及肺功能情况。结果：与本组治疗前比较,两组SAP患者治疗后X射线片病灶、肺啰音、咳嗽、发热、痰色、便秘评分均明显降低(P<0.05);两组SAP患者的第1秒内用力呼气量占呼气量的比例(FEV1/FVC)、第1秒用力呼气容积百分比(FEV1%)均明显改善(P<0.05)。与对照组治疗后比较,观察组患者的FEV1/FVC、FEV1%改善更明显(P<0.05)。与本组治疗前比较,两组SAP患者经治疗后中性粒细胞与淋巴细胞比值(NLR值)均明显降低(P<0.05);与对照组治疗后比较,观察组患者的NLR值明显降低(P<0.05)。与本组治疗前比较,两组SAP患者在治疗后的血清降钙素原(PCT)、超敏C...     

机械通气下应用肺表面活性物质治疗新生儿肺炎合并呼吸衰竭的疗效

目的：探讨新生儿肺炎合并呼吸衰竭治疗中机械通气下应用肺表面活性物质的疗效。方法：回顾性选取2017年2月至2022年2月无锡市儿童医院新生儿科收治的新生儿肺炎合并呼吸衰竭患儿80例,依据治疗方法分为机械通气下应用肺表面活性物质治疗组(观察组)、机械通气治疗组(对照组)两组,各40例。分析两组患儿血气指标、平均动脉压(MAP)和呼吸力学指标、机械通气时间、总吸氧时间、住院时间、并发症发生情况之间的差异。结果：治疗前,两组患儿的动脉血氧分压(PaO₂)、氧合指数(PaO₂/FiO₂)、动脉血二氧化碳分压(PaCO₂)、氢离子浓度指数(pH)、MAP、呼气末正压(PEEP)、平台压(Pplat)、气道峰压(PIP)之间比较,差异均无统计学意义(P> 0.05);治疗后,两组患儿的PaO₂、PaO₂/FiO₂均高于治疗前,PaCO₂、MAP、PEEP均低于治疗前,差异均具有统计学意义(P <0.05),但治疗...