ObjectiveTo analyze the clinical and epidemiological characteristics of hospitalized avian influenza A (H7N9) virus infections in Hunan province from 2013 to 2017, and provide evidences for control, diagnosis and treatment of this disease.MethodsNinety-one hospitalized patients were confirmed with H7N9 infection in Hunan. Excluding 2 patients less than 18 years old and 10 with missing data, 79 patients with H7N9 infection were analyzed.ResultsMost confirmed cases were affected in the second and fifth epidemic wave and number of patients in the fifth wave was more than the sum in prior 4 waves. Epidemiological characteristics, clinical symptoms and case fatality did not change significantly. Administration of antiviral drugs was more active in the fifth wave [from illness onset to antiviral drug: (6.3±2.4)d vs. (7.6±2.4)d, P=0.047]. Multiple logistic regression analysis showed that shock (OR=4.683, 95%CI 1.136–19.301, P=0.033) was the independent risk factor of H7N9 infections. There were no significant differences in case fatality among group oseltamivir, group oseltamivir+peramivir, and group peramivir.ConclusionsPatients with avian influenza A (H7N9) increased in the fifth wave but clinical characteristics changed little. Antiviral treatment should be more active. Shock is an independent risk factor of H7N9 infections. Oseltamivir-peramivir biotherapy can not reduce case fatality compared with oseltamivir or peramivir monotherapy.
ObjectiveTo explore the epidemiological characteristics, clinical manifestations, laboratory examination and imaging findings of patients with coronavirus disease 2019 (COVID-19) outside Hubei Province in 2019.MethodsFrom January 21, 2020 to February 18, 2020, 17 patients with COVID-19 diagnosed by SARS-CoV-2 nucleic acid test in Xianyang Central Hospital of Shaanxi Province and 23 patients in Liaocheng Infectious Disease Hospital of Shandong Province were collected. The information of epidemiology, age, time of onset, first symptom, white blood cell, lymphocyte count, procalcitonin (PCT), serum amyloid protein A (SAA), C-reactive protein (CRP) and chest CT were collected and analyzed.Results40.0% of the 40 patients had a clear history of contact with Wuhan or other areas of Hubei, 60.0% had no clear exposure history, 60.0% were aggregative diseases, 40.0% were imported patients; the average visit time was (4.9±3.5) d, 35% of the patients had underlying diseases; 75.0% of the patients had fever, 7.5% of the initial symptoms were cough, 5.0% pharyngitis, 2.5% headache, and 10.0% were asymptomatic. In the laboratory examination, 77.5% of the patients' white blood cells were normal, 45.0% of the patients' lymphocyte count could be decreased, 72.5% and 55.0% of the patients' SAA and CRP increased respectively, 92.5% of the patients' PCT was normal, 92.5% of the patients were positive for the first nucleic acid test, and 72.5% of the patients' chest CT showed multiple ground glass lesions in one or both lungs, and the positive coincidence rate between the initial nucleic acid test and the chest CT test was 92.5%. 90% of the patients in the group were common type, and all patients were treated with aerosol inhalation of α-interferon combined with lopinavir/ritonavir tablets, 62.5% were treated with antibiotics and 15.0% were treated with glucocorticoid. All patients were improved and 14 patients were cured and discharged from hospital.ConclusionsSARS-COV-2 is highly contagious, family aggregation infection and asymptomatic infection may be the main mode of transmission outside Hubei Province, mild and common types are common, there are no specific changes in laboratory examination, and the condition is stable after treatment.
ObjectiveTo discuss the clinical characteristics of liver cirrhosis in elderly patients. MethodsWe retrospectively analyzed the clinical data of 67 patients (elderly group) with liver cirrhosis aged ≥60 treated between January 1998 and December 2010. Then, we compared these cases with another 72 liver cirrhosis patients (non-elderly group) aged<60. ResultsThe incidence of jaundice, ascites and albumin deficiency in the elderly patients was significantly higher than that in the non-elderly patients (P<0.05). Complications in the elderly group were relatively more, including electrolyte imbalance, infections, gastrointestinal bleeding, hepatic encephalopathy, liver cancer, liver and kidney syndrome and liver and lung syndrome, and the incidence of these complications was all significantly higher than the non-elderly group (P<0.05) except the liver and kidney syndrome (P>0.05). The causes of liver cirrhosis in both groups were similar. The most common cause was hepatitis B virus infection, followed by chronic alcoholism, but in the elderly group, chronic alcoholism, cholestasis, poisoning from medicines and poisons and liver blood circulation disorders were more common than the non-elderly group (P<0.05); hepatitis B and non-alcoholic fatty hepatitis were more common in the non-elderly group than in the elderly group (P<0.05). The elderly group had more Child-Pugh class C cases (P<0.05), while there were more class A cases in the non-elderly group (P<0.05). Twenty-six patients died in the elderly group with a mortality rate of 38.8%; while only 13 died in the non-elderly group with a mortality rate of 18.1%. The difference of mortality rate was significant between the two groups (P<0.05). Common causes of death in the elderly group were infection, hepatic encephalopathy, and electrolyte disorders and gastrointestinal bleeding, while the common causes of death in the non-elderly group were gastrointestinal bleeding and electrolyte disorders. ConclusionThe etiology, clinical manifestations and prognosis of liver cirrhosis in elderly patients differ from those in younger patients. We must pay more attention on treating complications of liver cirrhosis in elderly patients.
Objective To explore the correlation of Gli1 expression with clinical characteristics and prognosis of liver cancer. Methods Such Databases as PubMed, Embase, CNKI, Wanfang Database and Chinese Biomedical Literature Database were searched to collect cohort studies, which has published on the correlation between the expression of Gli1 and the clinical pathologic features of liver cancer and its prognostic value from the establishment of the databases to December 2016. Results Twelve studies with a total of 831 patients were included in this study. The high expression of Gli1 was associated with the tumor diameter >5 cm [relative risk (RR)=1.39, 95% confidence interval (CI) (1.08, 1.79)], clinical stage [RR=1.26, 95%CI (1.05, 1.51)], intrahepatic metastasis [RR=1.39, 95%CI (1.06, 1.83)] and venous invasion [RR=1.44, 95%CI (1.01, 2.04)], but the correlation of Gli1 expression was not significant with gender, histological differentiation, tumor diameter >3 cm, hepatitis B virus, cirrhosis and alpha fetoprotein. Meanwhile, the results of Meta-analysis showed that the higher Gli1 expression in liver cancer patients had a worse 3-/5-year overall survival rate and overall survival rate than those of the lower Gli1 expression group [3-year, RR=3.38, 95%CI (2.01, 5.67); 5-year, RR=1.51, 95%CI (1.19, 1.91); overall survival, RR=1.60, 95%CI (1.11, 2.30)]. And the higher Gli1 expression in liver cancer patients had a worse disease free survival rate than that in the lower Gli1 expression group [RR=1.89, 95%CI (1.35, 2.66)]. Conclusion The high expression of Gli1 is associated with poor prognostic outcome in liver cancer, and may be used as an important prognostic marker for patients with liver cancer.
ObjectiveTo investigate the clinical heterogeneity and auto-immunologic state in patients with diabetic ketosis (DK) or diabetic ketoacidosis (DKA). MethodsDiabetic patients who presented with DK/DKA were recruited from West China Hospital of Sichuan University from January 1, 2000, to December 31, 2008. We analyzed the clinical classification, biochemical profiles, and auto-immunologic state of the patients. ResultsAmong them, 257 (15.0%) patients had type 1 diabetes, while 883 (51.6%) with type 2 diabetes, and 515 (30.1%) could be typed as "atypical diabetes" or "untying diabetes". The average age of hospitalized patients with type 1 diabetes was (31.1±13.5) years, which was significantly lower than that of the type 2 diabetes patients [(58.1±13.2) years] (P＜0.001). The most common contributing factor for DK/DKA was infection, followed by noncompliance with therapy. Glutamic acid decarboxylase antibody positive rate was 4.37% in patients with "atypical diabetes", which was similar with type 2 diabetes group (2.69%, P=0.79), but lower than that of the patients with type 1 diabetes (13.79%, P＜0.001). ConclusionsWe conclude that DK or DKA can occur not only in type 1 diabetic patients but also in patients with type 2 diabetes under infection or stress condition. DK/DKA patients have a high clinical heterogeneity. The auto-immunologic state and β-cell function have significant implications for the diagnosis and classification of diabetes.
ObjectiveTo investigate the clinical characteristics of epileptics with pregnancy and then provide reference for standardized management of epileptics with pregnancy. MethodsFrom June 2012 to June 2021, epileptics with pregnancy who delivered in Jinan Central Hospital were selected as the research subjects. The clinical data such as the application of Antiseizure medications (ASMs) during pregnancy, seizure frequency, pregnancy outcomes, delivery ways, offspring feeding ways and the incidence of complications were investigated and analyzed. ResultsAmong 36 epileptics with pregnancy, 20 cases (55.56%) were treated with ASMs alone, 5 cases (13.88%) were treated with combined medication, and 11 cases (30.56%) were treated without ASMs during pregnancy. 15 cases (41.67%) adhered to systematic application of ASMs, 17 cases (47.22%) did not adhere to systematic application of ASMs, and 4 cases (11.11%) had unknown medication history. The frequency of seizures increased in 5 cases, decreased in 7 cases and unchanged in 24 cases during pregnancy. Pregnancy outcomes: full-term delivery in 33 cases (91.67%), preterm delivery in 1 case (2.78%) and abortion in 2 cases (5.56%). Delivery mode: cesarean section in 31 cases (91.18%), vaginal delivery in 3 cases (8.82%). After delivery, 4 cases (11.76%) were fed with milk powder and 30 cases (88.24%) were breast-fed. Complications: There were 6 cases complicated with anemia (16.67%), 5 cases complicated with gestational hypertension (13.89%), 3 cases complicated with gestational diabetes (8.33%), 4 cases complicated with premature rupture of membranes (11.11%), 2 cases complicated with fetal growth restriction (5.56%), 2 cases complicated with oligohydramnios (5.56%), 3 cases complicated with fetal distress (8.33%) and 3 cases complicated with neonatal asphyxia (8.33%). ConclusionsThe proportion of epileptics with pregnancy who were systematically treated with ASMs was low and the seizures were poorly controlled. There is a lack of standardized management for such patients in clinical practice.
ObjectiveTo investigate the clinical characteristics and prognosis of cerebral hemorrhage in young and elderly patients, to provide evidences for individual clinical diagnosis and treatment, and lay a foundation for building a predictive model of prognosis in cerebral hemorrhage.MethodsPatients with spontaneous cerebral hemorrhage in the Third People’s Hospital of Chengdu were recruited prospectively and continuously from January 2014 to January 2019. They were divided into the youth group (≤50 years old) and the elderly group (>50 years old), and their risk factors, disease characteristics, etiology, and prognosis were analyzed.ResultsA total of 757 patients were recruited. There were 160 cases (21.1%) in the youth group, including 120 males and 40 females, aged from 17 to 50 years, with an average age of (42.06±7.62) years old; 597 cases (78.9%) in the elderly group, including 361 males and 236 females, aged from 51 to 96 years, with an average age of (69.34±10.56) years old. The incidences of hypertension (74.2% vs. 51.2%), diabetes (15.1% vs. 4.4%), coronary heart disease (12.1% vs. 1.3%), and the level of blood glucose at admission [7.1 (5.8, 8.4) vs. 6.3 (5.3, 8.1) mmol/L] in the elderly group were higher than those in the youth group (P<0.05), respectively. However, the proportions of males (60.5% vs. 75.0%), smoking (24.5% vs. 36.9%), and the diastolic blood pressure at admission [(92.37±18.50) vs. (100.95±25.25) mm Hg (1 mm Hg=0.133 kPa)] in the elderly group were lower than those in the youth group (P<0.05), respectively. There was no significant difference between the two groups in systolic blood pressure at admission, Glasgow Coma Score, National Institutes of Health Stroke Scale score, initial hematoma volume, hematoma enlargement, brain hernia, location of hemorrhage, midline shift, hydrocephalus, combined subarachnoid hemorrhage, or intraventricular extension (P>0.05). Hypertension was the most common etiology in the two groups. There was a significant difference in the etiology of cerebral hemorrhage between the two groups (P<0.05), the difference was mainly reflected in cerebral amyloid angiopathy, cavernous hemangioma, and arteriovenous malformation. The fatality rate during hospitalization (9.4% vs. 20.9%), 3 months after discharge (10.3% vs. 26.3%), and at 1 year follow-up (19.0% vs. 37.6%) in the youth group was lower than that in the elderly group (P<0.05), respectively. The disability rate 3 months after discharge and at 1 year follow-up in the youth group was lower than that in the elderly group (32.1% vs. 44.2%, 16.9% vs. 34.4%; P<0.05), respectively.ConclusionsThe education of healthy lifestyles should be strengthened to reduce the adverse effects of smoking in young patients. Young patients should choose antihypertensives that can control diastolic blood pressure better. There are more structural abnormalities in young patients, so routine vascular examination is reasonable. It is necessary to focus on whether the original underlying diseases are stable in elderly patients. Cerebral amyloid angiopathy is an important cause of cerebral hemorrhage in elderly patients, and is a risk factor of recurrence. Anticoagulation or antiplatelet therapy should be cautious.
Objective To investigate the clinical characteristics of interstitial pneumonia patients with positive anti-signal recognition particle antibody (SRP-IP), and compare those with interstitial pneumonia patients with positive anti-Jo-1 antibody (Jo1-IP). Methods Clinical data of SRP-IP patients admitted to Department of Respiratory and Critical Care Medicine of Drum Tower Hospital affiliated to Nanjing University Medical School from May 2017 to May 2021, including clinical manifestations, laboratory examinations, pulmonary function tests and radiographic types, were retrospectively analyzed. The results were compared with those of Jo1-IP patients admitted during the same period. Results The SRP-IP patients were older than Jo1-IP patients (P=0.044). There were no significant differences in clinical manifestations or pulmonary function tests results between the two groups. The proportion of SRP-IP patients combined with positive anti-EJ antibody (P<0.001) or perinuclear anti-neutrophil cytoplasmic antibody (P=0.028) was significantly higher than that of Jo1-IP patients, while the proportion of SRP-IP patients combined positive anti-Ro-52 antibody was significantly lower than that of Jo1-IP patients (P=0.009). The erythrocyte sedimentation rate (ESR) of SRP-IP patients was faster than that of Jo1-IP patients (P=0.026). The serum IgM level (P=0.039) and peripheral NK cell counts (P=0.013) of SRP-IP patients were significantly lower than those of Jo1-IP patients. The most common chest CT findings in SRP-IP patients were organizing pneumonia and the proportion of usual interstitial pneumonia in SRP-IP patients was higher than that of Jo1-IP patients (P=0.032). The levels of creatine kinase (P=0.010), creatine kinase myocardial brand (P=0.025) and alanine aminotransferase (P=0.045) in interstitial pneumonia patients with high titer (++~+++) SRP antibody were higher than those in interstitial pneumonia patients with low titer (+) SRP antibody. SRP-IP and Jo1-IP patients were mainly treated with glucocorticoids combined with or without immunosuppressants, and there was no significant difference in the choice of treatment between the two groups. The proportion of patients with Jo1-IP evaluated as improved was significantly higher than that of patients with SRP-IP (p=0.005), while the proportion of patients with SRP-IP evaluated as stable was significantly higher than that of patients with Jo1-IP (P=0.035). The mortality of SRP-IP patients within 3 months was significantly higher than that of Jo1-IP patients (P=0.028). Conclusion Compared with Jo1-IP patients, SRP-IP patients are older, have faster ESR, are more likely to be combined with other autoantibodies, have lower serum IgM level and peripheral blood NK cell count, have more UIP imaging manifestations, and have a worse short-term prognosis.
ObjectiveTo strengthen the understanding to hypersensitivity pneumonitis and make early diagnosis and standard treatment by analyzing the clinical features, the diagnosis and treatment of a patient diagnosed as hypersensitivity pneumonitis presenting as progressive fibrotic interstitial lung disease in combination with literature review.MethodsThe diagnosis and treatment process and relevant clinical data of the patient were analyzed retrospectively and literatures were reviewed. Based on 282 relevant literatures, the diagnostic methods, treatment and prognostic factors of hypersensitivity pneumonitis were summarized.ResultsThe patient, female, 45 years old, self-employed, was admitted to the hospital due to "cough, sputum for 9 years, dyspnea for more than 6 months" without obvious extrapulmonary clinical manifestations. Creaks at the bottom of the lungs and clubbed toes were found through physical examination. High-resolution computed tomography indicated that the main manifestations were ground glass and grid-like shadows, presenting characteristics of interstitial pneumonia. The pulmonary lesions aggravated gradually, and part of the lung lobe presented honeycomb lung at the time of diagnosis. Eight years ago, she performed fibrobronchoscopy in other hospital revealing an increased lymphocyte proportion (39%) in bronchoalveolar lavage fluid. Lung function suggested very severe restrictive ventilation dysfunction. She was given prednisone for a short time, and the drug was stopped by herself with uncertain efficacy. Later, she performed frozen lung biopsy suggesting peribronchiolar metaplasia interstitial broadening with lymphocytic infiltration, without granuloma or fibroblast lesions. No obvious abnormity was seen in makers of infections and immunology. At this point, the patient was clearly diagnosed as hypersensitivity pneumonitis. Meanwhile, the patient's pulmonary lesions were still mainly made of ground glass and plaques, partly with changes like honeycomb. Poor response was obtained with anti-inflammatory treatment of prednisone for 3 months and anti-fibrosis treatment of pirfenidon for more than 2 months. Literature review resulted in 87 patients, including 39 males (44.82%) and 48 females (55.18%), with an average age of (47.0±18.4) years. Seventy patients (80.46%) had clear allergens. 3.45% patients' lymphocyte percentage in bronchoalveolar lavage fluid ranged from 20% to 39%, and 19.54% patients' lymphocyte percentage was more than 40%. 4.60% of the patients achieved remission through detachment from allergens; 71.27% of the patients achieved remission with glucocorticoid treatment, 14.94% improved with glucocorticoid treatment, and 1.15% died; 6.89% of the patients achieved remission after receiving anti-allergy therapy. Patients with chronic hypersensitivity pneumonia were found with poor prognosis.ConclusionsIn patients with diffuse interstitial pulmonary fibrosis with unknown cause, transbronchoscope freezing lung biopsy as early as possible is a feasible method for early diagnosis and improving prognosis. Patients with hypersensitivity pneumonitis with a long course of pulmonary fibrosis have a poor response to glucocorticoid and other classic treatments, and most of them have a poor prognosis.
ObjectiveTo explore the clinical characteristic, operation time, and methods of elderly calculous cholecystitis. MethodsThe data of 386 cases of elderly calculous cholecystitis in our hospital from January 2008 to April 2014 were retrospectivly analyzed. ResultsIn 386 patients, 234 cases were chronic cholecystitis, 152 cases were acute calculous cholecystitis; there were preoperative complications in 174 cases (45.08%); 234 cases of chronic calculous cholecystitis patients underwent elective operation, 35 cases in 152 cases of acute phase underwent operation at 72 h, the remaining 117 cases underwent operation in within 2 weeks of onset. Laparoscopic cholecystectomy (LC) were in 283 cases, including transfer laparotomy operation in 8 cases; underwent conventional open cholecystectomy in 103 cases. Postoperative complications occurred in 49 cases, the complication rate was 12.69%, including incision infection, pulmonary infection, acute urinary retention, urinary tract infection, biliary fistula and so on. Three hundreds and eighty-four cases were cured, 2 cases died, for cholecystolithiasis complicated with severe acute cholangitis, died from multi organ failure in 3 days after operation. ConclusionsThe clinical characteristics of elderly calculous cholecystitis is unique. To strictly grasp the operation indication, selection of operation time, take individual operation method with the disease, and strengthen treatment of perioperative period are the key to improve the cure rate and the operation success rate of elderly cholecystitis.