Objective To explore the correlation between the levels of nitrite / nitrate( NO2 /NO3) in exhaled breath condensate ( EBC) and pulmonary infection in mechanically ventilated patients. Methods The clinical data from ventilated patients in critical care units of Peking University People’s Hospital from November 2006 to August 2007 were collected and analyzed. The patients’clinical pulmonary index score ( CPIS) were calculated. EBC of those patients were collected via endotracheal tube or tracheostomy cannula,and the concentrations of NO2 /NO3 were assayed. The level of NO2 /NO3 in different CPIS patients in 24 hours’ventilation, weaning proportion in 3 days and mortality in different NO2 /NO3 level patients were compared. The correlation of the CPIS and level of NO2 /NO3 were explored between survival and non-survival patients. Results A total of 76 patients were enroled. The NO2 /NO3 levels in patients of CPIS≤3, CPIS 3-6 and CPIS gt;6 in 24 hours of ventilation were ( 23. 31 ±5. 79) , ( 28. 72 ±9. 10) and ( 35. 42 ±12. 10) μmol / L respectively, with significantly differences between each other ( P lt; 0. 01) . The lower the patients’concentration of NO2 /NO3 was, the earlier the weaning and the lower the mortality were. The NO2 /NO3 levels on 4th and 7th day were detected in 24 survival patients and 23 non-survival patients. The difference of NO2 /NO3 levels between the survival patients and non-survival patients became significant on 7th day [ ( 29. 32 ±9. 52) μmol / L vs. ( 37. 22 ±12. 03) μmol / L, P lt; 0. 01] . Linear correlation analysis showed that the NO2 /NO3 level was positively correlated with CPIS ( r = 0. 76, P lt; 0. 01) . Conclusions The NO2 /NO3 level of EBC in ventilated patients is positively correlated to the severity of pulmonary infection, thus may be used as a new predictor for weaning and prognosis.
Respiratory viruses are important pathogens responsible for community- and hospital-acquired pneumonia in adults. Outbreaks of highly pathogenic viruses in recent years have made us aware of the difficulty and importance of diagnosis and treatment of viral pneumonia. This review summarized the current status of diagnosis and treatment of viral pneumonia in adults so as to improve our understanding of it.
Objective To observe the changes and influencing factors on pulse oxygen saturation and hemoglobin in Tibetan residents of 4 200 meters above sea level. Methods The health examination data of the Tibetan village residents were collected in Rerong Country, Shannan Prefecture of Tibet autonomous region from January 4 to February 4, 2012. And the information of pulse oxygen saturation was recorded at the same time. The residents were categorized by sex, age and smoking history to observe the difference in each group. Results The clinical data of 234 healthy Tibetan residents were collected with average age of (37.9±13.9) years old, and 97 were male (41.5%). There were no difference in pulse oxygen saturation [(86.1±3.4)% and (86.0±4.7)%, P=0.784) between male and female residents, and heart rate of the male was less than that of the female [(77.9±9.8) bpm and (81.1±12.1) bpm, P=0.036], while the hemoglobin content was higher in male residents [(164.5±15.4) g/L and (139.1±19.2) g/L, P=0.000). With the increase of age, especially in the group older than 60 years, the pulse oxygen saturation significantly decreased (P=0.003), while hemoglobin content showed a gradual increase trend (P=0.000). And in the group which smoking history more than 20 pack-years, the pulse oxygen saturation was lesser than the other groups, and the hemoglobin content increased (P=0.000). Conclusions The pulse oxygen saturation level of Tibetan residents of 4 200 meters above sea level is negatively correlated with age and smoking history, and the level of hemoglobin is positively correlated with age and smoking history. In resting state, there is no significant difference in heart rate between the groups divided by ages.
ObjectiveTo explore the expression of periostin in bronchoalveolar lavage fluid (BALF) of patients with dermatomyositis-related interstitial lung disease (DM-ILD) and rheumatoid arthritis-related interstitial lung disease (RA-ILD).MethodsA total of 44 patients with DM-ILD and 28 patients with RA-ILD were underwent bronchoalveolar lavage. Cells in BALF were collected and analyzed by absolute different cell counts. The level of periostin and Krebs von den Lungen-6 (KL-6) were tested by enzyme linked immunosorbent assay. Results of high resolution CT of patients were scored. Thirty patients without interstitial lung disease (ILD) served as a control group.ResultsLevels of periostin and KL-6 were significantly increased in BALF of patients with DM-ILD and RA-ILD compared with control group (all P<0.05). Levels of periostin were positively correlated with lymphocyte counts and levels of KL-6 in BALF (allP<0.05). Furthermore, levels of periostin were significantly correlated with high resolution CT scores (P<0.05).ConclusionsLevels of periostin are increased in patients with DM-ILD and RA-ILD. Periostin might be served as an indicator of CTD-ILD.
ObjectiveTo investigate the clinical characteristics and prognostic factors of influenza pneumonia from 2014 to early 2018.MethodsThe general information, clinical symptoms, laboratory examination and treatment of 69 patients with influenza pneumonia from October 2014 to March 2018 were collected. The clinical characteristics of 32 patients with influenza pneumonia from 2017 to 2018 were compared with 37 patients with influenza pneumonia from 2014 to 2016. The prognostic factors of influenza pneumonia were also investigated.ResultsThe median patient age was 68 (55-78) years, and 41 cases (59.4%) were men in 69 patients. The five most common comorbidities were hypertension (44.9%), diabetes (23.3%), chronic obstructive pulmonary disease (17.4%), coronary atherosclerotic heart disease (13.0%), and chronic kidney disease (10.1%). The median levels of fasting blood glucose, lactate dehydrogenase, C-reactive protein, and procalcitonin in the patients with influenza pneumonia in 2017-2018 were significantly higher than those in the same period of 2014-2016, which were respectively 7.1 (5.4 - 8.3)mmol/L vs. 5.2 (4.5 - 7.3)mmol/L (P=0.017), 213.0 (98.0 - 320.5)U/L vs. 178 (98.0 - 280.0)U/L (P=0.049), 65.5 (15.4 - 139.8)mg/L vs. 45.5 (14.1 - 75.3)mg/L (P=0.050), 0.66 (0.24 - 1.58)μg/L vs. 0.17 (0.11 - 0.43)μg/L (P=0.004). The proportion of bacterial infection, septic shock, acute renal failure and mortality in the patients with influenza pneumonia in 2017-2018 was higher than that in the 2014-2016 group, which were respectively 40.6% vs. 18.9% (P=0.047), 21.9% vs. 5.4% (P=0.043), 21.9% vs. 2.7% (P=0.035), 31.3% vs. 5.4% (P=0.005). Multivariate analysis showed that numbers of lymphocytes, blood urea nitrogen, and procalcitonin were independent risk factors for mortality in the patients with influenza pneumonia. The odds ratio was respectively 0.001 (95%CI 0.00 - 0.200), 1.342 (95%CI 0.996 - 1.808), 1.113. (95%CI 1.006 - 1.230).ConclusionsCompared with the patients with influenza pneumonia in 2014-2016, the patients in 2017-2018 have higher levels of fasting blood glucose and lactate dehydrogenase, and are also susceptible to secondary bacterial infection, septic shock, and acute renal failure. Decreased lymphocytes, elevated blood urea nitrogen, and elevated procalcitonin are independent risk factors for death in patients with influenza pneumonia.
ObjectiveTo explored the influence of disease changes, weight gain, eosinophil levels and other factor in pregnancy women with asthma. MethodsCase records of gestational asthma patients produced in the obstetrics department of Peking University People's Hospital from October 2010 to October 2020 were collected, and refer to electronic medical records of clinics (pre-pregnancy and pregnancy). According to the disease control (asthma related unplanned respiratory clinics, emergency or hospitalization), patients were divided into pregnancy stable group and pregnancy fluctuation group. The basic characteristics, pre-pregnancy asthma control, weight gain during pregnancy and peripheral blood eosinophil level before labor were retrospectively analyzed. The cause of asthma attacks, clinical characteristics and distribution of gestational time in pregnancy fluctuations were described. Peripheral blood eosinophil levels in different period during pregnancy in the stable group were analyzed. ResultsTotally 124 cases of natural pregnancy singleton were enrolled in the study. The age was (32.3±3.9) years old. There were 71 patients in stable group and 53 patients in fluctuation group. The proportion of pre-pregnancy instability in the fluctuating pregnancy group was higher than that in the stable pregnancy group (P<0.05). The proportion of intermittent medication before pregnancy was higher in the fluctuating pregnancy group than in the stable pregnancy group (P<0.05). Peripheral blood eosinophil count before labor and the number of cases with eosinophil count≥0.15×109/L before labor were higher in the fluctuation group (all P<0.05). The proportion of hypertentive diseases in pregnancy and fetal distress in uterus were higher in the fluctuation group (all P<0.05). The common cold was the common trigger factor (38.2%) and asthma recurrences occur between 13 and 36 weeks of gestation (65.8%) in fluctuation group. In further analysis of subgroup (the stable group), peripheral blood eosinophil count in early pregnancy (P<0.05) and pregnant metaphase (P<0.05) were higher than before delivery. The number of cases with eosinophil count>0.15×109/L in pregnant metaphase (P<0.05) was higher than before delivery. ConclusionsAsthma fluctuates during pregnancy is associated with adverse maternal and fetal outcomes. It is very important and critical that asthma control before pregnancy, weight gain management and eosinophil level monitoring of patients with asthma during pregnancy. The whole management is imperative in women with asthma during pregnancy.
Objective To investigate the clinical features of pnuemonia in renal transplant recipients in order to improve the clinical diagnostic and treatment efficacy.Methods The clinical data of 29 recipients with pneumonia following renal transplantation in Peking University People’s Hospital from January 1,1999 to July 31,2006 were collected and analyzed retrospectively.Results Of the 29 cases with pneumonia，one case（3.4%，1/29）were diagnosed as nosocomial acquired pneumonia and twenty eight cases（96.6%，28/29）as community acquired pneumonia.Of the total,cytomegalovirus （CMV） pneumonia were validated in 19 cases, bacteria pneumonia in 10 cases, fungus pneumonia in 3 cases,and Pneumocystis Carini infection in one case while none pathogen were confirmed in 5 cases with pneumonia.37.5%（9/24）cases with pneumonia which pathogen were ascertained were resulted from multiple pathogen infection.Opportunistic organism is the main pathogen of pneumonia in renal transplant recipients and the disease commonly manifested as interstitial pneumonia. 27 cases（93.1%）developed to severe pneumonia in which 15 cases were deteriorated to acute respiratory distress syndrome.Excluding 5 cases who withdrew from the hospital,4 cases （16.7%，4/24）died and 20（83.3%，20/24） cases were cured.During the second to the sixth month especially the second to the thrid month after renal transplantation the recipients were at higher-risk of pneumonia.Conclusions The majority of pneumonia in kidney recipients were severe community acquired pneumonia caused by multiple pathogens.CMV pneumonia and bacteria pneumonia are the most common types and major causes of mortality.Mortality of fungus pneumonia and CMV pneumonia are highest.Proper diagnostic procedures and therapeutic strategies are critical to improve survival rate.
ObjectiveTo analyze the clinical features of Legionella-associated cavitary pneumonia, and to explore the diagnosis, treatment planning, and clinical management of patients.MethodsThe data of a patient with severe Legionella-associated cavitary pneumonia were collected and analyzed. Databases including PubMed, Ovid, Wanfang, VIP and Chinese National Knowledge Infrastructure were searched for pertinent literatures, using the keyword "Legionella, lung abscess or cavitary pneumonia" in Chinese and English from Jan. 1990 to Jun. 2019. The related literature was reviewed.ResultsA 60-year-old male patient was admitted to hospital because of fever, cough, and expectoration for five days. On presentation, his temperature was 38.3 °C, and pulmonary auscultation revealed rales on the left side of the lungs. Culture of lower airway secretions obtained by bronchoscopy revealed Legionella pneumophila infection, and serotype 6. Chest computerized tomography showed a consolidation in the left lung and an abscess in the left upper lobe. The patient was discharged from the hospital after three months of anti-Legionella treatment (Mosfloxacin, Azithromycin, etc.). Fifteen manuscripts, including 18 cases, were retrieved from databases. With the addition of our case, a total of 19 cases were analyzed in detail. There were 15 males and four females, aged from 4 months to 73 years old. Most of them (14/19, 73.7%) were accompanied by multiple underlying diseases. Initial empiric antimicrobial therapy failed in 15 (78.9%) cases, and 7 (36.8%) patients required combination therapy. The courses of antimicrobial treatment were from 3 to 49 weeks. All except one patient were fully recovered and discharged from hospital.ConclusionsLegionella pneumonia with pulmonary abscess or cavity is rare and often presents with fever. Pulmonary imaging shows infiltration in the initial, but can be free of cavities or abscesses. Most patients have basic diseases. Severe patients often need to be treated in combination with antibiotics for long periods of time.