Pleural empyema after COVID-19: A delayed presentation

Globally, the number of coronavirus disease-2019 (COVID-19) cases and deaths shows a declining trend since a peak in January 2022. For now, the pandemic phase looks to be ended, until a severe new variant may trigger another wave. At present, in India, small pockets of COVID-19 cases and post-COVID complications are still being reported. Therefore, physicians should remain vigilant about the atypical presentations and potential delayed or long-term complications of SARS-CoV-2 infection, even in individuals who had a mild COVID-19 infection. Here, we present the case of a 52-year-old male patient with a history of hypertension, who is a non-smoker and developed culture-negative pleural empyema 7 months after a mild COVID-19 infection. The patient was successfully treated with antibiotics and early video-assisted thoracoscopic surgery

Pulmonary infection caused by Nocardia otitidiscaviarum a case report and literature review / 中国热带医学

@#Abstract: Objective　To investigate the clinical and laboratory characteristics of pulmonary infection caused by Nocardia otitidiscaviarum. Methods　The clinical data of a patient with pulmonary infection caused by Nocardia otitidiscaviarum were reported, and the clinical characteristics, laboratory characteristics and drug sensitivity of pulmonary infection caused by Nocardia otitidiscaviarum were summarized in combination with the relevant literature at home and abroad from January 2010 to December 2022. Results　A 67-year-old female patient was admitted to the hospital on June 30, 2020 because of "repeated chest tightness and shortness of breath for 3 years, aggravated cough, expectoration and fever". The sputum, alveolar lavage fluid and blood of the patient were collected for culture, and the detected pathogenic bacteria were identified. There are pathogenic bacteria growing in sputum and alveolar lavage fluid, which are identified as Nocardia otitidiscaviarum by Autof ms mass spectrometer. According to the results of pathogenic bacteria and the patient's condition, meropenem combined with compound sulfamethoxazole tablets were given anti-infection treatment, and the patient's condition improved and discharged. Conclusion　The clinical manifestations and imaging features of nocardiosis are lack of specificity, and are prone to misdiagnosis and missed diagnosis. Etiology is the key to disease diagnosis, and clinical examination and culture should be conducted in time.

Clinical Prediction of Lung Cancer Complicated with Pulmonary Infection After Thoracoscopic Surgery Based on Nomogram Model / 肿瘤防治研究

Objective To analyze the risk factors of lung cancer patients complicated with pulmonary infection after thoracoscopic surgery and establish a predictive nomogram model. Methods A total of 315 patients with primary lung cancer who had undergone thoracoscopic surgery from January 2018 to October 2021 in our hospital were divided into two groups according to the incidence of pulmonary infection. Two groups of clinical data were collected for single-factor and regression analyses, and independent predictors were obtained. On this basis, a risk model was constructed and its predictive effectiveness was evaluated. Results The independent risk factors of lung cancer patients complicated with pulmonary infection after thoracoscopic radical operation were as follows: age≥62.5 years, smoking index≥100, PEF≤72.1 ml/s, TNM stage Ⅲ/Ⅳ, and operation time≥188.5 min (P < 0.05). Based on the above factors, the risk model of the column chart was established. Model-verification results showed that the C-index of the model was 0.909, and the correction curve showed that the column chart model had good differentiation and consistency. Conclusion Lung cancer patients' age, smoking index, TNM stage, PEF, and operation time are closely related to pulmonary infection after thoracoscopic radical operation. The nomogram model is useful for identifying high-risk patients and reducing postoperative complications.

Etiological characteristics and drug resistance of patients with severe pulmonary infection caused by brain trauma in Suining Area of Sichuan Province / 公共卫生与预防医学

Objective To analyze the pathogenic characteristics and resistance of severe lung infection patients in Suining area, and to provide a reference for early clinical intervention. Methods A total of 359 patients with pulmonary infection were selected in Suining city from December 2019 to December 2020.The patients were divided into mild group (231 cases) and severe group (128 cases) according to the severity of nosocomial pneumonia.Sputum samples were collected for pathogen identification and drug sensitivity test. Multivariate logistic regression was used to analyze the influencing factors of severe pulmonary infection. Results There were 128 cases of severe pneumonia in 359 patients with traumatic brain injury. 147 strains of pathogenic bacteria were isolated, including 91 strains (61.90%) of gram-negative bacteria, mainly including 42 strains (28.57%) of Acinetobacter baumannii, 29 strains (19.73%) of Pseudomonas aeruginosa and 16 strains (10.88%) of Klebsiella pneumoniae. There were 37 gram-positive strains (25.17%), and 31 strains (21.09%) were staphylococcus aureus. A total of 19 strains of fungi (12.93%); Acinetobacter baumannii and Klebsiella pneumoniae were more sensitive to cefoperazone sodium sulbactam sodium and iaropenem, and more resistant to benzylbenzicillin, sulfamethoxazole/trimethoprazine and cefazolin. Pseudomonas aeruginosa had higher sensitivity to ceftazidine, piperacillin/tazobactam, and higher resistance to cefazolin sodium, ampicillin and other drugs. Staphylococcus aureus was highly sensitive to linezolid, vancomycin and teicoranin, and had high resistance to cefazolin and penicillin. There were statistically significant differences between the two groups in age, GCS score, combined basic diseases >2, coma time >24h, hypoproteinemia and invasive operation (P<0.05). Logistic regression analysis showed that GCS score, hypoproteinemia and invasive operation were independent risk factors for severe pulmonary infection in patients with traumatic brain injuries (P<0.05). Conclusion Suining patients with gram-negative bacteria, mainly Acinetobacter baumannii, Pseudomonas aeruginosa, aeruginosa, should be based on the pathogen susceptibility results of patients, for invasive operation, high GCS score should be positive treatment, and actively correct hypoproteinemia, can reduce the occurrence of severe lung infection.

Epidemiological characteristics and risk prediction model of pulmonary infection in elderly patients in a hospital in Hebei Province / 公共卫生与预防医学

Objective To analyze the epidemiological characteristics and influencing factors of pulmonary infection in the elderly, and to construct a risk prediction model. Methods Stratified cluster sampling was used to randomly select 683 elderly patients in Zhangjiakou First Hospital as the investigation subjects. Sputum specimens were collected and sent for bacterial isolation, culture, identification, and drug sensitivity test. According to whether the patients had pulmonary infection, they were divided into pulmonary infection group (n=315) and non-pulmonary infection group (n=368). The clinical data of the two groups such as age, sex, COPD, and ICU admission were analyzed. Univariate analysis and logistic regression analysis were used to analyze the influencing factors of pulmonary infection in elderly patients, and a risk prediction model was established. Results A total of 331 strains of pathogenic bacteria were detected in 315 patients with pulmonary infection, and there were 207 strains (62.54%) of gram-negative bacteria detected, mainly including 95 strains (28.70%) of Acinetobacter baumannii and 71 strains (21.45%) of Klebsiella pneumoniae. There were 169 strains (26.28%) of gram-positive bacteria detected, mainly 68 strains (20.54%) of Staphylococcus aureus. In addition, there were 25 strains of fungi (7.55%). There were no significant differences in gender, smoking history, history of COPD, asthma, and stroke between the two groups (P>0.05). The proportion of patients aged≥70, mechanical ventilation, admission to ICU and recent respiratory tract infection in the experimental group was significantly higher than that in the control group (P<0.05). Multivariate logistic regression analysis showed that age, smoking history, mechanical ventilation, and ICU admission were independent risk factors for pulmonary infection in elderly patients (P<0.05). According to the above four independent influencing factors and corresponding regression coefficient of each factor, the prediction model of pulmonary infection in elderly patients was constructed, Z=-5.948+1.198× (age) +1.281×(smoking history) +2.029×(mechanical ventilation) +1.211×(ICU admission). Conclusion Lung infection in elderly patients in our hospital is dominated by gram-negative bacilli. Antibiotics should be rationally selected according to drug sensitivity results. Age≥70 years old and COPD can increase the risk of pulmonary infection in elderly patients, and the prediction model constructed can effectively predict the occurrence of pulmonary infection in elderly patients.

Establishment and effect evaluation of risk prediction model for lung infection after kidney transplantation / 器官移植

Objective To establish and evaluate the predictive value of the risk prediction model for lung infection within postoperative 1 year in kidney transplant recipients. Methods Clinical data of 197 kidney transplant recipients were retrospectively analyzed. All recipients were divided into the infection group (n=42) and non-infection group (n=155) according to the incidence of lung infection within postoperative 1 year. The incidence and risk factors of lung infection after kidney transplantation were analyzed. Risk prediction model was established by multiple logistic regression analysis. Forty-five kidney transplant recipients who met the inclusion criteria, including 8 cases in the infection group and 37 cases in the non-infection group, were selected to verify the predictive effect of the established model. Results The incidence of lung infection within 1 year after kidney transplantation was 21.3% (n=42), including 38 cases (90%) of pneumonia severity index (PSI) class Ⅰ, 1 case (2%) of PSI class Ⅲ and 3 cases (8%) of PSI class Ⅴ. Lung infection occurred within 1 month after operation in 13 cases, within postoperative 2-6 months in 22 cases and after postoperative 6 months in 7 cases. Nineteen recipients were diagnosed with bacterial infection, 7 cases of fungal infection, 10 cases of viral infection and 6 cases of mixed infection. Smoking history, diabetes mellitus history, pulmonary disease history and albumin level of < 35 g/L were the independent risk factors for lung infection after kidney transplantation (all P < 0.05). The equation of risk prediction model for postoperative lung infection in kidney transplant recipients was logit (lung infection within postoperative 1 year in kidney transplant recipients)=-1.891+1.063×smoking history (yes=1, no=0)+1.398×diabetes mellitus history (yes=1, no=0)+1.732×pulmonary disease history (yes=1, no=0)+1.269×albumin level (< 35 g/L=1, ≥35 g/L=0). The area under the curve (AUC) of receiver operating characteristic (ROC) was 0.788, the sensitivity was 0.786, the specificity was 0.645, and the Youden index was 0.431, respectively. Hosmer-Lemeshow goodness-of-fit test demonstrated that the predicted value of this model yielded relatively high consistency with the observed value. The AUC in the verification group was 0.834. Hosmer-Lemeshow goodness-of-fit test validated high degree of calibration of this model. Conclusions The risk prediction model, consisting of smoking history, diabetes mellitus history, pulmonary disease history and albumin level as predictors, may effectively predict the incidence of lung infection within postoperative 1 year in kidney transplant recipients.

Pathogenic bacteria distribution and risk factors of pulmonary infection in patients with diabetic nephropathy / 公共卫生与预防医学

Objective To analyze the distribution of pathogenic bacteria and risk factors of pulmonary infection in patients with diabetic nephropathy (DN), and to provide a theoretical basis for the management and prevention of pulmonary infection in DN patients. Methods A total of 486 DN patients treated in our hospital from March 2018 to December 2020 were selected and divided into experimental group (pulmonary infection, n=178) and control group (no pulmonary infection, n=308) according to the occurrence of pulmonary infection. Sputum samples from all patients were cultured and analyzed. The data of age, gender, length of hospital stay, blood glucose level and renal function indexes of patients in the two groups were collected. Logistic regression was used to analyze the independent risk factors of pulmonary infection in DN patients. Results A total of 178 cases of pulmonary infection in DN patients were included in this study, among which 142 strains of pathogenic bacteria were detected, including 91 strains (64.08%) of gram-negative bacteria, 43 strains (30.28%) of gram-positive bacteria, and 8 strains of fungi (5.63%). The gram-negative bacteria mainly consisted of 39 strains (27.46%) of Klebsiella pneumoniae, 28 strains (19.72%) of Pseudomonas aeruginosa and 18 strains (12.68%) of Acinetobacter baumannii. The gram-positive bacteria included mainly 32 strains (22.54%) of Staphylococcus aureus. There were statistically significant differences between the two groups in age, COPD history, length of hospital stay, HBA1c, serum albumin, volume overload, uremia, and malnutrition (P<0.05). Multivariate logistic regression analysis showed that COPD history, HbA1c, volume overload, serum albumin, uremia and malnutrition were the influencing factors of DN combined with pulmonary infection (P<0.05). Conclusion DN patients are prone to pulmonary infection, and the main pathogens are Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa. The main risk factors are COPD history, HbA1c, volume overload, serum albumin, uremia, and malnutrition. It is recommended to supplement nutrition, control blood glucose, delay the decline of organ function, and improve body immunity to prevent pulmonary infection in DN patients.

Effect and Mechanism of Fuzheng Touxie Prescription on Immune Homeostasis of Drug-resistant Pseudomonas aeruginosa Lung Infection Rats / 中国实验方剂学杂志

Objective:To investigate the effect and mechanism of Fuzheng Touxie prescription （FZTX） on the immune homeostasis of drug-resistant <italic>Pseudomonas aeruginosa</italic> lung infection in rats at different time points. Method:A total of 168 rats were divided into a blank group （<italic>n</italic>=8），a model group （<italic>n</italic>=40），a Touxie （TX） group （<italic>n</italic>=40），an early Fuzheng （FZ） group （<italic>n</italic>=40）， and a delayed FZ group （<italic>n</italic>=40）. The blank group was given distilled water by gavage， the model group was given distilled water by gavage after infection，the TX group was given clear heat and penetrate evil drug free decoction granules（3.5 g·kg^-1） by gavage after infection， the early FZ group was given Fuzheng Touxie whole formula free decoction granules（10.75 g·kg^-1） by gavage after infection， the delayed FZ group was given clear heat and penetrate evil drug free decoction granules by gavage after infection， on the third day plus Fuzheng drug free decoction granules［（3.5+10.75） g·kg^-1］ by gavage， the three treatment groups were gavaged twice a day， 2 mL each time .Each drug treatment group was divided into five groups according to five time points （3 h，1 d，3 d，5 d， and 7 d）， with eight rats in each group. The levels of tumor necrosis factor-<italic>α</italic>（TNF-<italic>α</italic>），high mobility group protein 1（HMGB1），interleukin-10（IL-10）， and tumor necrosis factor -<italic>α</italic>-induced protein-8-like2 （TIPE2） were measured by enzyme-linked immunosorbent assay （ELISA）， and HMGB1 protein expression level by Western blot. Result:At 3 h，the TNF-<italic>α</italic> content in the drug treatment groups was higher than that in the blank group and the model group （<italic>P</italic><0.05）. At 3 d，the TNF-<italic>α</italic> content in the early FZ group and the delayed FZ group was lower than that in the model group （<italic>P</italic><0.05） and the TX group （<italic>P</italic><0.05）. At 1 d，the HMGB1 content in the TX group and the delayed FZ group was higher than that in the model group （<italic>P</italic><0.05）. At 5 d，the HMGB1 content was lower in the delayed FZ group than in the model group （<italic>P</italic><0.05）. At 7 d，HMGB1 protein expression in the model group was higher than that in the blank group （<italic>P</italic><0.05） and the early FZ group （<italic>P</italic><0.05）. At 3 d，the IL-10 content was significantly higher in both the early FZ group and the delayed FZ group than that in the model group （<italic>P</italic><0.05）. At 5 d，the IL-10 content was higher in the early FZ group than that in the TX group （<italic>P</italic><0.05）. At 7 d，the IL-10 content in the early FZ group and the delayed FZ group was lower than that in the TX group （<italic>P</italic><0.05）. At 5 d，the TIPE2 content in the early FZ group was lower than that in the model group （<italic>P</italic><0.05）. At 7 d，the TIPE2 content in the TX group and the delayed FZ group was lower than that in the model group （<italic>P</italic><0.05）. Conclusion:FZTX or modified prescription can promote the inflammatory response to eliminate pathogenic bacteria in the early stage and suppress the inflammatory response in the late stage to avoid the inflammatory cascade effect and lung tissue damage，indicating that Fuzheng drugs have an important role in maintaining the immune homeostasis of the body after infection.

Clinical Efficacy and Mechanism of Quyu Qingjintang on Stroke Complicated with Lung Infection with Phlegm-heat Accumulation Lung Syndrome and Blood Stasis Syndrome / 中国实验方剂学杂志

Objective:To explore the clinical efficacy and mechanism of Quyu Qingjintang in the treatment of stroke complicated with lung infection （SCLI） with phlegm-heat accumulation lung syndrome and blood stasis syndrome. Method:The 60 patients with SCLI with phlegm-heat accumulation lung syndrome and blood stasis syndrome were selected and divided into control group （30 cases） and observation group （30 cases）. The patients in both groups received basic treatments such as thrombolysis and anticoagulation， and were injected with imipenem cilastatin sodium and ambroxol hydrochloride. The patients in control group additionally received Tanreqing capsule on the basis of the conventional treatment while those in observation group were additionally treated with Quyu Qingjintang on the basis of the conventional treatment. The clinical efficacy， lung function， inflammatory factor levels， time to symptoms disappearance， haptoglobin （HPT） and amyloid A （SAA） levels， T lymphocyte subset level and safety index were compared between two groups. Result:The total effective rate was 93.33% （28/30） in observation group， significantly higher than 70.00% （21/30） in control group （<italic>χ²=</italic>5.450， <italic>P</italic><0.05）. After treatment， the symptoms of both groups were improved （<italic>P</italic><0.05）. The scores of fever， cough， wheezing， and expectoration in observation group were lower than those in control group （<italic>P</italic><0.05）. The levels of interleukin-6（IL-6）， white blood cell（WBC）， procalcitonin（PCT）， C-reactive protein（CRP）， HPT， and SAA in observation group were significantly lower than those in control group （<italic>P</italic><0.05）. The forced expiratory volume in one second （FEV₁）， forced vital capacity （FVC） and peak expiratory flow rate （PEF） in observation group were better than those in control group （<italic>P</italic><0.05）. The levels of CD3⁺， CD4⁺， CD4⁺/CD8⁺ in observation group were significantly higher than those in control group （<italic>P</italic><0.05）. The recovery time of WBC count， hospitalization time， lung rales， the time to fever and cough disappearance in observation group were lower than those in control group （<italic>P</italic><0.05）， no serious adverse reactions occurred in two groups. Conclusion:Quyu Qingjintang in the treatment of stroke complicated with lung infection with phlegm-heat accumulation lung syndrome and blood stasis syndrome can significantly improve the treatment efficiency， improve the symptoms of pulmonary infection， reduce the level of inflammatory factors， and improve lung function， with less adverse reactions and high safety， so it is worthy of clinical application.

Inhibition of CD96 enhances interferon-γ secretion by natural killer cells to alleviate lung injury in mice with pulmonary infection / 南方医科大学学报

OBJECTIVE@#To assess the effect of neutralizing CD96 on natural killer (NK) cell functions in mice with pulmonary infection and explore the possible mechanism.@*METHODS@#Male BALB/c mice were randomly divided into infection group (Cm group), anti-CD96 treatment group (anti-CD96 group) and control group (=5). In the former two groups, was inoculated intranasal administration to establish mouse models of pulmonary infection, and the mice in the control group received intranasal administration of the inhalation buffer. In anti-CD96 group, the mice were injected with anti-CD96 antibody intraperitoneally at the dose of 250 μg every 3 days after the infection; the mice in Cm group received intraperitoneal injections of saline. The body weight of the mice was recorded daily. The mice were sacrificed 5 days after infection, and CD96 expression was detected by quantitative real-time PCR and Western blotting. HE staining and pathological scores were used to evaluate pneumonia of the mice. The inclusion body forming units (IFUs) were detected in the lung tissue homogenates to assess lung tissue chlamydia load. Flow cytometry and ELISA were used to assess the capacity of the lung NK cells to produce interferon-γ (IFN-γ) and regulate macrophages and Th1 cells.@*RESULTS@# infection inhibited CD96 expression in NK cells of the mice. Compared with those in Cm group, the mice in antiCD96 mice showed significantly milder lung inflammation ( < 0.05) and reduced chlamydia load in the lung tissue ( < 0.05). Neutralizing CD96 with anti-CD96 significantly enhanced IFN-γ secretion by the NK cells ( < 0.05) and augmented the immunoregulatory effect of the NK cells shown by enhanced responses of the lung macrophages ( < 0.05) and Th1 cells ( < 0.05).@*CONCLUSIONS@#Inhibition of CD96 alleviates pneumonia in -infected mice possibly by enhancing IFN-γ secretion by NK cells and augmenting the immunoregulatory effect of the NK cells on innate and adaptive immunity.

Retrospective Matched-cohort Study of Domestic Vancomycin and Imported Vancomycin in the Treatment of Methicillin-resi s- tant Staphylococcus aureus Caused Lung Infection after Neurosurgery / 中国药房

OBJECTIVE： To compare the efficacy and safety of domestic vancomycin and imported vancomycin in the treatment of methicillin-resistant Staphylococcus aureus （MRSA） caused lung infection after neurosurgery. METHODS： The patients after neurosurgery with MRSA pulmonary infection diagnosed in our hospital from Jan. 2014 to Jun. 2015 and using domestic vancomycin were included in domestic vancomycin group， while those who used imported vancomycin from Jul. 2015 to Dec. 2018 were included in imported vancomycin group. The baseline data of the two groups were matched by 1 ∶ 1 according to propensity  score matching method. The 30-day all-cause mortality， 90-day all-cause mortality of severe patients， 7 d effective bacterial clearance rate and the incidence of ADR were compared between 2 groups. RESULTS： There were 108 cases in domestic vancomycin group and 279 cases in imported vancomycin group. After propensity score matching， 108 cases in domestic and 108 cases in imported vancomycin group were finally included. The 30-day mortality rates of domestic group and imported group were 10.19％（11/108） and 7.41％（8/108） respectively， and the 90-day all-cause mortality of 22 pairs of severe patients were 63.64％. The 7 d effective bacterial clearance rates were 75.00％（48/64） and 81.94％（59/72）， and there was no statistical significance （P＞0.05）. The incidences of creatinine increase ＞1 fold were 25.93％（28/108） and 12.04％（13/108）， the total incidences of ADR were 29.63％（32/108） and 15.74％（17/108）， respectively， with statistical significance （P＜0.05）. CONCLUSIONS： The therapeutic efficacy of imported vancomycin is similar to that of domestic vancomycin in the treatment of postoperative pulmonary infection with MRSA after neurosurgery， but the safety needs to pay close attation， especially the rise of serum creatinime.

Detection rate of pathogens from sputum, blood, and bronchoalveolar lavage fluid samples in acquired immunodeficiency syndrome patients complicated with pulmonary infection / 中华传染病杂志

Objective To study the detection rate of pathogens from sputum , blood, and bronchoalveolar lavage fluid ( BALF ) samples in acquired immunodeficiency syndrome ( AIDS ) patients complicated with pulmonary infection.Methods Seventy-three hospitalized AIDS patients complicated with pulmonary infection in Beijing Ditan Hospital , Capital Medical University were enrolled from February 2018 to September 2018.Blood, sputum and BALF samples were collected.Blood samples were cultured to detect anaerobic bacteria, aerobic bacteria, fungi and mycobacteria.Antigen agglutination method was applied in blood samples to detect cryptococcus neoformans.The sputum samples were tested for Mycobacterium tuberculosis by acid-fast staining and were cultured to detect bacteria and fungi.The sputum samples were observed under microscope for sporotrichosis and fungal spores.The BALF samples were cultured to detect bacteria and fungi. The BALF samples were tested for Mycobacterium tuberculosis by polymerase chain reaction amplification and acid-fast staining.Pneumocystis were detected in BALF samples by methenamine silver staining method .The BALF samples were observed under a microscope for sporotrichosis and fungal spores .The detection rate of pathogens from blood, sputum and BALF samples were compared.Chi-square test was conducted for statistical analysis.Results In 73 AIDS patients complicated with pulmonary infection , the pathogen detection rates in blood, sputum and BALF samples were 8 (11.0%), 23 ( 31.5%) and 48 (65.8%), respectively.The difference was statistically significant ( F ＝48.513, P ＜0.01 ).The detection rate in BALF samples was significantly higher than that in blood or sputum samples ( χ2 ＝43.349 and 17.136, respectively, both P＜0.01).The detection rate in sputum samples was significantly higher than that in blood (χ2 ＝9.215, P＜0.05). The highest detection rates of pathogens in blood , sputum and BALF samples were Talaromyces marneffei 4.1%(3), viridans group streptococci 16.4%(12) and 35.6%(26), respectively.Conclusions The detection rate of pathogens in BALF samples from AIDS patients complicated with pulmonary infection is the highest , followed by sputum and blood samples.

Comparative study between Charlison′s weighted index of comorbidities score,the diagnostic criteria for emergency sepsis score and combination of the two scoring systems to predict the emergency pulmonary infection prognosis / 中国实用护理杂志

Objective To compare the predictive effect of Charlison's weighted index of comorbidities (WIC), the diagnostic criteria for emergency sepsis (MEDS) and combination of the two scoring systems to predict the emergency pulmonary infection prognosis. Methods A total of 327 patients with pulmonary infection admitted from January 2016 to January 2017 were enrolled in this study whose WIC score,MEDS score and risk stratification were recorded at admission.They were divided into survival group and death group according to the 28 d treatment outcome,the optimal cutoff of WIC score and MEDS score to predict the prognosis were found by ROC curve, and the prediction effect of WIC score, MEDS score, the combined use of both and APACHEⅡto predict the prognosis were compared. Results The mortality of low,middle and high risk of WIC score were 13.7%(29/212),48.7%(38/78)and 78.4%(29/37)with significant difference(χ2=82.097,P=0.000),mortality of low,middle and high risk of MEDS score were 11.3%(23/203),50.6%(40/77)and 73.3%(33/45)with significant difference(χ2=145.526,P=0.000).The WIC scores in survival group and death group were 1.3 ± 0.9 and 2.7 ± 1.1 with significant difference(t=11.030,P=0.000).The MEDS score of live group(6.1 ± 4.0) was significantly lower than death group(12.6 ± 4.9)(t=11.502,P=0.000).the optimal cutoff values of WIC and MEDS to predict prognosis were 1.7 points, 11.6 points, the ROC curve area between WIC, MEDS score and combined application to predict prognosis were 0.632, 0.798, 0.897, and the sensitivity and accuracy of the combined prediction[93.8%(212/226)/89.9%(294/327)] were significantly higher than those of the individual WIC[72.7%(168/231)/75.2%(246/327)] and MEDS[67.5%(156/232)/72.2%(236/327)] (χ2=0.562-42.594, P < 0.05). The sensitivity and accuracy of the combined application and APACHE Ⅱto predict of prognosis had no statistical significant difference(P>0.05).Conclusions The sensitivity and accuracy of WIC score combined with MEDS score to predict the prognosis of patients with acute lung infection is higher than the individual WIC score and MEDS score,and its prediction effect is more better.

Meridian respiratory training improves pulmonary function after stroke / 中华物理医学与康复杂志

Objective To explore the effect of modified meridian breathing training on the lung function of acute stroke patients. Methods Sixty acute stroke patients were randomly divided into an intervention group and a control group, each of 30. In addition to the conventional neurological treatment, the control group received routine breathing training, while the intervention group was given modified meridian breathing training by professional reha-bilitation therapists once a day for 4 weeks. Forced vital capacity ( FVC) and forced expiratory volume in one second ( FEV1) , as well as the rate of pulmonary infection were assessed before and after the treatment. Results After 4 weeks of treatment, a significant increase was observed in the average FEV1 and FVC of both groups, but the im-provement in the intervention group was significantly greater than in the control group. There were 3 lung infections ( 10％) in the intervention group, which was significantly lower than the 7 cases ( 23. 3％) in the control group. Conclusion Modified meridian breathing training can improve the lung function of acute stroke patients and reduce the incidence of lung infection.

Quercetin improves Pseudomonas aeruginosa-induced lung infection in rats / 中成药

AIM To study the improvement of quercetin on Pseudomonas aeruginosa-induced lung infection in rats.METHODS Forty SPF SD rats were randomly divided into five groups,eight rats in each group:normal group,P.aeruginosa infection group,quercetin group,levofloxacin group,levofloxacin combined with quercetin group (combined group),the rats were anesthetized and then injected with P.aeruginosa in bronchus.The pathological changes of lung tissue in rats were observed,the contents of IL-4 and IFN-γcytokines,changes of transcription factors T-bet and Gata-3 in lung tissue were detected,and then semi-quantitative RT-PCR was used for the detection of IL-4,IFN-γ,T-bet and Gata-3 mRNA expressions.RESULTS The content of IL-4,levels of IL-4 and Gata-3 mRNA in lung tissue in the quercetin group,the levofloxacin group and the combined group were lower than those in the P.aeruginosa infection group,but the opposite was true in the levels of IFN-γ and T-bet mRNA.CONCLUSION Quercetin and levofloxacin can induce the differentiation from type Th2 to type Th1 for rat organism,but there is no synergistic effect between them.

Quercetin improves Pseudomonas aeruginosa-induced lung infection in rats / 中成药

AIM To study the improvement of quercetin on Pseudomonas aeruginosa-induced lung infection in rats.METHODS Forty SPF SD rats were randomly divided into five groups,eight rats in each group:normal group,P.aeruginosa infection group,quercetin group,levofloxacin group,levofloxacin combined with quercetin group (combined group),the rats were anesthetized and then injected with P.aeruginosa in bronchus.The pathological changes of lung tissue in rats were observed,the contents of IL-4 and IFN-γcytokines,changes of transcription factors T-bet and Gata-3 in lung tissue were detected,and then semi-quantitative RT-PCR was used for the detection of IL-4,IFN-γ,T-bet and Gata-3 mRNA expressions.RESULTS The content of IL-4,levels of IL-4 and Gata-3 mRNA in lung tissue in the quercetin group,the levofloxacin group and the combined group were lower than those in the P.aeruginosa infection group,but the opposite was true in the levels of IFN-γ and T-bet mRNA.CONCLUSION Quercetin and levofloxacin can induce the differentiation from type Th2 to type Th1 for rat organism,but there is no synergistic effect between them.

Clinical Observation of Tiotropium Bromide Assisted with Bronchoalveolar Lavage for Bronchiectasis Com-plicated with Lung Infection / 中国药房

OBJECTIVE:To investigate the effects of tiotropium bromide assisted with bronchoalveolar lavage (BAL) on short-term efficacy,quality of life and re-hospitalization rate of patients with bronchiectasis complicated with lung infection. METH-ODS:A total of 140 patients with bronchiectasis complicated with lung infection selected from our hospital during Oct. 2013-Dec. 2015 were divided into control group and observation group by lottery,with 70 cases in each group. Based on intervention therapy, control group received BAL. Observation group was additionally given Tiotropium bromide powder inhalation 18 μg ,once a day before going to bed,on the basis of control group. Both groups were treated for 4 weeks. Clinical efficacy was compared between 2 group;pulmonary ventilation function indexes,blood gas analysis indexes,BODE index scores and QLI scores before and after treatment,re-hospitalization rate and the occurrence of ADR were also compared between 2 groups. RESULTS:The total response rate of observation group was 91.43%,which was significantly higher than that of control group(78.57%),with statistical signif-icance (P0.05). After treatment,FVC,FEV1,FEV1%,p(O2) and QLI score of 2 groups were increased significantly,while p(CO2)and BODE index scores were decreased significantly,com-pared to before treatment;all indexes of the observation group was significantly better than the control group,with statistical sig-nificance (P<0.05). The re-hospitalization rate of observation group 3,6 months after treatment was significantly lower thanthat of control group,with statistical significance(P<0.05). No ADR was found in 2 groups. CONCLUSIONS:For patients with bronchiectasis complicated with lung infection,tiotropium bromide assisted with BAL can effectively relieve the clinical symp-toms and signs,improve lung ventilation function and the quality of daily life and can be helpful to reduce the risk of re-hospital-ization with good safety.

Comparison of the Effect of Imipenem and Cilastatin Sodium and Meropenem in the Treatment of Acute Leukemia Granulocytopenic Phase Combined with Severe Lung Infection / 中国药房

OBJECTIVE:To compare the clinical efficacy and safety of imipenem and cislastatin sodium and meropenem in the treatment of acute leukemia granulocytopenic phase combined with severe lung infection. METHODS:A total of 64 patients with acute leukemia granulocytopenic phase combined with severe lung infection were selected from our hospital during Jul. 2015-Jul. 2016 as study objects. They were divided into trial group(odd number)and control group(even number)according to admis-sion order,with 32 cases in each group. Control group was given Meropenem for injection 1 g+0.9％ Sodium chloride injection 100 mL,ivgtt(about 30 min),q8 h. Trial group was given Imipenem and cislastatin sodium for injection 1 g+0.9％ Sodium chlo-ride injection 100 mL,ivgtt(about 30 min),q12 h. Both groups were treated for 14 d. Clinical efficacies as well as blood gas pa-rameters [p(O2),p(CO2),SaO2] and pathogenic clearance were observed in 2 groups,and the occurrence of ADR was recorded. RESULTS:The total response rate of trial group(78.13％)was significantly higher than that of control group(71.88％),with sta-tistical significance (P0.05). After treatment,the levels of p(O2) and SaO2 in 2 groups were in-creased significantly,while the level of p(CO2) was decreased significantly;there was statistical significance compared to be-fore treatment(P>0.05). There were 27 cases of pathogenic clearance in trial group(clearance rate of 84.38％),which was sig-nificantly more than control group (26 cases,clearance rate of 81.25％),without statistical significance (P>0.05). The inci-dence of ADR in trial group(9.38％)was significantly lower than control group(15.63％),without statistical significance(P>0.05). CONCLUSIONS:Imipenem and cislastatin sodium and meropenem show good clinical efficacy for acute leukemia granu-locytopenic phase combined with severe lung infection,blood gas parameters improvement and pathogenic clearance effect,both of them have good safety.

Observation of clinical effect of Xuebijing injection adjuvant therapy for severe lung infection / 中国基层医药

Objective To study the clinical effects and mechanism of Xuebijing injection combined with antibiotics in the treatment of severe lung infection in ICU.Methods 110 cases of ICU severe lung infection were randomly divided into control group(55 cases) and observation group(55 cases).The control group was administered with cefotaxime sodium and sodium benzene azole penicillin,while the observation group was co-administered with Xuebijing injection and cefotaxime sodium,sodium benzene azole penicillin.All treatment lasted for 7 days.Meanwhile,the serum levels of C-reactive protein (CRP),TNF-α,IL-6,COX-2 and SOD were measured before and after the therapy.Results After treatment,the levels of CRP and TNF-α,IL-6 were significantly reduced in the two groups[after treatment CRP,TNF-α,IL-6 levels of the control group:(46.50 ± 17.74) ng/L,(339.50 ± 112.61) ng/L,(141.20 ± 42.66) ng/L;and those in the observation group:(35.60 ± 16.89) ng/L,(268.20 ± 98.47) ng/L,(118.70 ± 39.81) ng/L;the control group:t =7.329,9.682,6.038;the observation group:t =11.012,14.335,14.335,all P ＜ 0.01],and the reduced amplitude of the observation group was significantly lower than that of the control group (t =3.300,P ＜ 0.01).The serum levels of COX-2 and SOD were significantly reduced [after treatment COX-2 and SOD levels of the control group:(189.50 ± 34.52) ng/L,(203.60 ± 67.26) U/mL;those of the observation group:(118.20 ± 25.36) ng/L,(162.30 ± 59.78) U/mL;COX-2:the control group:t =15.021,P ＜ 0.01;the observation group:t =32.931,P ＜ 0.01;SOD:the control group,t =4.183,P ＜ 0.01;the observation group,t =7.682,P ＜0.01],and the reduced amplitude of the observation group was significantly lower than that of the control group(t =3.404,P ＜0.01).Conclusion Xuebijing injection combined with antibiotics in the treatment of severe lung infection in ICU has good effects,which is due to the inhibition of COX-2 and SOD to improve inflammation and oxidative stress damage in cells.

Compromiso pulmonar en pacientes hospitalizados con infección por el virus de inmunodeficiencia humana en el Hospital Pablo Tobón Uribe (Medellín, Colombia) / Pulmonary compromise in inpatients with human immunodeficiency virus infection at Pablo Tobón Uribe Hospital, Medellín, Colombia

Más de la mitad de los pacientes con infección por virus de inmunodeficiencia humana (VIH) pueden tener compromiso pulmonar en el transcurso de su vida. Este puede ser multicausal y las infecciones oportunistas son las principales, sin embargo, las causas no infecciosas no son menos importantes. Objetivo: Describir las características del compromiso pulmonar en pacientes hospitalizados con infección por VIH. Metodología: Estudio descriptivo observacional. Resultados: Se incluyó a 63 pacientes, el 85,7% fueron hombres. La edad promedio fue 40,6 ± 12 años. El 21,4% tuvieron antecedente de promiscuidad sexual y 28,6% fueron hombres con sexo con hombres. Se identificó tabaquismo en 60,3%, alcoholismo en 52,4% y consumo de drogas en 20,6%. El 23,8% tuvo historia de tuberculosis. Al ingreso, el 79,4% tenía sida, el recuento promedio de CD4 fue 138,5 ± 17,7 células/mm3 y el 49,2% tenía CD4 < 100 células/mm3. Las principales comorbilidades fueron: enfermedad neoplásica 20,6%, diarrea crónica 19%, EPOC 6,3% y diabetes mellitus 3,2%. Los principales síntomas al ingreso fueron: respiratorios 66,7%, gastrointestinales 47,6% y neurológicos 34,9%. Los principales oportunistas documentados fueron Mycobacterium spp, H. capsulatum y P. jirovecii. El sarcoma de Kaposi, la enfermedad lifoproliferativa y la EPOC fueron causas de compromiso no infeccioso. Los principales hallazgos radiográficos fueron: infiltrados intersticiales (42,9%), compromiso pleural (23,8%) y lesiones cavitarias (7,9%). El compromiso multilobar fue evidente en el 15,9%. Las principales complicaciones fueron falla respiratoria, disfunción orgánica múltiple y falla renal aguda. El 19% requirió ingreso a UCI y, de estos, el 83,3% necesitó ventilación mecánica. La estancia hospitalariapromedio fue de 18 ± 20 días y la mortalidad del 17,5%. Discusión: Las infecciones por oportunistas son las principales causas de compromiso pulmonar y, dentro de estas, las causadas por micobacterias. Puede ocurrir más de una infección oportunista simultáneamente, pero en nuestra población fueron infrecuentes. Las causas noinfecciosas también son importantes.

More than a half of patients with HIV infection have pulmonary involvement throug-hout their lives. Opportunistic infections are the main cause; however, many patients havenoninfectious pulmonary involvement. Objective: To describe the characteristics of pulmonary involvement in inpatients with HIVinfection.Methods: Descriptive observational study. Results: A total of 63 patients were included, and 85.7% were men. The average age was40.6 ± 12 years. Some 21.4% had a history of sexual promiscuity and 28.6% were men whohad sex with men. Smoking was found in 60.3%, alcoholism in 52.4% and drug abuse in 20.6%.A tuberculosis history was documented in 23.8% of patients. At admission, 79.4% had AIDS, themean CD4 count was 138.5 ± 17.7 cells/mm3and 49.2% had CD4 counts < 100 cells/mm3. Majorcomorbidities included neoplastic disease in 20.6%, chronic diarrhea in 19%, COPD in 6.3% anddiabetes in 3.2%. Major opportunistic agents were Mycobacterium spp, H. capsulatum and P.jirovecii. Kaposi's sarcoma, lymphoproliferative disease and COPD were causes of noninfectiouspulmonary involvement. The main radiographic findings included interstitial infiltrates in 42.9%,pleural involvement in 23.8%, alveolar infiltrates in 7.9% and cavitary lesions in 7.9%. Multilobarcompromise was evident in 15.9% of the patients. The major complications were respiratoryfailure, multiple organ dysfunction and acute renal failure. Some 19% required care in the ICUand 83.3% of these required mechanical ventilation. The mean stay was 18 ± 20 days and themortality was 17.5%. Discussion: Opportunistic infections are the main causes of lung involvement and mycobacterialdiseases were most frequent. Mycobacterial diseases can occur simultaneously with an oppor-tunistic infection, but in our series this was infrequent. Non-infectious diseases are importantbut are less common.