To investigate the relationship between obstructive sleep apnea hypopnea syndrome (OSAHS) severity and fat, bone, and muscle indices. This study included 102 patients with OSAHS and retrospectively reviewed their physical examination data. All patients underwent polysomnography, body composition analysis, dual-energy X-ray absorptiometry, computed tomography (CT) and blood test. Correlation and multiple linear regression analyses were performed using SPSS 22.0. Among the fat indices, fat mass (FM) (r = 0.27–0.43), body fat percentage (BFP) (r = 0. 25–0.35), visceral fat area (VFA) (r = 0.28–0.40) and trunk fat mass (TFM) (r = 0.26–0.34) were positively correlated with hypopnea index (HI), apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and percent of time spent with oxygen saturation below 90

BACKGROUND AND OBJECTIVE:As a well-established inflammatory biomarker, leukocyte count is associated with higher mortality in acute pulmonary embolism (PE). We aimed to confirm the prognostic utility of leukocyte count and its integration with simplified Pulmonary Embolism Severity Index (sPESI) for predicting all-cause hospital mortality in acute PE. METHODS:Data derived from a national, multicentre and prospective registry including patients with acute PE were analysed to develop and validate an in-hospital mortality prediction model incorporating leukocyte count and sPESI. Mendelian Randomisation (MR) was performed to assess the relationship between leukocyte count and mortality. RESULTS:A total of 7312 PE patients were stratified into three groups based on admission leukocyte count: < 4 × 109/L (n = 301, 4.1%), (4-10) × 109/L (n = 5074, 69.4%) and > 10 × 109/L (n = 1937, 26.5%). Patients with leukocytosis exhibited a higher prevalence of anaemia, thrombocytopenia, hypoxemia, cardiac and renal injury, as well as haemodynamic instability. The in-hospital all-cause mortality was 3.0%, 2.3% and 6.4% (p < 0.001) across the three groups, respectively. The area under the curve (AUC) of sPESI was 0.719 (95% CI 0.681-0.756, p < 0.001), increasing to 0.738 (95% CI 0.701-0.775, p < 0.001) when combined with leukocyte count groups. The prognostic value of leukocyte count and its combination with sPESI was validated in a cohort with 7660 PE patients. MR analysis demonstrated that elevated leukocyte counts increased mortality risk (OR = 1.11, 95% CI 1.00-1.24, p = 0.047). CONCLUSION:Admission leukocyte count enhances the prognostic accuracy of sPESI for in-hospital all-cause mortality in PE. Leukocyte count could serve as a potential biomarker for identifying PE patients at increased mortality risk.

Isavuconazole has been used to treat invasive fungal infections, however, it is unclear whether the efficacy of isavuconazole is superior to that of voriconazole. The purpose of this meta-analysis was to assess the efficacy and safety of isavuconazole compared to voriconazole in treating invasive fungal infections. Electronic databases, including PubMed, EMBASE, Cochrane Library, and Web of Science, were searched to identify relevant studies. Studies evaluating the effect of isavuconazole in the treatment of patients with invasive fungal infections were included. Pooled rates of overall response, all-cause mortality, drug-related adverse events (AEs), and discontinuation due to drug-related AEs were calculated. Seven studies involving 890 patients were included. Meta-analysis showed that there was no significant difference between isavuconazole and voriconazole in overall response (risk ratio [RR]: 1.02, 95

Background Clinical characteristics of patients with pulmonary thromboembolism have been described in previous studies. Although very old patients with pulmonary thromboembolism are a special group based on comorbidities and age, they do not receive special attention. Objective This study aims to explore the clinical characteristics and mortality predictors among very old patients with pulmonary thromboembolism in a relatively large population. Design and participants The study included a total of 7438 patients from a national, multicenter, registry study, the China pUlmonary thromboembolism REgistry Study (CURES). Consecutive patients with acute pulmonary thromboembolism were enrolled and were divided into three groups. Comparisons were performed between these three groups in terms of clinical characteristics, comorbidities and in-hospital prognosis. Mortality predictors were analyzed in very old patients with pulmonary embolism. Key results In 7,438 patients with acute pulmonary thromboembolism, 609 patients aged equal to or greater than 80 years (male 354 (58.1%)). There were 2743 patients aged between 65 and 79 years (male 1313 (48%)) and 4095 patients aged younger than 65 years (male 2272 (55.5%)). Patients with advanced age had significantly more comorbidities and worse condition, however, some predisposing factors were more obvious in younger patients with pulmonary thromboembolism. PaO2 < 60 mmHg, eGFR < 60 mL/min/1.73m2, malignancy, anticoagulation as first therapy were mortality predictors for all-cause death in very old patients with pulmonary thromboembolism. The analysis found that younger patients were more likely to have chest pain, hemoptysis (the difference was statistically significant) and dyspnea triad. Conclusion In very old population diagnosed with pulmonary thromboembolism, worse laboratory results, atypical symptoms and physical signs were common. Mortality was very high and comorbid conditions were their features compared to younger patients. PaO2 < 60 mmHg, eGFR < 60 mL/min/1.73m2 and malignancy were positive mortality predictors for all-cause death in very old patients with pulmonary thromboembolism while anticoagulation as first therapy was negative mortality predictors.

Objectives There are conflicting data concerning the prognostic significance of syncope in acute pulmonary embolism (PE). This study aimed to investigate the impact of syncope on clinical outcomes of acute PE, and determine the clinical phenotypes of PE patients with syncope and their correlation with prognosis. Methods In the ongoing, national, multicenter, registry study, the China pUlmonary thromboembolism REgistry Study (CURES) enrolling consecutive patients with acute PE, patients with and without syncope were investigated. Principal component analysis (PCA) was performed using nine variables relevant to syncope and PE, including age, sex, body mass index, history of cardiovascular disease, recent surgery or trauma, malignancy, pulse, systolic blood pressure, and respiratory rate. Patient classification was performed using cluster analysis based on the PCA-transformed data. The clinical presentation, disease severity and outcomes were compared among the phenotypes. Results In 7,438 patients with acute PE, 777 (10.4%) had syncope, with younger age, more females and higher body mass index. Patients with syncope had higher frequency of precordial pain, palpitation, and elevated cardiac biomarkers, as well as higher D-Dimer level. In the syncope group, more patients had right ventricular/left ventricular ratio > 0.9 in ultrasonic cardiogram and these patients had higher estimated pulmonary arterial systolic pressure compared with patients without syncope. As the initial antithrombotic treatment, more patients with syncope received systemic thrombolysis. Despite a higher prevalence of hemodynamic instability (OR 7.626, 95% CI 2.960–19.644, P < 0.001), syncope did not increase in-hospital death. Principal component analysis revealed that four independent components accounted for 60.3% of variance. PE patients with syncope were classified into four phenotypes, in which patients with high pulse and respiratory rate had markedly higher all-cause mortality during admission. Conclusion Syncope was associated with hemodynamic instability and more application of thrombolysis, without increasing in-hospital deaths. Different clinical phenotypes existed in PE patients with syncope, which might be caused by various mechanisms and thus correlated with clinical outcomes.

Abstract Background Renal function is associated with prognoses for acute pulmonary embolism (PE). Objective To investigate the application of anticoagulants and dosage of LMWH among patients with renal insufficiency (RI), and the association between LWMH dosage and the patients’ in-hospital outcomes. Methods Adult patients diagnosed with non-high risk acute PE from 2009 to 2015, with available data of creatinine clearance (CCr) were enrolled from a multicenter registry in China. Renal insufficiency (RI) was defined as CCr < 60 ml/min. LMWH dosage was converted into IU/kg daily dose and presented as adjusted dose (≤ 100 IU/kg/day) and conventional dose (> 100 IU/kg/day). All-cause death, PE-related death and bleeding events during hospitalization were analyzed as endpoints. Results Among the enrolled 5870 patients, RI occurred in 1311 (22.3%). 30 ≤ CCr < 60 ml/min was associated with higher rate of bleeding events and CCr < 30 ml/min was associated with all-cause death, PE-related death and major bleeding. Adjusted-dose LMWH was applied in 26.1% of patients with 30 ≤ CCr < 60 ml/min and in 26.2% of CCr < 30 ml/min patients. Among patients with RI, in-hospital bleeding occurred more frequently in those who were administered conventional dose of LMWH, compared with adjusted dose (9.2% vs 5.0%, p = 0.047). Adjusted dose of LMWH presented as protective factor for in-hospital bleeding (OR 0.62, 95%CI 0.27–1.00, p = 0.0496) and the risk of bleeding increased as length of hospital stay prolonged (OR 1.03, 95%CI 1.01–1.06, p = 0.0014). Conclusions The proportion of adjusted usage of LMWH was low. The application of adjusted-dose LMWH was associated with lower risk of in-hospital bleeding for RI patients, in real-world setting of PE treatment. Anticoagulation strategy for RI patients should be paid more attention and requires evidence of high quality. Trial Registration The CURES was registered in ClinicalTrias.gov, identifier number: NCT02943343 .

目的 探究急性高碳酸血症呼吸衰竭(AHRF)老年患者应用无创通气(NIV)治疗失败的相关因素.方法 回顾性分析2015年8月至2017年8月在北京医院因AHRF行NIV治疗的100例老年住院患者资料,根据患者治疗结果分为NIV失败组和NIV成功组,应用Logistic回归分析AHRF老年患者NIV治疗失败的相关因素.结果 100例患者中男性53例(53.0％),平均年龄(79.4±6.4)岁,其中43例(43.0％)患者应用NIV治疗失败.NIV治疗前合并重症肺炎(OR=5.109,95％CI:1.203～21.702,P=0.027)、胸部 X 线片示病变浸润≥3个象限(OR=5.903,95％CI:1.514～23.013,P=0.011)和 SAPS Ⅱ≥34分(OR=7.046,95％CI:2.164～22.944,P=0.001)是AHRF老年患者NIV治疗失败的独立相关因素.结论 AHRF老年患者应用NIV治疗存在失败风险,NIV治疗前合并重症肺炎、胸部X线片示病变浸润≥3个象限和SAPS Ⅱ≥34分是AHRF老年患者NIV治疗失败的独立相关因素,NIV应用前综合评估对预防NIV治疗失败非常重要.

Similar trends of management and in-hospital mortality of acute pulmonary embolism (PE) have been reported in European and American populations. However, these tendencies are not clear in Asian countries. We retrospectively analysed the trends of risk stratification, management and in-hospital mortality for patients with acute PE through a multicentre registry in China (CURES). Adult patients with acute symptomatic PE were included between 2009 and 2015. Trends in disease diagnosis, treatment and death in hospital were fully analysed. Risk stratification was retrospectively classified by haemodynamic status and the simplified Pulmonary Embolism Severity Index (sPESI) score according to the 2014 European Society of Cardiology/European Respiratory Society guidelines. Among 7438 patients, the proportions with high (haemodynamic instability), intermediate (sPESI≥1) and low (sPESI=0) risk were 4.2%, 67.1% and 28.7%, respectively. Computed tomographic pulmonary angiography was the most widely used diagnostic approach (87.6%) and anticoagulation was the most frequently adopted initial therapy (83.7%). Between 2009 and 2015, a significant decline was observed for all-cause mortality (from 3.1% to 1.3%, adjusted p for trend =0.0003), with a concomitant reduction in the use of initial systemic thrombolysis (from 14.8% to 5.0%, p for trend <0.0001). The common predictors for all-cause mortality shared by haemodynamically stable and unstable patients were co-existing cancer, older age and impaired renal function. The considerable reduction of mortality over the years was accompanied by changes in initial treatment. These findings highlight the importance of risk stratification-guided management throughout the nation.

目的 总结北京医院老年流行性感冒(流感)患者的临床特点及分析并发脓毒症的影响因素.方法 收集2017年10月至2018年3月该院老年病区确诊为流感的47例老年患者的临床和实验室资料,回顾性分析老年流感患者的临床特点,比较甲乙型流感的临床特点,并探讨流感并发脓毒症的影响因素.结果 47例老年流感患者以发热、咳嗽和咳痰为主要症状,比例分别为91.5％、74.5％和66.0％.使用磷酸奥司他韦治疗后,第48小时平均体温[(37.3±0.8)℃]较第24小时[(38.3±0.8)℃]有显著下降(t=5.732,P=0.000);分组比较,甲型流感[(78±18)mm Hg]和乙型流感[(63±7)mm Hg]在诊断时动脉血氧分压(PaO2)差异有统计学意义(t=2.428,P=0.034).并发脓毒症组与非脓毒症组单因素分析发现,年龄≥80岁,合并冠心病、慢性心功能不全、慢性阻塞性肺疾病(慢阻肺),并发全身炎症反应综合征(SIRS),喘息症状、C反应蛋白、呼吸频率>20次以及无创通气治疗差异有统计学意义.多因素logistic回归分析发现,合并冠心病(β=3.924,P=0.016)、慢阻肺(β=3.232,P=0.034)及喘息症状(β=6.158,P=0.010)是出现脓毒症的独立影响因素.结论 老年患者流感多以发热和呼吸道症状为主,磷酸奥司他韦治疗48 h后体温显著降低.合并冠心病、慢阻肺和出现喘息症状是患者并发脓毒症的独立影响因素.

Objective:To increase the understanding of neuroleptic malignant syndrome, rhabdomyolysis and acute renal injury in advanced-aged patients with Parkinson's disease after abdominal surgery.Methods:We report a case of malignant syndrome, rhabdomyolysis and acute renal injury in an 85-year-old patient with Parkinson's disease after abdominal surgery in our department.The diagnosis and successful treatment experience were summarized, and a literature review was conducted.Results:The body temperature was as high as 40.5℃ in this patient, accompanied by stiffness, sustained involuntary shaking, increased muscle tone, serum creatine kinase at 104 615 U/L, tachycardia, low blood pressure, accelerated breathing rate, disturbance of consciousness, excessive sweating and other clinical manifestations, which met the diagnostic criteria for neuroleptic malignant syndrome.The patient had complications including concurrent rhabdomyolysis, acute renal injury and shock.The emergency was resolved after an early diagnosis and proactive treatment.Conclusions:If patients with Parkinson's disease have a high fever with rigidity or sudden aggravation within a short period of time after medication, the possibility of neuroleptic malignant syndrome should be considered and the causes should be screened.

Acute respiratory failure (ARF) is a fatal respiratory critical illness, in which treatment it is essential to correct oxygen deficiency and reduce complications.In recent years, non-invasive ventilation has developed rapidly and become one of the most important developments in the field of mechanical ventilation, which is increasingly used in the treatment of ARF.However, some patients with ARF who have not been properly screened and evaluated have limited benefits from noninvasive ventilation therapy, with ultimately required endotracheal intubation or death.Many factors have been found in the clinical application process that can affect the therapeutic effect of noninvasive ventilation.This article is aimed to analyze and summary the risk factors related to the failure of noninvasive ventilation in the treatment of ARF, including the aspects of demographic data, patients′ general state and physiological parameters, ventilator related factors and etc.

目的 探讨老年人流行性感冒(简称流感)的临床特征.方法 收集2017年10月至2018年3月北京医院老年病区确诊的甲型流感和乙型流感老年患者的临床和实验室资料进行分析.结果 47例老年流感患者的总体临床特征:平均年龄(86.47±11.62)岁,近50％的患者合并心脑血管疾病和慢性阻塞性肺疾病;91.5％的患者有发热,最高平均体温为(38.34±0.75)℃,以中低热为主.咳嗽、咳痰的比例分别为74.5％、66.0％.平均氧合指数(283.94±65.93)mmHg.使用奥司他韦治疗后,第2天平均体温明显下降至(37.34±0.77)℃,第3天平均体温降至正常(36.96±0.62)℃,住院病死率为2.1％.年龄≥90岁老人组住院率(100％)和60～<90岁老人组住院率(74.1％)比较,差异有显著性(P=0.015)、需无创通气支持率差异有显著性.≥90岁老人组脓毒症概率更高和第7天治愈率更低.结论 老年患者流感多表现为中、低热,以呼吸道症状为主,病程初期即可出现明显低氧血症.年龄≥90岁老年人组有更高的住院率,需更多的无创呼吸机支持治疗.

Background: Epidemiological data on pulmonary embolism (PE) in China needs to be updated and reported. The China Pulmonary Thromboembolism Registry Study (CURES) is designed to provide the cross-sectional spectrum and chronological trends of PE in China, as well as to reveal the intrinsic etiology and pathogenesis of the disease. Methods and design: The CURES is an ongoing large prospective multicenter registry, which was originally initiated in January 2009 via enrolling suspected or confirmed PE or PE with DVT (deep venous thrombosis) patients and assessed their in-hospital outcomes. As of July 2011, in order to determine the PE-relevant short-term outcomes, enrolled participants were followed-up for at least three months in a longitudinal manner. Since August 2016, with the launch and development of precision medicine research scheme in China, the main principle investigators of CURES decided to collect enrolled patients' blood samples with regular follow-ups every three or six months for at least two years (for long-term outcomes). Up to 31 December 2019, the CURES has enrolled 14,937 eligible patients and collected 1500 blood samples of patients from 100 medical centers in the China PE-DVT network. The study protocol has been approved by the China-Japan Friendship Hospital ethics committee, and all collaborating centers received approvals from their local ethics committee. All patients provided written or verbal informed consent to their participation.

Objective:To analyze and summarize adverse reactions such as hypoglycemia, lactic acidosis and pancytopenia caused by Linezolid in elderly patients, in order to enhance clinicians' awareness of adverse reactions of Linezolid.Methods:One case with Linezolid-induced lactic acidosis, pancytopenia and hypoglycemia was reported in a patient receiving long-term and repeated use of Linezolid for recurrent urinary tract infections(RUTI)in Beijing Hospital.National and international literature on the three severe and rare adverse reactions caused by Linezolid before December 2018 was reviewed, and the risk factors, clinical characteristics and prognosis of the three severe adverse reactions caused by Linezolid were summarized and analyzed.Results:A total of 86 cases with Linezolid-induced adverse reactions such as hypoglycemia, lactic acidosis and pancytopenia were analyzed.Among them, the ratio of males to females was 1.8∶1.0, the median age was 64.5 years, and 44 cases were over 65 years, accounting for 51.2%.Among the 57 patients with lactic acidosis, 25 lactic acidosis cases were combined with liver and kidney diseases, which were the most commonly involved organs(43.9%, 25/57). The time of onset for lactic acidosis was 4 h-109 d, with a median value of 32 d, and the peak values of blood lactate were 2.6-38.1 mmol/L, with a median value of 13.3 mol/L.Pancytopenia occurred 4 h-120 days after the treatment, and the median value was 21 days.The time of onset for hypoglycemia was 8 h-26, and the median time was 10.3 days.The lowest value of blood glucose was 0.2 mmol/L.Of the 86 cases, 61(70.9%)patients improved, and 12 cases of 51 patients with lactic acidosis died, with a mortality rate of 23.5%.Conclusions:Clinicians should be aware of serious adverse reactions including hypoglycemia, lactic acidosis and pancytopenia during Linezolid treatment in elderly patients.It is recommended to monitor changes in blood glucose, blood lactate and blood cell count during Linezolid treatment, and to avoid long-term use of Linezolid, so as to maximize the benefits for patients.

Objective To investigate clinical features and prognosis of patients with cancerrelated isolated distal deep vein thrombosis(IDDVT).Methods Data of 64 patients with malignant tumor complicated with IDDVT at our hospital from January 2003 to January 2013 were retrospectively analyzed for the clinical features and prognosis.Results Among the 64 patients,32 male and 32 female cases were involved,aged 37 to 87 years,average(66.0 ± 12.6) years.There were 42 cases aged 65 years and older and 22 cases aged under 65 years.The IDDVT involved veins of lower extremity in 64 patients,unilaterally (47/64)or bilaterally (17/64).The intermuscular veins were involved by IDDVT in 46 cases(71.9％).Posterior tibial veins were involved in 17 cases(26.6％),peroneal veins were involved in 14 cases(21.9％),anterior tibial veins were involved in 2 cases (3.1 ％).Common symptoms were swollen lower extremity and pain (53.1％).Bleeding occurred in 2 (3.6 ％) of the 55 patients(55/64,85.9 ％) who underwent anticoagulant therapy,and no major bleeding occurred.The cumulative incidence of IDDVT at 3,6,and 12 months after tumor diagnosis was 64.0％ (41/64 cases),75.0 ％ (48/64 cases) and 85.9 ％ (55/64 cases),respectively.The cumulative incidences of IDDVT at 3 and 6 months were higher after diagnosis of lung cancer than after diagnosis of digestive tract tumors(P =0.005 and 0.035).By the end of follow-up(a median follow-up of 13.0 months),30 patients(46.9 ％)died.The mortality rate was lower in the non-elderly group than in the elderly group (22.7％ vs.59.5％,x2 =7.850,P=0.005).The mortality rate was lower in patients with stage Ⅰ-Ⅲa than in patients with stage Ⅲb-Ⅳ(24.0％ vs.68.8％,x2=11.246,P=0.001).The mortality rate was lower in patients with gynecologic tumors(10.0％) than in patients with lung cancer(55.6％),digestive tract tumors (40.0％) and hematologic tumors (71.4％) (P =0.041,0.037 and 0.035,respectively).TNM Ⅲ b-Ⅳ (OR =8.42,95 ％ CI:1.93-30.00,P =0.004) and age ≥ 65 years (OR =6.28,95％CI:1.50-27.76,P=0.012)were independent risk factors for death.Conclusions Cancerassociated IDDVT most commonly involves the intermuscular veins.The incidence of hemorrhage after anticoagulant therapy is low.For patients without anticoagulation contraindications,active anticoagulant therapy should be recommended.The advanced cancer and old age are independent risk factors for cancer-related IDDVT death.

目的 分析伴有咯血的肺血栓栓塞(PTE)患者临床特征和住院期间预后.方法 纳入2010年1月至2015年1月北京医院住院的急性PTE患者220例,采集患者的基线特征、临床表现、实验室检查、影像学表现、治疗情况和住院转归(含病死率和出血发生率);按是否伴有咯血分为咯血组和无咯血组,比较两组患者临床特征和预后的差异.结果 220例患者中,16例(7.3％)伴有咯血,204例(92.7％)不伴咯血.咯血组年龄显著小于无咯血组[(59.7±16.6)岁对(67.2±13.6)岁,P=0.037],男性更多见(75.0％对44.6％,P=0.034).与无咯血患者相比,咯血组患者发热和胸痛发生率较高(分别为31.3％对11.3％,P=0.037;50.0％对26.0％,P=0.039).咯血组平均确诊时间为(8.91±6.09)d.咯血组患者放置下腔静脉滤器(IVCF)的比例更高(18.8％对3.4％,P=0.028).两组患者的危险程度和住院病死率差异无统计学意义.结论 PTE引起的咯血缺乏特异性,常导致误诊或诊断延误,尽早明确诊断,有助于正确的治疗,减少不当措施带来的不良后果.

Abstract Background Rapid stratification and appropriate treatment on admission are critical to saving lives of patients with acute pulmonary embolism (PE). None of the clinical prediction tools perform well when applied to all patients with acute PE. It may be important to integrate respiratory features into the 2014 European Society of Cardiology model. First, we aimed to assess the relationship between the arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FIO2) ratio and in-hospital mortality, determine the optimal cutoff value of PaO2/FIO2, and determine if this value, which is quick and easy to obtain on admission, is a predictor of in-hospital mortality in this population. Second, we aimed to evaluate the potential additional determinants including laboratory parameters that may affect the in-hospital mortality. We hypothesized that the PaO2/FiO2 ratio would be a clinical prediction tool for in-hospital mortality in patients with acute PE. Methods A prospective single-center observational cohort study was conducted in Beijing Hospital from January 2010 to November 2017. Arterial blood gas analysis data captured on admission, clinical characteristics, risk factors, laboratory data, imaging findings, and in-hospital mortality were compared between survivors and non-survivors. The area under the receiver operating characteristic curve (AUC) for in-hospital mortality based on the PaO2/FiO2 value was determined, and the association between the parameters and in-hospital mortality was analyzed by using logistic regression analysis. Results Body mass index, history of cancer, PaO2/FiO2 value, pulse rate, cardiac troponin I level, lactate dehydrogenase level, white blood cell count, D-dimer level, and risk stratification measurements differed between survivors and non-survivors. The optimal cutoff value of PaO2/FiO2 for predicting mortality was 265 (AUC = 0.765, P < 0.001). Only a PaO2/FiO2 ratio < 265 (95% confidence interval [CI] 1.823–21.483, P = 0.004), history of cancer (95% CI 1.161–15.927, P = 0.029), and risk stratification (95% CI 1.047–16.957, P = 0.043) continued to be associated with an increased risk of in-hospital mortality of acute PE. Conclusion A simple determination of the PaO2/FiO2 ratio at <265 may provide important information on admission about patients’ in-hospital prognosis, and PaO2/FiO2 ratio < 265, history of cancer, and risk stratification are predictors of in-hospital mortality of acute PE.

Objective To explore the incidence,clinical characteristic and outcome of malignancy surgical patients with venous thromboembolism (VTE).Methods The clinical data of sixty-eight malignancy surgical cases who suffered from VTE during the postoperative 90 days and hospitalized from January 2003 to April 2013 at Beijing Hospital were reviewed.Results There were 10 967 cases of malignancy surgeries during the observed ten years and 68 cases suffered from VTE during the postoperative 90 days (incidence was 0.62 ％),including gynecological malignancy,lung cancer,urinary system malignancy,digestive tract malignancy,breast cancer and hematological malignancy.Gynecological malignancy and lung cancer had the highest VTE incidence (1.03％ and 0.95％ respectively),there was significant difference with the other types (all P ＜0.05).Among 68 patients,31 cases of male and 37 cases of female were involved,with an average age of (63.94±10.50) years old,average postoperative time of (33 ± 30) days,average anesthesia duration of (172.75± 104.71) minutes,including 29 cases (42.65％) with cardiovascular diseases,34 cases (50.00％) immobilized more than three days after operation,40 cases (58.82 ％) with middle and low differentiation carcinoma in pathology,and 51 cases (75.00％) with Caprini score equal or greater than five.There were 36 cases in elderly group (≥65 years old)and 32 cases in non-elderly group (＜65 years old).Compared with non-elderly group,the body mass index was lower (t =-2.052,P =0.044),Caprini score (t =2.613,P =0.011),D-dimer (Z =-1.976,P =0.048),and incidence of late-onset VTE (occurring in postoperative 5-12 weeks)(x2=8.438,P =0.004) were higher in elderly group.All the three cases of fetal pulmonary thromboembolism were late-onset VTE patients in elderly group without any prophylactic measures.Conclusions The incidence of VTE in malignancy surgery patients during the postoperative 90 days is 0.62％.Gynecological malignancy and lung cancer are the most common types.The observation time for the VTE events should be extended to 12 weeks after surgery in elderly patients,as fetal pulmonary thromboembolism may occur during postoperative 5-12 weeks.

Objective To observe the clinical features of death cases which caused by tuberculosis.Methods This study was performed retrospectively with data collected over the years 1980 to 2015 in Beijing hospital.There were 11 disseminated TB patients diagnosed by autopsy,none of them was correctly diagnosed before death.Clinical data and autopsy result were recorded to analyze the causes of misdiagnosis.Results Male/female ratio was 2.7 ∶ 1.The average age was 73.09 ± 13.38.Four cases were long-term health care residents,nine cases suffered from other chronic diseases.Multiple organs were found with diffused granulomatous nodule and caseous necrosis in autopsy.The main cause of death was hematogenous disseminated tuberculosis.The common involved organs were lung (100％),spleen (91 ％) and liver (82 ％).Fever (10 eases) and fatigue (8 cases) were the most common symptoms,while cough and sputum were not serious.Pulmonary rales (7 cases) and hepatosplenomegaly (7 cases) were the most common signs.Chest X-ray was done in 9 cases and all were negative for typical evidence of miliary TB.TB related specific tests were done in 6 cases and all negative.Conclusions The main cause of TB death is hematogenous disseminated pulmonary tuberculosis with extra pulmonary tuberculosis.Elderly people are easy to be affected.Clinical symptom and imaging are atypical.Positive rate for auxiliary exam is low.Both lead to difficulties in early diagnosis and poor prognosis.

Objective To study the sources of emboli in patients with pulmonary embolism diagnosed by autopsy,and therefore to provide help in the diagnosis and treatment of thromboembolism.Methods We retrospectively analyzed the pathology and clinical data of 43 patients with pulmonary embolism diagnosed by autopsy from 1962 to 2012 in Beijing Hospital.Results In patients with pulmonary embolism diagnosed by autopsy,32.6％ of the emboli came from deep veins of the lower extremities,9.3％ from the renal vein,9.3％ from the prostate sinus,7.0％ from the venous plexus around the prostate,7.0％ from the hepatic vein and 7.0％ from the submucosal vein of the bladder.Other sources included the right atrium 4.7％,portal vein 4.7％,pancreatic peripheral vein 4.7％,prostate,heart,esophageal vein 4.7％,right common iliac vein 2.3％,right upper limb brachial vein 2.3％.No source of emboli was found in 4.7％ patients with pulmonary embolism.Non-lower extremity deep vein emboli accounted for 60.5％.Only 9.3％ of the cases were diagnosed with pulmonary embolism with deep vein thrombosis before death.Conclusion There was a wide range of sources of emboli in patients with pathologically proven pulmonary embolism.Although the deep veins of lower extremities are the most common,more than 60％ of the emboli came from the renal vein,prostate vein,hepatic vein and other abdominal or pelvic veins,the heart,and the upper extremity deep veins.In addition to the lower extremity deep veins,other sources of emboli should be actively examined when the patient was diagnosed with acute pulmonary embolism.