Objective To observe the efficacy and safety of sildenafil in one case of PoPH patients. Methods A case of PoPH patient who was successfully treated with sildenafil was retrospectively analyzed，and literatures related sildenafil and PoPH were reviewed. Results A case of PoPH patient admitted with dyspnea on extetion was diagnosed with echocardiography，gastroscrope and other examinations. She was treated with sildenafil and responded well by decreased pulmonary arterial pressure，improved exercise tolerance and life quality，without obvious side effects. Literatures review suggested that PoPH is an under-recognized but life-threatening complication of cirrhosis or noncirrhotic portal hypertension with poor prognosis which exists in decompensated chronic liver diseases patients. The most classic symptoms of PoPH is progressive dyspnea on extertion. PoPH patients may benefit from sildenafil therapy with decreased pulmonary arterial pressure and improved life quality. Conclusions Theawareness of PoPH should be increased and Sildenafil may be effective and safe for PoPH patients. However，more evidences from clinical trials are needed.
Objective We investigated the effect of supplementation with alanyl-glutamine dipeptide on insulin resistance and outcome in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods A prospective, randomized, open and controlled trial was conducted. Patients with COPD and respiratory failure were recruited between Jan 2005 to Feb 2006 and randomly assigned to a trial group (n=14) with glutamine dipeptide supplmented parenteral nutrition and a control group (n=16) with isocaloric, isonitrogenic parenteral nutrition. On the third day and fifth day of nutrition treatment, blood glucose was clamped at level of 4.4 to 6.1 mmol/L by intravenously bumped insulin. Blood gas, blood glucose level, insulin dosage were recorded everyday. The outcomes were mortality, length of stay (LOS) in hospital and in ICU, mechanical ventilation times and the costs of ICU and hospital.Results Thirty patients successfully completed the trial. There was no difference in blood gas between two groups, but PaO2 increased gradually. Compared with control group, blood glucose level had trend to decrease in trial group. The average insul in consumption decreased significantly in trial group on the fifth day. There was no statistical difference between two groups in mortality, length of stay in hospital and the costs of hospital. But compared with control group, length of stay in ICU and mechanical ventilation days had trend to decrease in trial group. Conclusion Alanyl-glutamine dipeptide do not improve pulmonary function of patients with COPD and respiratory failure. However, alanyl-glutamine dipeptide attenuated insul in resistance and stabilized blood glucose. This trial does not confirm alanyl-glutamine di peptide can improve outcome in critically ill patients with COPD and respiratory failure between two groups in mortality at the end of 30 days, length of stay in hospital and the costs of hospital. But the length of stay in ICU and the duration of mechanical ventilation does decrease, but not significantly, in the trial group.
Objective To systematically review venous thromboembolism (VTE) risk assessment tools. Methods The Embase, PubMed, CNKI, CBM, WanFang Data, VIP databases and 22 relevant institutions and associations were searched to identify all VTE assessment tools from inception to December 31, 2022. Two researchers independently screened the literature, extracted data, and cross-checked the data. A qualitative analysis was used to describe the country's essential characteristics, publishing organization, year, applicable disease type, applicable population, tool formation method, etc. Key elements and techniques were compared in terms of evaluation dimension, methods, and procedures to form the tool, risk stratification ability, and whether to verify. Results A total of 42 VTE risk assessment tools were included, of which 16 were in the United States, and only 4 were in China. They were released between 1996 and 2021, and the applicable disease types and populations differ. Nineteen tools were constructed based on case-control or retrospective cohort studies, 16 were conducted using prospective cohort studies, and 5 were based on cross-sectional and RCT studies; Additionally, 20 tools were built based on logistic regression models; The evaluation dimensions of each tool differed, and the most common frequency of occurrences were VTE history, age, BMI value, and confirmed tumor, accounting for 64.29%, 54.76%, 54.76%, and 47.62%, respectively. Thirty-three tools were stratified for risk, and 30 tools were presented in the form of risk scores; Some tools lacked clinical validation data, and only 12 tools were analyzed for specificity, sensitivity, NPV, PPV, and AUC. Conclusion The evaluation dimensions and evidence sources of existing VTE risk assessment tools are not completely consistent, the implementation methods and results presentation forms of the tools are not completely the same, and the scope of application is different; Some tool construction methods and processes are not clear enough, and there is a lack of validation research on external validity, which has certain limitations in promoting clinical practice in China.
Objective To improve the knowledge and diagnostic accuracy of combined pulmonary fibrosis and emphysema (CPFE) syndrome in connective tissue diseases (CTD) by summarizing the clinical characteristics of 20 CTD patients with CPFE and reviewing literatures. Methods The medical records of 20 CTD patients with CPFE from January 2011 to June 2015 were retrospectively analyzed. Results There were 11 males and 9 females. The average age was 47 years. Among them, 4 patients were smokers and 15 patients were nonsmokers. The average duration of CTD was 3.5 years with an average onset age of 41 years. Respiratory symptoms were reported in 17 patients and Velcro rale was found in 9 patients; The most common type of CTD disease in these 20 patients was inflammatory myopathy (9 patients, 45%) followed by systemic sclerosis (SSc) (4 patients, 20%). High resolution computerized tomography of lung showed typical radiological features of CPFE containing fibrosis lesions predominantly distributed in the subpleural (14 patients) and basal (18 patients) parts and emphysema mainly located in upper zones. Relatively normal results of lung volume and ventilation function, and markedly reduced carbon monoxide transfer capacity were observed. One patient was confirmed with pulmonary hypertension and 1 patient died from severe inflammation and acute respiratory distress syndrome. Conclusions The CPFE syndrome can be identified in CTD patients as an entity with male predominance, especially among patients with inflammatory myopathy and SSc. Higher risk of secondary pulmonary hypertension and acute lung injury in these patients may increase mortality. Early differentiation of CPFE from pure interstitial lung disease in CTD patients could be helpful in improving prognosis.
ObjectiveTo study the clinical features, short-term prognosis and risk factors of Pseudomonas Aeruginosa (P.aeruginosa) infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsThis study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021. AECOPD patients with P.aeruginosa infection were included as case group, AECOPD patients without P.aeruginosa infection were randomly selected as control group from the same hospitals and same hospitalization period as the patients in case group, at a ratio of 2∶1. The differences in basic conditions, complications, clinical manifestations on admission and in-hospital prognosis between the two groups were compared, and the risk factors of P.aeruginosa infection were analyzed. ResultsA total of 14007 inpatients with AECOPD were included in this study, and 338 patients were confirmed to have P.aeruginosa infection during hospitalization, with an incidence rate of 2.41%. The in-hospital prognosis of AECOPD patients with P.aeruginosa infection was worse than that of the control group, which was manifested in higher hospital mortality (4.4% vs. 1.9%, P=0.02) and longer hospital stay [13.0 (9.0, 19.25)d vs. 11.0 (8.0, 15.0)d, P=0.002]. In terms of clinical features, the proportions of patients with cough, expectoration, purulent sputum, dyspnea in the case group were higher than those in the control group, and the inflammatory indicators (neutrophil ratio, erythrocyte sedimentation rate) and partial pressure of carbon dioxide in arterial blood gas were higher than those in the control group, while the serum albumin was significantly lower than that in the control group (all P<0.05). Multivariate logistic regression analysis showed that Parkinson's disease [odds ratio (OR)=5.14, 95% confidence interval (CI): 1.43 to 18.49, P=0.012], bronchiectasis (OR=4.97, 95%CI: 3.70 to 6.67, P<0.001), invasive mechanical ventilation (OR=2.03, 95%CI: 1.23 to 3.36, P=0.006), serum albumin<35 g/L (OR=1.40, 95%CI: 1.04 to 1.88, P=0.026), partial pressure of carbon dioxide ≥45 mm Hg (OR=1.38, 95%CI: 1.01 to 1.90, P=0.046) were independent risk factors for P.aeruginosa infection in AECOPD patients. ConclusionsP.aeruginosa infection has a relative high morbidity and poor outcome among AECOPD inpatients. Parkinson’s disease, bronchiectasis, invasive mechanical ventilation, serum albumin below 35 g/L, partial pressure of carbon dioxide ≥45 mm Hg are independent risk factors of P.aeruginosa infection in AECOPD inpatients.
ObjectiveTo compare the predictive value of the BAP-65 score, the DECAF score, the CURB-65 score, and the Pneumonia Severity Index (PSI) on short-term mortality and adverse outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with community-acquired pneumonia (CAP). MethodsThis study enrolled patients hospitalized for AECOPD and CAP from ten hospitals in China from September 2017 to July 2021. All-cause mortality within 30 days was investigated. Patients were divided into the death and the survival groups according to their survival status. The differences in basic conditions, complications, symptoms, signs and auxiliary examination results between the two groups were compared, and the independent risk factors of all-cause mortality were analyzed. The included patients were scored and graded according to the 4 scales, respectively, and the validity of the four scales in predicting short-term mortality and adverse outcomes was compared based on the receiver operating charateristic (ROC) curve analysis. ResultsA total of 3375 patients including 2545 males and 830 females with a mean age of (73.66 ±10.73) years were enrolled in this study. Within 30 days, 129 (3.82%) patients died and 614 (18.19%) patients had an adverse outcome (including all-cause death, invasive mechanical ventilation and admission into intensive care unit). Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value were independent risk factors for 30-day mortality in AECOPD patients with CAP. The area under the ROC curve (AUC) of the CURB-65 score, BAP-65 score, DECAF score, and PSI score for predicting all-cause mortality were 0.780, 0.782, 0.614, and 0.816, and these AUCs for predicting adverse outcomes were 0.694, 0.687, 0.564 and 0.705, respectively. PSI score had the best predictive efficacy for all-cause mortality and adverse outcomes, and the DECAF score had the worst predictive efficacy. ConclusionsAECOPD patients with CAP have a relatively high incidence of all-cause mortality and adverse outcomes within 30 days. Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value are independent risk factors for 30-day mortality. PSI score has the best performance in predicting all-cause mortality and adverse outcomes, while the DECAF score has the worst performance.