29 February 2024, Volume 19 Issue 01 Previous Issue   
Experts forum
Association between sarcopenia and pneumonia in elderly and prevention strategies
HUANG Yi, YANG Meng, LIU Hangxu
2024, 19 (01):  1-5.  DOI: 10.16138/j.1673-6087.2024.01.01
Abstract ( 42 )   HTML ( 4 )   PDF (862KB) ( 59 )  

Sarcopenia and pneumonia are common diseases in the elderly. Both diseases are closely related to the quality of life and the disease burden in society. Sarcopenia can cause functional impairments and affect the occurrence and prognosis of pneumonia, and occurrence of pneumonia will also increase the risk of sarcopenia or worsen its’ condition. Our article discussed the association between sarcopenia and pneumonia, summarized the related prevention strategies, and aimed to reduce the social health problems and disease burden caused by the diseases in the elderly.

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Pay attention to clinical issues easy to be neglected in diagnosis and treatment of Legionella pneumonia
2024, 19 (01):  6-12.  DOI: 10.16138/j.1673-6087.2024.01.02
Abstract ( 59 )   HTML ( 5 )   PDF (1160KB) ( 31 )  

Legionella pneumonia usually develops rapidly and has a high mortality. With the advancements of detection technology, the rate of identifying Legionella infections increases in recent years. However, misdiagnosis of the disease still exists, and delayed treatment is one of the reasons for patient death. Therefore, it’s crucial to identify the clinical characteristics of Legionella pneumonia early and provide timely and appropriate treatment. Although some clinical features of Legionella pneumonia have been clinically recognized, many issues still have been overlooked. This paper is a comprehensive review of the clinical manifestations, auxiliary examinations and treatment strategies of Legionella pneumonia, and it aims to improve clinicians’ understanding of the diagnosis and treatment of the disease to make patients’ prognosis better.

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Issues requiring attention in clinical diagnosis and treatment of diabetes mellitus combined with pulmonary infection
ZHENG Xiaoyan, YI Huahua, ZHOU Min
2024, 19 (01):  13-18.  DOI: 10.16138/j.1673-6087.2024.01.03
Abstract ( 54 )   HTML ( 7 )   PDF (974KB) ( 21 )  

The prevalence of diabetes is increasing and the risk of pulmonary infection among patients with diabetes mellitus is higher than that among people without diabetes mellitus. The clinical characteristics and prognosis of pulmonary infection patients with diabetic are also distinct from that of patients without diabetic. To improve the level of clinical diagnosis and treatment, it’s important to understand the mechanisms of pulmonary infection in diabetic patients and to be familiar with the clinical manifestations of bacterial, fungal and viral infections in them.

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Is severe pneumonia ARDS?
HE Quanying
2024, 19 (01):  19-24.  DOI: 10.16138/j.1673-6087.2024.01.04
Abstract ( 50 )   HTML ( 6 )   PDF (853KB) ( 27 )  

The acute respiratory distress syndrome (ARDS) is an acute hypoxic respiratory insufficiency caused by severe infection, shock, trauma and burns. It is easily confused with severe pneumonia combined with hypoxemia and severe COVID-19 pneumonia. In this paper, the concept, pathogenesis, pathological changes, pathophysiology and definition of ARDS were discussed, and the similarities and differences between ARDS and severe pneumonia combined with hypoxemia or severe COVID-19 pneumonia were analyzed and conducted in-depth interpretation.

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Reinfection of COVID-19 and response
JIE Zhijun, SHA Jiafeng, ZHANG Meng
2024, 19 (01):  25-31.  DOI: 10.16138/j.1673-6087.2024.01.05
Abstract ( 63 )   HTML ( 8 )   PDF (848KB) ( 33 )  

The global situation of the coronavirus disease 2019 (COVID-19) infection remains concerning. As the viruses continue to evolve, the risk of reinfection has markedly increased. COVID-19 vaccination history, previous infection history, antibody titers, age and immune escape can all affect the occurrence of reinfection. Scientific rehabilitation training can help to alleviate post-acute COVID-19 sequalae, and vaccination remains a crucial measure of infection prevention. In the paper, we discussed the current epidemic situation of COVID-19, epidemiology of reinfection and its’ related factors, and strategies to provide reference for epidemic prevention and control.

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Importance of drug monitoring for compound sulfamethoxazole therapy in patients with Pneumocystis jiroveci pneumonia
2024, 19 (01):  31-35.  DOI: 10.16138/j.1673-6087.2024.01.06
Abstract ( 62 )   HTML ( 3 )   PDF (1413KB) ( 24 )  

Pneumocystis jiroveci pneumonia (PJP) is one of the more common and serious opportunistic infections in patients with human immunodeficiency virus (HIV). With the use of immunosuppressants and chemotherapy drugs, most PJP cases reported in China are non-HIV immunosuppressed patients. Compound sulfamethoxazole (SMZco) is the first-line drug for the treatment of PJP, and there are wide individual differences in its pharmacokinetics. Through citing a PJP case treated with SMZco under drug monitoring, a systematic review was conducted from the aspects of SMZco pharmacokinetics, dose-related adverse reactions, and optimal therapeutic dose research. It aims to demonstrate the importance of drug monitoring for sulfamethoxazole therapy, which ensures the drug reaches effective therapeutic concentrations and the occurrence of its’ adverse reactions was reduced.

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Advances in human respiratory microbiome and detection techniques
WU Wenjuan, TIAN Wenjie
2024, 19 (01):  37-42.  DOI: 10.16138/j.1673-6087.2024.01.07
Abstract ( 41 )   HTML ( 3 )   PDF (909KB) ( 52 )  

Human respiratory microbiome has great diversity and heterogeneity in healthy and diseased states, rapid and accurate microbial detection is the key to distinguish respiratory tract infection from non-infection. In recent years, new detection technologies represented by metagenomic technology have developed rapidly in the field of pathogen diagnosis, which improves the detection rate of pathogenic microorganisms, and also makes great breakthroughs in analyzing human host reaction and predicting drug resistance. This article reviews the research progress and achievements of molecular technology in the respiratory microbiome, inspiring readers to think about the development and clinical transformation of new technologies in the future, aiming to explore therapeutic strategies for respiratory diseases based on the respiratory microbiome.

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Original article
Severe type Ⅰ herpes virus pneumonia diagnosed by mNGS: 4 cases reports and literature review
ZHANG Lili, XIE Simin, FENG Yun, $\boxed{\hbox{CHEN Hong}}$
2024, 19 (01):  43-50.  DOI: 10.16138/j.1673-6087.2024.01.08
Abstract ( 32 )   HTML ( 5 )   PDF (2180KB) ( 15 )  

Objective To explore the diagnosis and treatment of severe type Ⅰ herpes virus (HSV-1) pneumonia patients with normal immune function. Methods Four patients admitted to Ruijin Hospital of Shanghai Jiao Tong University School of Medicine from April 2021 to December 2021 who were diagnosed as severe HSV-1 pneumonia were enrolled, and their clinical data and the relevant domestic and foreign literatures were reviewed. All 4 patients were male, and their age was between 72 and 89 years. Results The main symptoms were fever, cough, expectoration (some patients had bloody sputum), asthma and dyspnea. All patients developed severe type Ⅰ respiratory failure. The infection indicators of all four patients increased, along with a relative decrease in lymphocyte counts, and a significant increase in CD3, CD4, and CD8 absolute counts after treatment. HSV-1 was detected in respiratory specimen using metagenomic next generation sequencing (mNGS) in them. After receiving early antiviral and hormonal anti-inflammatory therapy and respiratory support, the conditions in all four patient improved, and three of them were cured and discharged from the hospital. A total of 26 cases of HSV-1 pneumonia with low immunity and 3 cases with normal immune function were found in the literature, and most of cases lacked specific clinical symptoms and signs. As anti-bacterial or fungal treatment failed, most of them received the etiological examination of alveolar lavage fluid and was confirmed HSV-1 infection. The patients were given acyclovir antiviral therapy, and some patients also got hormone therapy. Three cases with normal immune function and 22 of 26 cases with low immunity showed improved condition, while 4 cases died. Conclusions The clinical symptoms of severe HSV-1 pneumonia lacked specificity and the diagnosis was difficult in elderly patients. mNGS of respiratory secretions combined with routing laboratory tests is helpful to identify the pathogen and make early diagnosis of the disease. The disease can be effectively treated through early recognition of the disease, administration of antiviral drugs, and a short-term treatment of glucocorticoid.

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Clinical significance of plasma peak concentration determination of compound sulfamethoxazole in treatment of Pneumocystis jirovecii pneumonia in patients with non-human immunodeficiency virus infection
SHU Yang, HE Xiaoshuang, $\boxed{\hbox{CHEN Hong}}$, SHI Guochao, FANG Jie
2024, 19 (01):  51-56.  DOI: 10.16138/j.1673-6087.2024.01.09
Abstract ( 45 )   HTML ( 3 )   PDF (982KB) ( 24 )  

Objective To explore the significance of monitoring the blood peak concentration of sulfamethoxazole (SMZ) to learn the efficacy and safety of compound SMZ (SMZco) tablets in the treatment of Pneumocystis jirovecii pneumonia (PJP) in patients with non-human immunodeficiency virus (HIV). Methods Clinical data of PJP infected patients with non-HIV hospitalized in Ruijin Hospital, from January 2019 to May 2023 were enrollled, and the relationship between the peak plasma concentration of SMZ and the efficacy and occurrence of adverse reactions was retrospectively analyzed. Results A total of 47 patients were included in this study. The peak plasma concentration of SMZ ranged from 87.49 mg/L to 334.31 mg/L, the median (interquartile distance) was 168.62 (79.72) mg/L, and the peak plasma concentration in 64% of patients was >150 mg/L. The 30-day all-cause mortality of the patients was 28%,and the positive response rate was 66%. Among them, there was no statistical difference in 30-day all-cause death and treatment positive response rate between the patients with peak concentration ≤150 mg/L and the patients with peak concentration of SMZ >150 mg/L. In terms of safety, a total of 29 (62%) patients showed adverse reactions. The incidence of thrombocytopenia (40% vs 6%, P=0.025), decreased hemoglobin (37% vs 0, P=0.013) and serious adverse reactions (43% vs 12%, P=0.026) were higher in the patients with SMZ peak concentration >150 mg/L than those in the patients with SMZ peak concentration <150 mg/L. The incidence of serious adverse reactions was higher in the patients with a peak concentration of SMZco >150 mg/L. Conclusions The results of the study showed that as SMZco tablets were used in the treatment of non-HIV patients infected with PJP, those with a peak plasma concentration ≤150 mg/L of SMZ could achieve comparable efficacy, and their risk of serious adverse reactions was less than that of the patients with a peak plasma concentration >150 mg/L. It is suggested that the plasma peak concentration of SMZ should be monitored regularly.

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Effectiveness of self-made “8” shaped dental floss traction device in colorectal endoscopic submucosal dissection surgery
LI Xiaoli, LI Weiguang, QIAN Aihua, CAI Wenwei
2024, 19 (01):  57-62.  DOI: 10.16138/j.1673-6087.2024.01.10
Abstract ( 25 )   HTML ( 3 )   PDF (2285KB) ( 13 )  

Objective To investigate the effectiveness of self-made “8” type dental floss traction in endoscopic submucosal dissection (ESD) of the colon and rectum. Methods The patients with superficial colorectal lesions of a diameter of ≥1 cm who underwent endoscopic treatment between November 2021 and July 2022 were enrolled and divided into two groups based on whether traction was used during the surgery, which were traction assisted ESD group (n=23, using self-made “8” dental floss traction) and traditional ESD group (n=22, non-traction). The total surgical time, submucosal detachment time, complete lesion resection rate, curative resection rate, and incidence of adverse events between the two groups were analyzed and compared. Results The total surgical time [(58.5±16.2) min vs (83.5±22.2) min, P<0.05] and submucosal detachment time [(46.3±16.1) min vs (68.0±18.8) min, P<0.05] in the traction assisted ESD treatment group were significantly shorter than those in the traditional ESD treatment group. The complete resection rate in both groups was 100%; the curative resection rate of the traditional ESD group was 90.9%, and the curative resection rate of the traction assisted ESD group was 91.3%,there was no significant difference between the two groups (P>0.05); There was no statistically significant difference in the incidence of adverse events such as bleeding and perforation between the two groups (P>0.05). Conclusions Compared with traditional ESD, using self-made “8” type dental floss traction to assist ESD can significantly reduce surgical time and was a safe and effective treatment method for superficial colorectal lesions.

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A study of training mode of PDCA circulation management combined with scenario-based simulation on improving first-aid quality in outpatient
DENG Xueqin, CHEN Yu, CHEN Shuaijun, BAO Xuan
2024, 19 (01):  63-67.  DOI: 10.16138/j.1673-6087.2024.01.11
Abstract ( 37 )   HTML ( 4 )   PDF (893KB) ( 18 )  

Objective To evaluate the effect of training mode combing Plan-Do-Check-Act (PDCA) circulation management with scenario-based simulation on first-aid quality in outpatient emergency incidents. Methods From January in 2021 to December in 2022, the outpatient nurses in Ruijin Hospital (North Branch) affiliated to Shanghai Jiao Tong University School of Medicine were selected and total 38 nurses with an of average age [(29.89±5.62) years] enrolled in the study, including 1 male and 37 females. In the same period, a total of 71 outpatient emergency incidents were selected as the research objects. All collected information was done retrospective analysis. The nurses were divided into two groups. Before January in 2022, the nurses received the first-aid training of routine mode were enrolled in pre-implementation group. After January in 2022, the nurses trained through the first-aid training of PDCA circulation management combined with scenario-based simulation (new mode) were enrolled in post-implementation group. The two groups were compared in terms of first-aid ability (theory test, basic operation examination, comprehensive first-aid ability examination), first-aid performance (start-up time, transport time, first-aid success rate, disputes/complaints rate, satisfaction score) in real emergency incidents, and self-efficacy (scores of general self-efficacy scale). Results Following the first-aid training, the post-implementation group’s scores in theory test (89.19±6.50 vs 85.11±6.84) and comprehensive first-aid ability examination (87.76±6.10 vs 84.38±5.19) as well as scores in various items of basic operation examination were significantly higher than those in pre-implementation group (P<0.001). Meanwhile, the first-aid performance in the post-implementation group showed significantly shorter start-up time [(4.89±1.24) min vs (5.56±1.19) min] and transporting time [(9.36±1.05) min vs (10.24±1.26) min], lower dispute/complaint rate (2.8% vs 17.1%) and higher satisfaction score (87.14±9.68 vs 85.11±6.84) than those in the pre-implementation group in real emergency incidents (P<0.05). In addition, the post-implementation group’s overall scores of general self-efficacy scale increased remarkably than that in the pre-implementation group (2.53±0.24 vs 2.31±0.22, P<0.05). Conclusions The first-aid training combining PDCA circulation management with scenario-based simulation can effectively enhance outpatient nurses’ first-aid ability and self-efficacy, reduce their stress and anxiety, and make them improve first-aid quality and achieve better performance in real emergency incidents.

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Research report
Value of remnant lipoprotein cholesterol and homocysteine in predicting new-onset atrial fibrillation in elderly patients with acute myocardial infarction
LI Qing, ZHENG Zhaoxia, LUO Jinghui, LI Li, NIU Fuying
2024, 19 (01):  68-71.  DOI: 10.16138/j.1673-6087.2024.01.12
Abstract ( 26 )   HTML ( 3 )   PDF (896KB) ( 15 )  

Objective To investigate the value of remnant lipoprotein cholesterol(RLP-C)and homocysteine(Hcy)in predicting new-onset atrial fibrillation(AF) in elderly patients with acute myocardial infarction(AMI). Methods A total of 449 elderly patients with AMI admitted to the Cardiology Department of Langfang Fourth People’s Hospital from January 2018 to June 2023 were enrolled as the research objects. The patients were divided into AF group (n=90) and non-AF group (n=359) according to the occurrence of new-onset AF during hospitalization. The clinical data of the two groups were collected. Logistic regression was used to analyze the risk factors of new-onset AF, and receiver operating characteristic (ROC) curve was used to judge the predictive effect of each index on new-onset AF. Results Compared with the non-AF group, the heart rate on admission, RLP-C and Hcy levels in the AF group were increased (P<0.05). There were significant differences in Killip grades between the two groups (P<0.05). Logistic regression analysis showed that heart rate on admission, RLP-C and Hcy were independent risk factors for new-onset AF (P<0.05). ROC curve analysis showed that the AUC of RLP-C, Hcy and their combination in predicting new-onset AF in elderly patients with AMI were 0.761, 0.720 and 0.845, respectively. The AUC of RLP-C and Hcy combined prediction was higher than that of single prediction (Z=3.061, 3.692, P<0.05). Conclusions RLP-C and Hcy are independent predictors of new-onset AF in elderly patients with AMI. The combination of RLP-C and Hcy can further improve the predictive value.

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Progress in diagnosis and treatment of obliterated bronchiolitis after lung transplantation
ZHU Haixing, ZHOU Min
2024, 19 (01):  72-76.  DOI: 10.16138/j.1673-6087.2024.01.13
Abstract ( 54 )   HTML ( 3 )   PDF (922KB) ( 39 )  

Bronchiolitis obliterans syndrome(BOS) is the most common non-infectious form of chronic lung allograft dysfunction. In recent years, diagnosis methods such as screening studies of lung function in the early 0p stage of the disease, small airway reconstruction techniques with thin-layer CT scan images, 3He-MRI and other imaging examination technique, and bronchoalveolar lavage-derived biomarkers are used, to make the understanding BOS to improve a lot. In terms of therapeutic strategies, many promising treatment modalities such as prophylactic azithromycin use, lung re-transplantation, and umbilical cord blood-derived mesenchymal stem cells have been applied. These advances in diagnostic methods and therapeutic strategies for occlusive bronchiolitis obliterans syndromes provide more theoretical references and insights into the early monitoring and management of the development of the disease.

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Research progress on diabetes patients combined with COVID-19 infection
HUANG Xianna, CHEN Yunce, ZHOU Min, NI Lei
2024, 19 (01):  77-81.  DOI: 10.16138/j.1673-6087.2024.01.14
Abstract ( 62 )   HTML ( 6 )   PDF (852KB) ( 31 )  

Diabetic patients are not only susceptible population to COVID-19 infection,but also prone to develop immune imbalance, excessive inflammatory responses, multi-organ dysfunction, and other complications after infection, resulting in complicated condition and a significantly increased risk of critical illness. Therefore, it requires more attention of clinicians. The article reviews the relevant domestic and international literatures and summarizes the mechanisms of abnormal glucose metabolism induced by COVID-19 infection, clinical characteristics of diabetes patients infected with COVID-19, and the principles of blood glucose management, to improve the clinical understanding and treatment success rate of such patients.

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Application of nitric oxide in corona virus disease 2019
WANG Yating, HE Chunwei, FU Ziyu, WANG Hui, MA Dedong
2024, 19 (01):  82-87.  DOI: 10.16138/j.1673-6087.2024.01.15
Abstract ( 33 )   HTML ( 7 )   PDF (879KB) ( 47 )  

The outbreak of coronavirus disease 2019 (COVID-19) has caused a worldwide medical crisis and strained health resources. Nitric oxide (NO) is shown to improve oxygenation, reduce pulmonary artery pressure, and reduce the need for noninvasive ventilation during severe acute respiratory syndrome (SARS) in 2003. SARS coronavirus (SARS-CoV) and SARS-CoV-2 have overlapping genetic structure and pathological characteristics, and NO has antiviral, vasodilator, anticoagulant and anti-inflammatory effects. This article reviewed the application of NO in COVID-19 patients, to provide the treatment strategy for new COVID-19 patients.

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