At present, coronavirus disease 2019 has become the most serious public health emergency in the world. The disease is still spreading around the world. The disease progresses rapidly and is highly contagious, causing great harm to the public health security of the world. Based on the research evidence published at home and abroad, this article systematically summarizes the biological structure of severe acute respiratory syndrome coronavirus 2, and the pathogenesis, transmission routes and susceptible populations, clinical features and treatment methods of coronavirus disease 2019. It aims to help medical workers understand coronavirus disease 2019 in order to better diagnose and treat the disease, and provide references for future research.
ObjectiveTo compare the clinical features of bacterial liver abscess (BLA) with or without diabetes and provide reference for clinical diagnosis and treatment.MethodsThe clinical data of 312 patients with BLA admitted to Huaian First People’s Hospital of Nanjing Medical University from January 2016 to January 2020 were collected. The differences in the clinical symptoms and signs, results of laboratory, imaging, etiological tests, treatment methods, and outcomes of the patients between with and without diabetes were compared.ResultsA total of 312 patients with BLA were collected, 128 BLA patients with diabetes and 184 BLA patients without diabetes. ① There were no significant differences in gender and age between patients with and without diabetes, but the boby mass index of BLA patients with diabetes was higher than that of the patients without diabetes [(25.54±4.99) kg/m2 versus (23.75±3.92) kg/m2, t=3.546, P<0.001]. ② In terms of etiology, the main cause of BLA was the biliary tract infection [37.18% (116/312)]. The incidence of cryptogenic infections in the BLA patients with diabetes was significantly higher than that of the BLA patients without diabetes [39.06% versus 26.63%, χ2=5.386, P=0.020]. ③ In terms of clinical manifestations, the fever was the main symptom of BLA [97.76% (305/312)]. The incidences of abdominal pain and percussion pain in the liver area of BLA patients with diabetes were significantly lower than those in the BLA patients without diabetes [32.03% versus 51.63%, χ2=11.793, P=0.001; 15.63% versus 30.98%, χ2=9.572, P=0.002]. ④ In terms of laboratory tests, compared with the patients without diabetes, the albumin level was lower [(30.88±5.25) g/L versus (33.67±4.33) g/L, t=–5.139, P<0.001], the procalcitonin level and neutral cell ratio were higher [(44.22±39.56) μg/L versus (36.03±22.73) μg/L, t=2.312, P=0.021; (86.68±7.05)% versus (80.73±8.12)%, t=6.710, P<0.001] in the patients with diabetes. ⑤ In terms of imaging findings, the BLA was mainly single abscesses [77.56% (242/312)] and mainly in the right lobe [66.34% (207/312)]. ⑥ In terms of microbiological examination, the bacterial positive detection rate of all patients was 71.15% (222/312). The main pathogen was Klebsiella pneumoniae [71.62% (159/222)]. The Klebsiella pneumoniae infection rate in the BLA patients with diabetes was higher than that in the BLA patients without diabetes [79.30% versus 66.67%, χ2=4.161, P=0.041]. ⑦ The septic shock occurred in 20 (6.41%) patients with BLA. After treatment of all patients, 4 cases of BLA with diabetes and 2 cases of BLA without diabetes died. The patients who died all came from septic shock.ConclusionsClinical manifestations of BLA patients with diabetes are atypical and main infection is Klebsiella pneumoniae. When BLA combined with septic shock, individual treatment strategy should be chosen basing on actual situation of patient.
【摘要】 目的 探讨脑后部可逆性脑病综合征（posterior reversible encephalopathy syndrome，PRES）的临床及MRI表现，提高对PRES的认识。 方法 回顾性分析2007年1月-2010年12月期间5例PRES患者的MRI资料并进行追踪随访。5例PRES患者中男1例，女4例，肾性高血压及产后子痫各1例、妊娠高血压3例。5例均行MRI多序列平扫检查及弥散加权成像（diffusion weighted imaging，DWI），其中4例同时行磁共振血管造影（magnetic resonance angiography，MRA），2例行MRI增强检查。 结果 5例发病时均有高血压，以突发头痛、子痫或癫痫发作、意识障碍及视觉障碍为临床特点，及时正确治疗后症状于3~5 d左右消失，1例遗留肢体功能障碍。MRI显示5例多发病灶主要位于双侧顶枕叶皮质下白质内，额叶及颞叶后部各2例，两侧小脑及脑干1例，皮质受累2例，病变呈长T1、长T2信号、液体衰减反转恢复序列呈高信号，5例患者病灶DWI图呈高或等信号，表观弥散系数（apparent diffusion coefficient，ADC）图呈略高信号；1例顶叶及1例基底节区部分病灶DWI图呈高信号，ADC图呈低信号，提示弥散受限。2例增强无强化，脑膜呈线状强化。随访MRI显示3例病灶完全消失。1例左侧基底节区部分病灶发展为脑梗死。 结论 PRES是一种临床-影像综合征，正确认识这一综合征对其早期诊断和治疗具有非常重要的意义。MRI能够提供较为可靠明确的诊断，其扩散成像对判断PRES预后亦很有价值。【Abstract】 Objective To investigate the clinical features and MRI manifestations of patients with posterior reversible encephalopathy syndrome (PRES), in order to improve its recognition. Methods From January 2007 to December 2010, MRI data of 5 patients with PRES were retrospectively analyzed and the patients were followed up. Among them, one was male and four were female. There were one case of postpartum eclampsia, one of renal hypertention, and 3 of pregnancy-induced hypertension. All the five patients were examined by MRI diffusion weighted imaging (DWI), among whom four underwent additional magnetic resonance angiography (MRA) and one underwent enhanced MRI. Results All the five patients with PRES had hypertension and their clinical symptoms were characterized by sudden occurrence of headache, eclampsia or seizure of epilepsy, altered mental status, and visual disturbances. Clinical symptoms vanished about 3-5 days after prompt and appropriate treatment except one case of residual body function failure. MRI scanning demonstrated multifocal subcortical white lesions in bilateral parieto-occipital lobes in five patients, in bilateral frontal lobes in two patients, in bilateral post temporal lobes in two patients, in bilateral cerebellum in one patient, and in bilateral brainstem in one patient, and cortical involvement occurred in one patient. Lesions appeared as hyperintense signals on fluid attenuated inversion recovery (FLAIR) and T2-weighted images, hypointense signals on T1-weighted images, normal or increased intensity on DWI, and mild hypointensity on apparent diffusion coefficient (ADC) maps. Some lesions in parietal lobes or basal ganglia showed hyperintensity on DWI and isointensity on ADC maps. The lesions in two patients appeared unenhanced with gadolinium enhancement and the meninges assumed the linear strengthening. Follow-up MRI showed that foci in three patients vanished completely, and the focus in the left basal ganglia in one patient developed into cerebral infarction. Conclusions PRES is a clinical-neuroradiological transient condition. Correctly understanding this syndrome is meaningful for its early diagnosis. MRI can provide a more reliable diagnosis, and its proliferation image formation is also valuable in predicting the PERS prognosis.
Objective To retrospectively analyze the clinical features of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU), so as to improve the level of clinical diagnosis and treatment. Methods A total of 81 patients diagnosed as IPA from March, 2017 to March, 2022 in the ICU of The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China were selected as infection group. A total of 81 non-IPA patients with pulmonary infection and Aspergillus negative sputum culture were selected as the control group. The host factors, Acute Physiology and Chronic Health Assessment Ⅱ score at admission, underlying diseases, clinical symptoms and signs, relevant laboratory test results, and lung CT findings were compared between the two groups. Univariate analysis and multivariate conditional logistic regression analysis were used to identify the risk factors for the occurrence of pulmonary aspergillosis in IPA patients in ICU. At the same time, the types of aspergillus in the IPA group and the outcomes of the two groups at 28 days after ICU admission were analyzed. Results Of the 81 IPA patients, 4 were proven diagnosed and 77 were putative diagnosed. IPA patients were mainly infected with Aspergillus fumigatus and Aspergillus flavus. Symptoms and signs such as fever, cough and expectoration, dyspnea and pulmonary rales occurred in both groups. The level of procalcitonin in IPA group was higher than that in non-IPA group, and the difference was statistically significant (P=0.016). The positive rate of serum galactomannan antigen test (GM test) in the IPA group was higher than that in the non-IPA group, and the differences was statistically significant (P=0.000). The incidence of pulmonary imaging cavities in IPA group was higher than that in non-IPA group, and the difference was statistically significant (P=0.022). Univariate analysis showed that central venous catheterization, septic shock, complete parenteral nutrition, chronic obstructive pulmonary disease, and immunosuppression were risk factors for IPA (P<0.05); Multivariate conditional logistic regression analysis showed that complete parenteral nutrition, chronic obstructive pulmonary disease, and immunosuppression were independent risk factors for IPA (P<0.05). The 28-day fatality rate in IPA group was higher than that in non-IPA group (55.6% vs. 34.6%, P=0.007). Conclusions IPA patients have no specific clinical symptoms and signs, and are mainly infected with Aspergillus fumigatus and Aspergillus flavus; GM test has guiding significance for the diagnosis of IPA. Serum GM test and pulmonary imaging have cavity findings that are helpful for the diagnosis of IPA. Patients with a history of chronic obstructive pulmonary disease, immunosuppression, or complete parenteral nutrition need to be on high alert for the possibility of IPA during ICU stay.
ObjectiveTo investigate the clinical characteristics of non-tuberculous mycobacterium (NTM) pulmonary disease and pulmonary tuberculosis, as well as the bacterial distribution of NTM pulmonary disease. Methods The bacterial distribution and clinical characteristics of 104 patients with NTM lung disease hospitalized in Jiangxi Provincial People’s Hospital from May 2017 to May 2020 were retrospectively analyzed, as well as the clinicplal characteristics of 155 patients with tuberculosis hospitalized during the same period. Results The age of NTM lung disease group [(60±15) years] was higher than that of tuberculosis group [(55±19) years]. There were statistically significant differences in basic diseases (such as malignant tumor, type 2 diabetes, old tuberculosis, bronchiectasis), laboratory examination (such as blood routine examination, albumin) and chest imaging characteristics between the two groups (P<0.05). There was no significant difference in clinical symptoms (such as cough, sputum or fever) (P>0.05). The common underlying diseases of NTM lung disease were malignant tumor (29%), bronchiectasis (21%), chronic obstructive pulmonary disease (19%), etc. The common clinical symptoms of NTM lung disease included cough, sputum, fever, hemoptysis, chest tightness and shortness of breath, and other non-specific respiratory symptoms. The common manifestations of NTM lung disease on chest high-resolution CT (HRCT) included patchy images (82%), mediastinal lymph node enalargement (35%), pleural thickening (31%), pleural effusion (26%) and other signs. The isolates of NTM included Mycobacterium avium (50%), Mycobacterium intracellulare (21%), Mycobacterium chelonae/abscessus (14%), Mycobacterium fortuitum (5%), Mycobacterium gordonae (4%), Mycobacterium gilvum (3%), and Mycobacterium smegmatis (3%). Multivariate Logistic regression analysis showed that advanced age (OR=1.027) was a risk factor for NTM lung disease. Conclusions The clinical manifestations of NTM lung disease and tuberculosis are similar and difficult to distinguish. For male patients over 60 years old with malignant tumor, old tuberculosis, bronchiectasis and other basic diseases, and the chest HRCT findings are mainly bronchiectasis, NTM lung disease should be actively excluded. There is little difference in clinical manifestations between different strains of NTM lung disease, and the treatment cycle of NTM lung disease is long and easy to be interrupted, requiring enhanced follow-up.
Objective To explore the clinical characteristics of Chlamydia psittaci pneumonia. Methods From January 2020 to March 2023, 21 cases of Psittacosis from the First Affiliated Hospital of Nanjing Medical University were diagnosed via metagenomic next-generation sequencing (mNGS). They were divided into a severe group (n=10) and a non-severe group (n=11) based on diagnostic criteria for severe pneumonia, and the clinical presentation, secondary examination, treatment, and prognosis of the two groups were analyzed retrospectively. Results Among the 21 patients, there were 11 males and 10 females, with a mean age of (51.7±11.6) years. All patients had an acute onset and 12 had a confirmed history of exposure to poultry. The onset of the disease occurred in the autumn and winter seasons in 18 patients. All the patients were suffering from high fevers. Other symptoms included coughing, phlegm, tightness in the chest and fatigue. Laboratory examinations showed that the levels of leukocytes, neutrophil counts, C-reactive protein, procalcitonin, aminotransferase, creatine kinase, lactic dehydrogenase, brain natriuretic peptide precursors and D-dimer were significantly higher in the severe group than those in the non-severe group. Chest CT scans revealed varying levels of consolidation and spot shadowing with peripheral exudate in all patients. The patients in the severe group were more likely to have bilateral lung involvement, bilateral pleural effusion, cavity and mediastinal lymph node enlargement. Eleven patients received tetracycline alone, three received laudanum alone, two received respiratory quinolones alone, and five received a combination of two drugs including tetracycline. Chest CT at clinical follow-up showed absorption of lung lesions. Conclusions Chlamydia psittaci pneumonia usually occurs in the fall and winter, and most patients have a history of contact with poultry. Clinical presentation and imaging are not specified. The technology of mNGS enables early diagnosis of the disease, and neutrophil lymphocyte ratio, neutrophil-lymphocyte ratio and lactic dehydrogenase levels help assess the risk of severe disease.
ObjectiveTo study the clinical features, predictive factors and short-term prognosis of active pulmonary tuberculosis 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 active pulmonary tuberculosis were included as case group, AECOPD patients without pulmonary tuberculosis were randomly selected as control group from the same hospitals and same hospitalization period as the patients in case group, at a ratio of 4:1. The basic information, comorbidities, clinical manifestations and auxiliary examinations, and adverse in-hospital outcomes between the two groups were compared.ResultsA total of 14007 inpatients with AECOPD were included in this study, and 245 patients were confirmed to have active pulmonary tuberculosis, with an incidence rate of 1.75%. In terms of basic information, the proportions of male and patients with history of acute exacerbation in the past year in the case group were higher than those in the control group (P<0.05), and the age and body mass index (BMI) were lower than those of the control group (P<0.05); in terms of comorbidities, the proportions of patients with hypertension and diabetes in the case group were lower than those in the control group (P<0.05). In terms of clinical manifestations, the prevalence of fever and hemoptysis in case group was higher than that of control group (P<0.05); as for laboratory examinations, the levels of hemoglobin, platelet count, serum albumin, inflammatory markers [erythrocyte sedimentation rate (ESR), C reactive protein] and the proportion of positive TB-IGRA were higher than that of control group (P<0.05). The prevalence of pulmonary bullae, atelectasis and bronchiectasis in the case group was higher than that in the control group. After multivariate logistic regression analysis, hemoptysis (OR= 3.68, 95%CI 1.15-11.79, P=0.028), increased ESR (OR=3.88, 95%CI 2.33-6.45, P<0.001), atelectasis (OR = 3.23, 95%CI 1.32-7.91, P=0.01) were independent predictors of active pulmonary tuberculosis in patients with AECOPD. In terms of in-hospital outcomes, there was a trend of higher hospital mortality than the control group (2.3% vs. 1%), but the difference was not statistically significant. However, the case group had longer hospital stay [9 d (6~14) vs. 7 d (5~11), P<0.001] and higher hospital costs [15568 ¥ (10618~21933) vs. (13672 ¥ (9650~21473), P=0.037]. ConclusionIt is not uncommon for AECOPD inpatients to be complicated with active pulmonary tuberculosis, which increases the length of hospital stay and hospitalization costs. When AECOPD patients present with hemoptysis, elevated ESR, and atelectasis, clinicians should be highly alert to the possibility of active pulmonary tuberculosis.
目的:探讨成人麻疹的流行病学与临床特征。方法:回顾性分析196例成人麻疹的临床资料。结果:患者以外来流动人员及本地农村人口多见,平均年龄26.78岁,多数患者未接种麻疹疫苗或麻疹疫苗史不详。成人麻疹患者临床症状重,皮疹典型,为充血性斑丘疹,麻疹黏膜斑(Koplik’s spots)明显,且持续时间长,可合并肝脏和心肌损伤,但并发症以肺炎和支气管炎为主。结论:有必要加强成人的免疫接种,尤其是外来的务工人员,强化医务人员对麻疹的认识,避免麻疹的流行。
Objective To investigate clinical features and surgical outcome in children with frontal lobe epilepsy by evaluating the correlation between the predictive factors and seizure freedom. Methods 18 children who underwent frontal lobe epileptogenic resection in the Epilepsy Center of the Children's Hospital of Fudan University between January 2017 and December 2019 with a minimum follow up of 2 year were analyzed retrospectively. Each patient was evaluated with detailed data to predict postsurgical seizure freedom by analysis of variance. Results Of the 18 patients, there were 11 males and 7 females, the age at surgery ranged from 21 months to 11 years old (6.8±2.73) and the duration of seizures was from 1 month to 9 years. 17 patients had focal seizures, while 1 had generalized epileptic spasm. In scalp EEG, interictal and initial ictal discharges were frontal in 11 and 9 cases, respectively. MRI was indicative of FCD in 10 cases, tumor in 2, tuberous sclerosis and gliosis lesion in 1 case each. 4 patients were MRI negative. 11 patients underwent epileptogenic lesion resections directly and 7 cases received depth electrodes implantation and underwent stereo-electroencephalography to localize epileptogenic zone. At follow-up of 2 years, 14 (77.8%) patients remained seizure-free (Engel Ⅰ), 1 (5.6%) had marked seizure reduction (Engel Ⅱ), 2 (11.0%) showed minor improvement (Engel Ⅲ), and only 1 (5.6%) showed no response (Engel Ⅳ). About predictors of seizure recurrence, there were no significant differences in gender, age at surgery, age of seizure onset, duration of epilepsy, lateralization of epileptogenic zone, positive MRI findings, interictal and ictal discharge, etiology, intellectual development and stereo-electroencephalography implantation, while significantly higher rates of seizure freedom correlated with complete the resection of the epileptogenic zone. Conclusions Focal cortical dysplasia is the most common cause in childhood with frontal lobe epilepsy and complete resection of the epileptogenic zone can lead to good seizure control outcome.
ObjectiveTo investigate the etiology, clinical features and treatment of familial exudative vitreoretinopathy (FEVR) secondary glaucoma. MethodsA retrospective clinical study. From January 1, 2016 to January 1, 2022, 15 patients (17 eyes) were diagnosed with FEVR secondary glaucoma in Beijing Tongren Hospital, Capital Medical University were included in the study. All patients underwent systematic ophthalmological evaluation. According to the patient's age, visual acuity, intraocular pressure, anterior segment, vitreous body and retina condition, the choice of translimbal lensectomy combined with vitrectomy, goniectomy, cyclophotocoagulation, intravitreal injection of anti-vascular endothelial growth factor (VEGF) treatment were chosen. The follow-up time was 3 to 37 months. The clinical characteristics of the affected eye, and the changes of intraocular pressure, anterior chamber depth and complications after surgery were observed. ResultsAmong the 15 patients, there were 11 males with 13 eyes, and 4 females with 4 eyes. Age was 6.14±7.37 years old. FEVR stages 2B, 3B, 4A, 4B, 5A, and 5B were 1, 1, 5, 6, 3, and 1 eye, respectively. The intraocular pressure of the affected eye was 42.74±9.06 mm Hg (1 mm Hg=0.133 kPa). All eyes had shallow anterior chamber and angle closure, anterior or posterior iris adhesions, lens opacity, retinal detachment, iris neovascularization in 4 eyes, and vitreous hemorrhage in 2 eyes. Sixteen eyes were treated with translimbal lensectomy combined with vitrectomy and goniotomy, of which 8 eyes were treated with anti-VEGF treatment; 1 eye was treated with cyclophotocoagulation combined with anti-VEGF treatment. After operation, the intraocular pressure of 16 eyes returned to normal range, and the depth of anterior chamber of 16 eyes returned to normal, and no obvious complications occurred. ConclusionsThe main etiology of secondary glaucoma in FEVR is the structural and functional abnormalities of the anterior chamber and angle, which are found in the 2B and above stages of FEVR. The lensectomy and vitrectomy via limbal approach can effectively control the intraocular pressure and restore the anterior chamber, with no serious complications.