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02 August 2014, Volume 34 Issue 8 Previous Issue    Next Issue

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Severe infection：from phenomenon to essence and from evaluation to treatment QIU Xiao-hua,QIU Hai-bo. 2014, 34(8): 733-736.  DOI: 10.7504/nk2014070101 Abstract ( )   PDF (969KB) ( )   Abstract：With the continuous progress in medical science，severe infection is gradually well recognized.The new antibiotics and the advancement of organ support technology make a considerable improvement of the treatment for severe infection.However，the incidence and mortality of severe infection remain high.Therefore，the nature of severe infection needs further exploration.Early diagnosis and proper treatment are still a clinical challenge to be overcome.

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Changes in clinical knowledge updates from the evolution of idiopathic interstitial pneumonia classification. XU Zuo-jun. 2014, 34(8): 737-739.  DOI: 10.7504/nk2014070106 Abstract ( )   PDF (949KB) ( )   Abstract：Idiopathic interstitial pneumonias(IIPs)are a group of interstitial lung disease with unknown causes and its classification experienced a gradually evolving process.In addition to describing new clinical histologic entities,the methods of classification move from the simply pathological patterns to the clinical algorithm based on observed disease behavior,the diagnostic criteria gradually switch from purely pathological diagnosis to the clinical,pathological and radiologic multidisciplinary discussion.This evolution reflects our deepening understanding of idiopathic interstitial pneumonias.

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Pulmonary infiltrates with eosinophilia. CHEN Bi，JIANG Han-dong. 2014, 34(8): 740-743.  DOI: 10.7504/nk2014070102 Abstract ( )   PDF (984KB) ( )   Abstract：Pulmonary Infiltrates with eosinophilia，clinically referred to as eosinophilic lung diseases (ELD)，are a heterogeneous group of disorders characterized by pulmonary infiltration associated with alveolar eosinophilia with or without peripheral eosinophilia.They are classified generally as primary ELD，secondary ELD，and other diseases occasionally associated with eosinophils.Clinical manifestation of these disorders can be varied，and their presentation can be mild or fatal.Accurate diagnosis is based on a full history and examination，along with clinical manifestations，radiological imaging and laboratory findings.Corticosteroids are the mainstay of treatment for ELD and most patients will require prolonged courses of daily steroids.The dose and use duration of corticosteroids should be individualized.

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Combined pulmonary fibrosis and emphysema syndrome. PENG Min，SHI Ju-hong，CAI Bai-qiang. 2014, 34(8): 744-747.  DOI: 10.7504/nk2014070103 Abstract ( )   PDF (957KB) ( )   Abstract：The co-existence of upper lung emphysema and lower lung fibrosis is being increasingly recognized as a distinct clinical entity in some smokers，which is so called combined pulmonary fibrosis and emphysema (CPFE) syndrome.Tobacco smoking has been identified as a major cause，although the exact pathogenesis is unclear.Pulmonary function testing reveals normal or subnormal lung volume contrasted by markedly impaired diffusion capacity，thus the assessment of disease severity in CPFE is different from chronic obstructive pulmonary disease (COPD) or idiopathic pulmonary fibrosis (IPF).Pulmonary hypertension is highly prevalent in CPFE and is the leading determinant of death.CPFE patients may not benefit from therapies specific for COPD or IPF.Further studies are needed.

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Progress in biological markers of interstitial pulmonary disease. WEI Lu-qing,PENG Shou-chun. 2014, 34(8): 748-751.  DOI: 10.7504/nk2014070104 Abstract ( )   PDF (985KB) ( )   Abstract：There are many different kinds of disease spectrums in interstitial lung diseases (ILD) whose diagnosis was difficult.Biological markers of ILD can be used for the diagnosis，differential diagnosis，prognosis judgment and disease condition monitoring.More than 10 kinds of biological markers are introduced in this paper，including KL-6，SP-A，MMP7 and circulating fibrocytes，etc.Up to now，it is unlikely that a single biomarker is able to be used as valuable diagnostic tool.A composite of several biomarkers may hold promise.

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Diagnosis of diffuse interstitial pulmonary disease：is bronchoalveolar lavage still valuable? ZHAO Ya-bin,LI Zhen-hua 2014, 34(8): 752-755.  DOI: 10.7504/nk2014070105 Abstract ( )   PDF (996KB) ( )   Abstract：Bronchoalveolar lavage (BAL) is widely used in the diagnosis and treatment of interstitial lung disease (ILD).Analysis of BAL fluid could reduce the differential diagnosis scope of ILD and identify confounding conditions such as malignancy，infection or some special types of ILD；BAL is not a necessity for patients with usual interstitial pneumonia shown by high-resolution computed tomography (HRCT).Although HRCT has reduced the needs of BAL for ILD，BAL is still important in diagnosis，differential diagnosis and prognosis of ILD.

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Interpretation of expert consensus 2014 on diagnosis and treatment of malignant pleural effusion. HU Cheng-ping. 2014, 34(8): 765-766.  DOI: 10.7504/nk2014070202 Abstract ( )   PDF (937KB) ( )   Abstract：Malignant pleural effusion(MPE)is a common clinical syndrome which usually caused by pleural mesothelioma，lung cancer，breast cancer，lymphoma and so on.There are multiple methods to diagnose MPE，but the “gold standard” way remains cytological identification of malignant cells within pleural effusion，or the pathology of the pleural biopsy specimen shows pathological manifestations of malignant tumor cells.Many studies shows that continues drainage of malignant pleural effusion becomes a first choice，which is a strong challenge for pleurodesis as the first-line therapy against MPE for years.

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Interpretation of the guideline on prevention of female stroke by AHA/ASH 2014. WU Jian，FENG Juan. 2014, 34(8): 767-770.  DOI: 10.7504/nk2014070203 Abstract ( )   PDF (999KB) ( )   The new guideline from the American Heart Association/American Stroke Association focusing on stroke prevention specifically in women was published online in the Stroke on April 6，2014.This guideline zeroes in on the risk factors unique to women，e.g.，reproductive factors and those more common in women，including migraine with aura，obesity，metabolic syndrome and atrial fibrillation.To more accurately reflect the risk of stroke in women across the lifespan，as well as the clear gaps in current risk scores，a female-specific stroke risk score is warranted.

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Antithrombotic therapy of cervical artery dissection. FANG Qi，ZHAO Hong-ru，DU Juan. 2014, 34(8): 771-773.  DOI: 10.7504/nk2014070301 Abstract ( )   PDF (976KB) ( )   Abstract：Cervical artery dissection is the important cause of ischemic stroke in young adults，resulting in vascular stenosis or occlusion.However，how to treat these patients pharmacologically has made clinicians confused.In recent years，anticoagulant therapy or antiplatelet therapy has become the focus of debate.

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Research progress of thrombosis paroxysmal nocturnal hemoglobinuria HE Guang-sheng. 2014, 34(8): 774-776.  DOI: 10.7504/nk2014070302 Abstract ( )   PDF (971KB) ( )   Abstract：The complement and coagulation systems are closely integrated with each influencing the activity of platelet in paroxysmal nocturnal hemoglobinuria(PNH).Thromboembolism is the most common cause of mortality and morbidity in patients with PNH.When thrombosis in an unusual site,or with evidence of hemolysis,or any cytopenia,testing for PNH by flow cytometry should be done.Activated platelets,release of arginase resulting in NO depletion,release of procoagulant red cell microparticles are related with thrombosis.Low-molecular-weight heparin,and continuing anticoagulation with the vitamin K antagonists is generally recommended.Allogeneic bone marrow transplant has been previously considered but could not improve the survival rate.Eculizumab treatment resulted in a reduction in the thromboembolism events effectively.

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Clinical experience of CMRI in patients with HOCM underwent myocardial alcohol ablation by artificial septal tunnel. GUAN Huai-min，XIE Jin-hong，CHEN Yu-shan，LUO Ming-hua，WANG He，QIU Cheng-jie，ZONG Yong-hua. 2014, 34(8): 777-781.  DOI: 10.7504/nk2014070303 Abstract ( )   Abstract：Objective To explore effect of cardiac MRI(CMRI) in Patients with HOCM underwent myocardial alcohol ablation by artificial septal tunnel.Methods The patients were checked by CMRI as experimental group.Meantime，patients were not checked by CMRI as control group.To determine diameter of myocardial tunnel according to septal thickness，length or depth by location of hypertrophic myocardium in anter-posterior septal，and target vessel of corresponding position by hypertrophic myocardium in basal or internal segment in the experimental group.To determine diameter and depth by cardiac ultrasound and distribution of septal branches in coronary angiography in the control group.To analyze dosage of anhydrous alcohol，level of creatine kinase isoenzyme(CK-MB) 24 hours after operation，sick Q wave in V1-3 leads，complete right bundle branch block(CRBBB)，severe(Ⅱ-Ⅲ) atrioventricular block(AVB) and instant left ventricular outflow tract pressure gradient(LVOTPG)during the operation.To evalue septal thickness，left atrial diameter(LAd)，left ventricular end-diastolic diameter(LVEDd)，left ventricular ejection fraction(LVEF)and aortic transvalvular pressure by cardiac ultrasound 3 months later.Results The dosage of anhydrous alcohol，level of CK-MB 24 hours after operation，CRRRR in and after operation and ratio of sick Q wave in two groups were no significant difference.One patient had Ⅲ0 AVB after operation and recovered totally one week later in control group.Instant LVOTPG in CMRI group was significantly lower(P<0.05).Septal thickness and LAd in CMRI group were significantly(P<0.05，P<0.05)and aortic transvalvular pressure was also less(P<0.05)，however，LVEDd and LVEF were no significant difference(P>0.05)by cardiac ultrasound 3 months later.Conclusion Myocardial alcohol ablation through artificial septal tunnel by CMRI was more superior than ultrasound for patients with HOCM.

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Efficacy and safety of macrolides in treatment of non-cysistic fibrosis bronchiectasis：a meta-analysis. ZHANG Lei，HE Zhi-yi，CHEN Huan，ZHANG Jian-quan，ZHONG Xiao-ning，ZOU Xiao-ying 2014, 34(8): 782-786.  DOI: 10.7504/nk2014070401 Abstract ( )   Abstract：Objective To investigate the efficacy and safety of macrolides therapy for patients with non-cystic fibrosis bronchiectasis.Methods We searched for randomized controlled trials which were published before March 2013 in EMBASE，PubMed，Medline，Chinese National Knowledge Infrastructure (CNKI) Database，Wanfang Data，and Chinese Science and Technology Journal Full-text Database (VIP) databases.Two reviewers independently accomplished the quality assessment and data extraction.Then meta-analysis was performed using Stata 11.0 software.Results Five trials containing 387 participants were involved，and the result indicated a significant reduction of exacerbation patients in macrolides group as compared with that in the placebo group (RR=0.612,95%CI 0.40-0.93).For subgroup analyses，only the treatment of azithromycin significantly decreased the number of exacerbation patients (RR=0.528,95%CI 0.406-0.686).What’s more，therapies lasting more than six months were more conclusive (RR=0.642,95%CI 0.420-0.891).However，the analysis for occurrence of adverse events in macrolides group showed no statistical difference as compared with that in the control group (RR=0.92,95%CI 0.812-1.042，P=0.19).Conclusion Macrolides therapy does provide a significant benefit of reducing exacerbations in patients with bronchiectasis，and patients may benefit more from treatments lasting over 6 months.

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Clinical characteristics and prognosis of plasma cell leukemia. BAO Li*，SHI Yu-wei，LAI Yue-yun，LU Jin，HUANG Xiao-jun. 2014, 34(8): 787-790.  DOI: 10.7504/nk2014070402 Abstract ( )   Abstract：Objective To evaluate the outcomes of patients with plasma cell leukemia (PCL) in the era of novel agents (Bortezomib and Thalidomide).Methods We retrospectively reviewed the outcomes of patients with PCL managed at our institution from May 2009 to November 2013.Responses and side-effects were evaluated.We used SPSS software to calculate survival and the Kaplan-Meier method to estimate survival curves.Results We identified 20 patients with PCL (14 with primary PCL［pPCL］and 6 with secondary PCL［sPCL］) from our institution.The median age at diagnosis of PCL was 56 years (range：31 to 80 years).The median time from diagnosis of multiple myeloma (MM) to sPCL was 4 months (range：4-78 months).Forty percent of patients had renal failure at the time of diagnosis and 85% of patients presented with lytic bone lesions.The most common cytogenetic abnormality was deletion 13q，and 20% of patients had deletion 17p.Fifty percent of patients had more than 3 chromosomal abnormalities.Among the 14 patients treated with bortezomib，5 patients achieved complete remission (CR)，2 patients with very good partial remission (VGPR)，and 3 with partial remission (PR) and the overall response rates (ORR) were 71.4%.Six patients received Thalidomide-based regimens and the ORR were 66.7%，including 1 case of CR，2 cases of VGPR and 1 case of PR.The median overall survival for all patients was 10 months.The median overall survival for patients with pPCL was 20.6，significantly longer than that for patients with sPCL(P=0.048).Bortezomib-treated patients had a better median survival time than thalidomide-treated ones (P=0.178).Conclusion Plasma cell leukemia is an uncommon but aggressive malignancy associated with high-risk cytogenetic abnormalities and frequent organ dysfunction，ultimately resulting in poor prognosis.Bortezomib-containing combinations improve the response rate and prolong survivals of patients as compared with traditional regimens.

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Relationship between sleep architecture disorder and enhancement of liver enzyme levels in patients with obstructive sleep apnea hypopnea syndrome YIN Feng-ting，ZHANG Yan-lin，LI Jie，CAO Yong-jun，CHEN Rui，LIU Chun-feng 2014, 34(8): 791-793.  DOI: 10.7504/nk2014070403 Abstract ( )   Abstract：Objective To investigate the influences of sleep architecture disorder on serum liver enzyme levels in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods We analyzed the sleep parameters of OSAHS patients and the controls diagnosed with polysomnography (PSG) in our hospital.Based on the results of the apnea-hypopnea index (AHI)，OSAHS patients were divided into 3 subgroups (mild，moderate and severe，respectively).Serum liver enzymes and sleep structures were compared between different groups.Correlation analysis was performed between the serum levels of liver enzymes and sleep structure.Results In OSAHS group，AHI，oxygen desaturation index (ODI)，percentage of oxygen saturation <90% of total recording time (Ts90%)，respiration relevant microarousal，longest time of apnea，proportion of NREM stage 1+2 and serum levels of ALT，AST and γ-GGT were significantly higher (P<0.05) while the lowest nocturnal oxygen saturation (L-SaO2) and proportion of slow-wave sleep were significantly lower (P<0.05) than those in the controls (P<0.05).Among OSAHS patients，AHI was significantly different between the 3 subgroups (P<0.05).The differences in Ts90%，respiration relevant microarousal，the longest time of apnea and hypopnea，proportion of NREM stage 1+2，proportion of slow-wave sleep and serum level of ALT and AST were significantly different from those in mild and moderate subgroups (P<0.05).As compared with severe subgroup，serum level of γ-GGT in mild subgroup were significantly elevated (P<0.05).Correlation analysis showed positive correlations between proportion of NREM stage 1+2 and the level of ALT and AST，negative correlations between proportion of slow-wave sleep and the level of ALT，and positive correlations between respiration relevant microarousal and the level of ALT.Conclusion OSAHS patients have sleep architecture disorder and liver damage，and elevated liver enzyme levels are related to disordered sleep architecture.

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Correlations of mycoplasma pneumoniae infection with airway inflammation and asthma control in patients with bronchial asthma. ZHOU A-wang*，DAI Yuan-rong，SHEN Xue-yan，CHEN Zhi-hua，SHEN Hua-hao. 2014, 34(8): 794-796.  DOI: 10.7504/nk2014070501 Abstract ( )   Abstract：Objective To explore the relationship between Mycoplasma pneumoniae infection and asthma control in patients with bronchial asthma，and to find the possible mechanism.Methods A total of 114 asthmatic patients with acute exacerbation and 116 patients in remission stage were selected in this study.Serum IgM and IgG specific to M.pneumoniae were detected in all the patients and the infection rates of M.pneumonia were compared between the two groups of patients.The eosinophilic (EOS) ratio in the sputum，total serum IgE，FEV1% pred and ACT score were also analyzed and compared between the two groups.Results We found that 41.2% of patients with acute exacerbation were infected by M.pneumoniae，significantly higher than that in patients in remission stage (22.4%) (P<0.05).Moreover，the EOS ratio in the sputum and total serum IgE were significantly higher while FEV1% pred and ACT score were significantly lower in patients with M.pneumoniae infection than those in patients without infection.Conclusion M.pneumonia infection cannot be ignored both in patients with acute exacerbation and in remission stage，especially in the former.M.pneumonia infection might enhance eosinophils recuitment，resulting in a bad asthma control.

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Feasibility of investigation on present situation of diagnosis and treatment in basic hospital in China. SUN Ming-li*，ZHANG Rui，NING Ning，SUN Kai，JING Zhi-cheng. 2014, 34(8): 797-800.  DOI: 10.7504/nk2014070502 Abstract ( )   Abstract：Objective To analogize the design rationality of questionnaire about present situation of diagnostic procedure and treatment algorithm in basic hospitals in China，and to analyze the necessity and feasibility of investigation practice.Methods The questionnaire about present situation of diagnostic procedure and treatment algorithm in basic hospitals in China was designed according to the prevalence，diagnostic procedure，treatment algorithm and the cognition on pulmonary hypertension，and answered by the directors in charge of diagnosis and treatment for pulmonary hypertension in 25 basic hospitals from Jinzhong City，Shanxi Province.The answered questionnaires were collected and analyzed.Results Twenty-five questionnaires were handed out and all of them were answered and handed in.The questionnaire involved 29 questions and all the questions can be answered accurately.Twenty-five hospitals included 2 upper second-class hospitals，16 A-level secondary hospitals，2 B-level secondary hospitals and 5 primary hospitals.One to three patients with pulmonary hypertension were diagnosed by noninvasive methods and treated without comprehensive assessment in 18 hospitals (72%).Except for traditional therapy，target therapy with drugs was available only in 3 hospitals (12%).Directors in 17 hospitals thought that questionnaires in Chinese basic hospital were necessary and feasible.Conclusion The design of questionnaire about present situation of diagnostic procedure and treatment algorithm in basic hospitals in China is reasonable.Performance of questionnaire in all over China is necessary and feasible.

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Recurrent risk predictive value in cerebral ischemic stroke on patients with ankle-brachial index and CTA. ZHOU Guo-qiang*，ZENG Jin-sheng，HUANG Zong-qing 2014, 34(8): 801-804.  DOI: 10.7504/nk2014070503 Abstract ( )   Abstract：Objective To explore the recurrent risk predictive value in cerebral ischemic stroke on patients with ankle-brachial index（ABI） and CT angiography（CTA）.Methods Total 465 patients with ischemic stroke were enrolled，arms and legs synchronous atherosclerosis detector was use to measure ABI，and speed 64 spiral CTA was use to measure head and neck region vessel，all patients were followed up for 2 years for observing the recurrence of ischemic cerebral stroke.Recurrence of ischemic cerebral stroke risk factors in 2 years using logistic regression analysis.The recurrent group and non-recurrent group compared with ABI，and the recurrent group and non-recurrent group compared with CTA.Results Low ABI and intracranial and extracranial  arteriarctia were independent prediction factor of the recurrence of ischemic cerebral stroke.The proportion of patients with ABI＜0.9 in recurrent group significantly higher than non-recurrent group（P=0.017）.The proportion of patients with intracranial and extracranial  arteriarctia in recurrent group significantly higher than non-recurrent group（P=0.001）.The proportion of patients in recurrence group accompanied by ABI＜0.9 and intracranial and extracranial arteriarctia is higher than the non-recurrent group（P<0.05）Conclusion The ABI and the head and neck region CTA changes in recurrence of ischemic stroke risk have predictive value，and the better the predictive value of their combination.Ischemic cerebral stroke patients accompanied by low ABI and intracranial and extracranial  arteriarctia are more likely to recurrent.Low ABI and intracranial and extracranial  arteriarctia were independent prediction factor of the recurrence of ischemic cerebral stroke.

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Antidepressant treatment for elderly inpatients in geriatric ward：an analysis of 77 cases YAN Xue-lian，KANG Lin，ZENG Ping，QU Xuan，HONG Xia，LIU Xiao-hong 2014, 34(8): 805-807.  DOI: 10.7504/nk2014070601 Abstract ( )   Abstract：Objective To explore the safety of antidepressants in treatment of elderly patients and provide a basis for rational use of medication.Methods A retrospective chart review was conducted on 77 inpatients aged over 65 years treated with antidepressants in Geriatric Ward of our hospital.Data on medications，initial doses and adverse reactions were collected and analyzed.Results All patients were treated with the second-generation antidepressants after consultation by multidisciplinary geriatric team.Sertraline was the most common medication.Most of the patients with a lower body mass index (BMI) chose mirtazapine.Half of the patients with chronic pain chose to use SNRIs.Seventy patients took antidepressants after hospitalization，72.8% of them with a low initial dose.The incidence of adverse reaction was 8.6% (6/70).Conclusion Healthy problems of the elderly patients，characteristics of medications，adverse reactions and drug-drug interactions may be taken into consideration for the right choice of an antidepressant.