Objective To investigate the therapeutic effect of dexamethasone on children with severe community acquired pneumonia ( CAP) . Methods 120 children with severe CAP admitted from January 2009 to June 2011 were recruited in the study. The patients were randomly divided into a dexamethasone group ( n = 62) and a control group ( n = 58) . The patients in the dexamethasone group received additional dexamethasone intravenous injection for 3 days ( 0. 2-0. 4 mg· kg- 1 · d- 1 , qd) on the basic treatment of the control group. Length of hospital stay, serum C reactive protein ( CRP) concentration on 4th day after admission, overall efficacy, mortality, incidence of adverse events during treatment were compared between the two groups. Results Median length hospital stay was 8 days in the dexamethasone group compared with 9 days in the control group without significant difference ( P gt;0. 05) . The serumCRP concentration on 4th day was lower in the dexamethasone group than that in the control group [ ( 23. 4 ±5. 6) mmol /L vs. ( 41. 3 ±6. 2) mmol /L, P lt;0. 05] . The overall efficacy was higher in the dexamethasone group than that in the control group ( 88. 7% vs. 74. 1% , P lt; 0. 05) . The in-hospital mortality and incidence of severe adverse events were not significantly different between the two groups ( P gt; 0. 05) . Conclusions Dexamethasone treatment is associated with a significant attenuation in systematic inflammatory response, but does not decrease mortality in hospitalized children with severe CAP.
ObjectiveTo investigate the clinical, imaging features, diagnosis, treatment and prognosis of pulmonary lymphomatoid granulomatosis (PLG).MethodsA case of PLG confirmed by autopsy and pathology was reported, and the related literature was reviewed.ResultsA 44-year-old male patient presented with cough, expectoration and shortness of breath as the main symptoms. The imaging findings of lung CT were diffuse vascular nodular and patchy changes in the lungs, especially in the lower lung. Clinical symptoms were not relieved with anti-infection and symptomatic treatment. The patient's condition gradually exacerbated and finally died. The autopsy revealed PLG with pathological grade Ⅲ. The infiltration of lymphocytes centered with blood vessel and necrosis were observed under light microscope. EBER in situ hybridization was positive. Totally 28 Chinese articles and 34 foreign articles were screened out. Literature review suggested that PLG usually occurred in middle-aged men and was associated with EBV infection. It is frequent with immunodepression. Its clinical symptoms were atypical. The main imaging manifestations were multiple nodules and masses more frequent along the bronchovascular bundle. A diagnosis of PLG depended on pathological histology, immunohistochemistry and EBER in situ hybridization. Surgery was the main treatment for local lesions. The patients of grade I and Ⅱ with rapid progress and all grade Ⅲ were usually treated with RCHOP regimen combined with chemotherapy. The prognosis was correlated with grading. Grade Ⅲ was aggressive and the prognosis was poor.ConclusionsPLG is an atypical pulmonary lymphoproliferative disorder. It can be seen in many immunosuppressive diseases. The CT imaging features of PLG have certain characteristics, but the final diagnosis should be combined with pathological diagnosis. Some patients can be relieved by treatment, and patients with grade Ⅲ have poor prognosis.
Objective To establish the evidence-based treatment strategy for an advanced lung cancer case with spinal metastasis, regarding the patient’s condition and treatment expectations. Methods According to PICO principles, questions in the patient’s treatment were converted into a search strategy. The literature searching was performed in several databases. In accordance with the five evidence grading standards in evidence-based medicine, the best clinical evidence was interpreted to guide the treatment decisions. Results A total of 148 papers were detected and screened, of which 4 systematic reviews or meta-analyses were included finally. Four issues that patients concerned, including restoring spinal cord function (walking and sphincter function), local pain control, long-term survival, and treatment complications, were all supported by grade-1 evidence. The patient finally chose surgical decompression, which was of a higher complication risk, but better possibility of restoring nerve function, significant pain relief, and improved long-term survival. The patient obtained fully recovery and regained walking function after surgery. Conclusion The evidence-based treatment is able to provide reasonable treatment options for lung cancer patients with spinal metastasis. Decompression surgery for patients with walking dysfunction should be carried out as soon as possible, in order to early restore spinal marrow function, relieve pain and improve long-term survival. But both doctors and patients should fully acquaint themselves with the higher risk of surgical complications.
Objective To evaluate the role that problem based learning (PBL) teaching plays in the education of doctors. Methods A total of 240 7-year students who entered the China Medical University in Shenyang in 2004 were divided into two groups: one group used PBL teaching model while the second group used a traditional teaching model. There were 120 students in each group. At the end of the teaching, a questionnaire on PBL teaching model was distributed to the both groups. We organized and classified answers to the questionnaire and conducted statistical analyses. Results Problem based learning is a model for education in which students dominate the course, question the case, look for evidence, participate in the group discussion and reach resolution. This emphasizes the process of learning and the training of student abilities, instead of the teaching of knowledge only. PBL is more effective at meeting the requirements of the global minimum essential requirements in medical education (GMER). Conclusions PBL teaching plays an important role in the training of doctors
Objective To observe the prognosis of pregnant patients with renal failure who underwent blood purification. Methods Pregnant patients with renal failure undergoing blood purification (hemodialysis or hemofiltration) from January 2009 to February 2017 were included in this study. Clinical data and pregnancy outcome were collected retrospectively. Results A total of 42 patients were enrolled in this study, including 38 with acute renal failure, 3 with chronic progressed renal failure, and 1 with chronic renal failure. There were 5 patients (11.9%) with chronic kidney disease (CKD) before pregnancy, 3 (7.2%) with systemic lupus erythematosus, 24 (54.8%) with hypertension, 5 (11.9%) with acute pancreatitis, and 7 (14.3%) with acute liver failure. In perinatal period, 7 patients (16.7%) died, whose underlying diseases were acute pancreatitis in 2, lupus nephritis in 1, acute hepatic failure in 3, and pulmonary tuberculosis breakout in 1. There were 5 patients with twin pregnancy, and 37 patients with single pregnancy. In the 28 patients with natural pregnancy ending, the live birth rate was 82.1% (23/28), and the live birth rate of twin pregnancy was only 50% (5/10). Twenty-seven patients were followed up, in whom 10 were in end stage of renal disease (ESRD), which was correlated with hypertension (P=0.001), and 3 patients were in CKD 1–4. Renal diseases were completely recovered in 14 patients. New CKD were diagnosed in 8 patients, without any correlated factor. Conclusions For pregnant patients with renal failure undergoing hemodialysis or hemofiltration, the death risk and the dead birth rate are high. Patients with hypertension or pre-existed renal failure have higher risk for ESRD. Some patients are not completely recovered from acute renal failure, with CKD left.
ObjectiveTo study the clinical and pathological characteristics and imaging manifestations of pulmonary mucosa associated lymphoid tissue (MALT) lymphoma.MethodsThe clinical and multidetector computed tomography (MDCT) imaging data of 17 patients with pathological proven pulmonary MALT lymphoma were reviewed retrospectively.ResultsThe MDCT manifestations were divided into 4 types: ① pneumonia/consolidation, ② mass/nodule type, ③ bronchovascular lymphatic type, ④ mixed type. The imaging features included air bronchiectasis in 13 cases and bronchiectasis in 9 cases. Multiple small pulmonary nodules were found in 11 cases, ground glass opacity in 9 cases, 4 cases of pleural effusion, pulmonary hilar and mediastinal lymph node enlargement in 3 cases. Among these 17 cases, 4 had extra-pulmonary involvement and 2 without obvious symptoms. The main clinical symptoms including cough, expectoration, dyspnea, fever, chest pain, hemoptysis, night sweats. The pathological manifestation is the infiltration of a large number of B lymphocytes and nuclear heterocells.ConclusionsThe clinical manifestations of pulmonary MALT lymphoma are not specific, but the progress is slow, and may be associated with autoimmune diseases. The main MDCT findings of pulmonary MALT lymphoma include consolidation, nodules or masses with air bronchogram. Lymph node enlargement is rare. Clinical diagnosis should also be based on pathological results.
Cardiac rehabilitation can safely and effectively improve the quality of patient's life and reduce readmission rate and mortality after cardiac surgery. Early cardiac rehabilitation after cardiac surgery is an indispensable part of cardiac rehabilitation. It can speed up the recovery of patient's exercise endurance, prevention of postoperative complications, shorten the time of returning to the family, increase the confidence of sustained rehabilitation, and lay foundation and set rehabilitation targets for the later stage of cardiac rehabilitation. This paper reviews the development history of early cardiac rehabilitation after cardiac surgery, and summarizes the current status, problems and outlook of rehabilitation management in China.
目的 评估非小细胞肺癌患者中癌症相关性乏力的发生情况及其与患者临床病理特征和生存期之间的相互关系。 方法 应用简明疲劳量表中文版评估2008年12月－2009年12月间收治的72例初治肺癌患者，入组患者均完成根治性手术及术后生存随访。 结果 72例早期非小细胞肺癌患者中，无乏力9例（12.5%），轻度乏力48例（66.7%），中度乏力15例（20.8%），重度乏力0例（0%），乏力总体发生率为87.5%。乏力指数与患者的年龄、性别、吸烟史均无相关性，与患者的体力状况评分（ECOG PS）、TNM分期呈正相关，与中位生存期呈负相关，均有统计学意义（P＜0.05）。 结论 癌症相关性乏力作为非小细胞肺癌患者中普遍存在的一种症状，不仅能够反映患者当时的主观感受和生活状况，还可能是判断患者术后病理分期及最终总生存期的预测因素。
ObjectiveTo assess the methodological quality of systematic reviews of Tai Chi for preventing falls in the elderly and the quality of evidence for outcome indicators.MethodsPubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang Data, CBM and VIP databases were electronically retrieved. According to the inclusion criteria and exclusion criteria, the final articles were selected and the relevant literature information was extracted by reading the abstract and the full text. The methodological quality of the included systematic reviews was evaluated using AMSTAR 2 tool, and the quality of the outcome indicators of the included systematic reviews was further graded according to the GRADE system.ResultsA total of 11 systematic reviews/meta-analyses were included. The AMSTAR 2 evaluation showed that 10 studies were in critically-low methodological quality, and 1 study was in low methodological quality. The GRADE evaluation results showed that among the 36 outcome indicators included, there were 10 intermediate quality indicators, 20 low-level quality indicators and 6 extremely low-level quality indicators. Among the indicators of intermediate quality, single-leg stand test (MD = 5.33, 95%CI 3.35 to 7.32, P< 0.01; WMD = 1.76, 95%CI −7.00 to 10.52, P< 0.01), time up and go test (MD = 1.04, 95%CI 0.67 to 1.41, P< 0.01), the berg balance scale (MD = 2.18, 95%CI 0.93 to 3.43, P< 0.01), number of falls (RR = 0.82, 95%CI 0.73 to 0.92), P< 0.01), the incidence of 2-falls (OR = 0.69, 95%CI 0.49 to 0.97, P< 0.01) and the incidence of 3-falls (OR = 0.39, 95%CI 0.21 to 0.73, P< 0.01). The results of the above indicators were statistically significant, indicating that Tai Chi was better than control group.ConclusionsAt present, the methodological quality of relevant systematic reviews of Tai Chi for preventing falls in the elderly was relatively low and the quality of the evidence was not good, so it can’t be proved that Tai Chi can effectively prevent falls in the elderly, which needs to be further studied at a high level.
ObjectivesTo systematically review the epidemiological characteristics of mild cognitive impairment (MCI) in Chinese elderly population.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, WanFang Data and CBM databases were electronically searched to collect studies on the epidemiological characteristics of mild cognitive impairment in the elderly in China from inception to May 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 25 studies involving 56 720 patients were included. The results of meta-analysis showed that the prevalence of MCI in Chinese elderly population was 14% (95%CI 12% to 17%), in which 12.1% (95%CI 9.7% to 14.5%) was male and 14.8% (95%CI 12.5% to 17.2%) was female. The prevalence of MCI was 8% (95%CI 6.0% to 10.1%) in the elderly aged 60 to 69, 13.1% (95%CI 10.6% to 15.6%) in the elderly aged 70 to 79 and 23.4% (95%CI 18.3% to 28.6%) in the elderly aged above 80. The prevalence of MCI was 23% (95%CI 18.3% to 27.6%) in the elderly who were illiterate, 15.2% (95%CI 11.2% to 19.2%) among the elderly with a primary education and 9.8% (95%CI 7.1% to 12.6%) among the elderly with an education above junior high school. The prevalence of MCI was 9.9% (95%CI 5.5% to 14.2%) in urban areas, and 16.7% (95%CI 11.2% to 22.2%) in rural areas. The prevalence of MCI was 12.1% (95%CI 7.7% to 16.5%) in married individuals and 17.1% (95%CI 13.9% to 20.2%) in single individuals. The prevalence of MCI was 15.4% (95%CI 11.4% to 19.4%) in northern China, 14.1% (95%CI 11.1% to 17.2%) in eastern China, 5.4% (95%CI 3.9% to 6.9%) in northeast China, 13% (95%CI 6.2% to 19.8%) in Central-south China, 11.7% (95%CI 10.2% to 13.2%) in the southwest China and 17.4% (95%CI 2.5% to 32.3%) in northwest China. By using the diagnostic criteria proposed by Petersen, the prevalence of MCI was 15.2% (95%CI 11.8% to 18.7%), and was 12.4% (95%CI 9.4% to 15.4%) using the criteria of the DSM-Ⅳ.ConclusionsThe prevalence of MCI is high in China, and varies with gender, age, education, location, marital status, region and diagnostic criteria.