Pneumocystis jirovecii is a ubiquitous opportunistic fungus that can cause life-threatening pneumonia. The clinical manifestations of pneumonia caused by severe acute respiratory syndrome coronavirus 2 and P. jirovecii are similar, posing a significant challenge in the diagnosis of P. jirovecii pneumonia or coronavirus disease 2019. Herein, we report a case of P. jirovecii pneumonia diagnosed through bronchoalveolar lavage and sputum smear analyses. The patient recovered successfully and was discharged following combination therapy with trimethoprim/sulfamethoxazole and corticosteroids. Early diagnosis and prompt treatment are of vital importance in managing P. jirovecii pneumonia, particularly in individuals with related risk factors for P. jirovecii pneumonia development.

脓毒症是一种严重危及生命的器质性功能障碍疾病,其发生发展过程中身体对感染的反应是造成组织损伤和器官功能衰竭的重要原因.脓毒症诱导的心功能障碍(SIMD)是脓毒症的常见并发症,约 50％的脓毒症患者会出现心肌功能障碍的表现.心功能受损程度对于脓毒症至关重要,因为它是疾病治疗方法选择及预后的重要评价指标.古代医籍多将SIMD归属于"温热病"的范畴,后世医家对该病病因病机和治则治法提出了诸多理论,临证中取得了良好的临床效果.随着医学的发展,中医药在SIMD治疗中越来越发挥重要作用.现从心肌肾上腺素能反应、能量代谢、收缩功能改变等方面阐述SIMD的发病机制,并对SIMD中西医治疗进行初步探讨,以期为SIMD的治疗提供参考.

根据伏邪温病理论并结合治疗脓毒症的临床实践经验,认为"伏邪久藏"为诱发脓毒症之潜在病因;"邪热内伏,瘀毒阻络,内外合邪"是脓毒症的发病之机;余邪深伏,正虚邪恋,致脓毒症合并持续炎症-免疫抑制-高分解代谢综合征(PICS)等不良预后.治疗上以"清、透、养"为大法,运用"清法"清除体内毒邪,"透法"透邪散热、开达通路、清剿余邪,"养法"扶正祛邪外出、顾护脾肾和阴液,防止脓毒症向PICS转变.

Background It is commonly observed that a higher target of mean arterial pressure (MAP) is in previous studies. This study assessed the association of MAP with short-term mortality in heart failure (HF) patients. Methods A retrospective cohort study was conducted by using data from Hospitalized patients with heart failure: integrating electronic healthcare records and external outcome database (v1.2 ). The characteristic of patients was described by 3 groups of MAP: below 80 mmHg, 80–100 mmHg, and above 100 mmHg. Univariate and multivariate logistic regression analyses were used to assess the relevance between MAP and all-cause mortality within 28 days and 6 months. For assessing the effect of multiple variables on patient survival time, 28-day and 6-month, Kaplan–Meier survival analysis and Forest plot were performed. Results The overall cohort comprised 2008 patients divided by MAP into 3 groups, each group had 344 (17.1%), 938 (46.7%), and 726 (36.2%) patients. Patients in MAP < 80 mmHg group had higher mortality than MAP 80-100 mmHg and MAP ≥ 100 mmHg in 28 days(3.8% versus 1.6% versus 1.2%) and in 6 months (4.9% versus 2.5% versus 2.3%). Univariate analysis showed that MAP as a continuous variate was associated with 28-day (OR was 0.98, 95% CIs: 0.96–0.99, P = 0.011) and 6-month mortality (OR was 0.98, 95% CIs: 0.97–1, P = 0.021) in HF patients. Model 4 put into multivariate logistic regression analyses showed MAP 80-100 mmHg (OR was 0.13, 95% CIs: 0.02–0.8, P = 0.027) stably associated with 28-day and 6-month mortality after adjusted covariable. Kaplan–Meier survival curves revealed a higher survival rate in the MAP ≥ 80 mmHg group than in the MAP < 80 mmHg group. The forest plot showed the stable effect of MAP ≥ 80 mmHg compared with MAP < 80 mmHg, the interaction analysis had no statistical significance effect between the two groups of MAP and multi-variable. Conclusion It is indicated that MAP was independently associated with 28-day, 6-month all-cause mortality of HF patients, and compared with MAP < 80 mmHg, MAP ≥ 80 mmHg had a lower risk of 28-day, 6-month all-cause mortality of patients with HF.

目的 观察益气通络方对心衰急性期患者在院期间生存及容量管理情况的影响.方法 回顾性收集407例于2016年1月至2023年2月诊断为心衰并在急诊或ICU住院的心衰患者的临床资料,以Cox回归分析评估使用益气通络方对心衰急性期患者院内生存的影响情况,以线性回归分析评估其对患者在院期间容量管理的相关性.结果 通过多因素Cox回归分析,使用益气通络方(HR益气通络=0.294,P=0.000)、合并休克(HR休克=2.098,P=0.005)、使用血管活性药物(HR血管活性药=13.951,P=0.000)、使用呼吸支持(HR呼吸支持=3.337,P=0.000)与重症心衰患者发生院内死亡的相关性具有统计学意义.针对日均净出量进行多因素线性回归分析,使用益气通络方与日均净出量增加呈正相关,相关性具有统计学意义(β=0.130,P=0.021).结论 使用益气通络方有利于改善急性心衰患者院内生存情况,并有助于心衰患者在院期间进行容量负平衡管理.

Objective:With the rapid increase in the number of real world studies, especially the use of health data in medical institutions, ethical issues such as the use of patient health data and the protection of patient′s privacy rights and the right to know have been gradually exposed. To strike a good balance between promoting data sharing and maintaining subjects′ personal privacy, the mode of informed consent appears to be crucial. This paper provided guidance for the selection of informed consent models for real world research health data utilization.Methods:The authors extensively studied the relevant laws and regulations of health data utilization worldwide, conducted extensive searches in Chinese and English databases, sorted out and analyzed various alternative informed consent models, and summarized their characteristics and applications.Results:At present, five alternative informed consent models were used to conduct real world research based on health data utilization. Researchers can choose informed consent models according to the research purpose, research design, research risk, operability of informed consent, and vulnerable groups.Conclusions:Different alternative informed consent models have varied characteristics. Researchers need to choose informed consent models based on the above factors to ensure the maximum protection of patients' privacy rights while using health data.

Sepsis, a life-threatening dysregulated status of the host response to infection, can cause multiorgan dysfunction and mortality. Sepsis places a heavy burden on the cardiovascular system due to the pathological imbalance of hyperinflammation and immune suppression. Myocardial injury and cardiac dysfunction caused by the aberrant host responses to pathogens can lead to cardiomyopathy, one of the most critical complications of sepsis. However, many questions about the specific mechanisms and characteristics of this complication remain to be answered. The causes of sepsis-induced cardiac dysfunction include abnormal cardiac perfusion, myocardial inhibitory substances, autonomic dysfunction, mitochondrial dysfunction, and calcium homeostasis dysregulation. The fight between the host and pathogens acts as the trigger for sepsis-induced cardiomyopathy. Pyroptosis, a form of programmed cell death, plays a critical role in the progress of sepsis. Toll-like receptors (TLRs) act as pattern recognition receptors and participate in innate immune pathways that recognize damage-associated molecular patterns as well as pathogen-associated molecular patterns to mediate pyroptosis. Notably, pyroptosis is tightly associated with cardiac dysfunction in sepsis and septic shock. In line with these observations, induction of TLR-mediated pyroptosis may be a promising therapeutic approach to treat sepsis-induced cardiomyopathy. This review focuses on the potential roles of TLR-mediated pyroptosis in sepsis-induced cardiomyopathy, to shed light on this promising therapeutic approach, thus helping to prevent and control septic shock caused by cardiovascular disorders and improve the prognosis of sepsis patients.

Benzodiazepine hypnotics' effects on glucose metabolism are seldom reported, and the association between long-term (>= 4 weeks) benzodiazepine usage and prediabetes has not been studied. This study was aimed to investigate the association between benzodiazepine hypnotic usage for >= 3 months and the prevalence of prediabetes. We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) during 2005 to 2008, selecting adult participants without diabetes who used benzodiazepine hypnotics for at least 3 months or did not take any hypnotics. Individuals taking other hypnotics, antipsychotics, glucocorticoids, or hypoglycemic drugs were excluded. We defined prediabetes as an hemoglobin A1C (HbA1C) 5.7-6.4%, as suggested by the American Diabetes Association. Prescribed drug information was self-reported and checked by official interviewers, and HbA1C data in NHANES was recognized by the National Glycohemoglobin Standardization Program. We calculated the propensity score according to the covariates and adjusted it using multivariate logistic regression. Lower thresholds of HbA1C >= 5.5% or >= 5.3% were also analyzed. Among 4694 eligible participants, 38 received benzodiazepine hypnotics; using these hypnotics for >= 3 months was not significantly associated with the prevalence of prediabetes, as well as HbA1C >= 5.5% or >= 5.3%. Adjusted for propensity score, the respective odds ratios for prediabetes, HbA1C >= 5.5%, and HbA1C >= 5.3% were 1.09 (95% confidence interval [CI] 0.19-6.32), 0.83 (95% CI 0.22-3.13), and 1.22 (95% CI 0.3-4.93). No significant association was found between benzodiazepine hypnotic usage >= 3 months and the prevalence of prediabetes.

新冠肺炎奥密克戎变异株自首次发现及传播以来,在世界100多个国家流行,严重危害人类的生命健康.中医药防治新冠肺炎疗效确凿、优势显著.为了更加有效指导奥密克戎变异株感染临床防治,世界中医药学会联合会急症专业委员会、中国上海中医药大学急危重症研究所、陕西中医药大学疫病研究院组织国内《新型冠状病毒肺炎诊疗方案(试行第九版)》修订专家和临床防控一线救治专家,在《新型冠状病毒诊疗方案(试行第九版)》基础上,结合新型冠状病毒奥密克戎变异株感染防治临床经验,就新型冠状病毒奥密克戎变异株感染中医药防治相关问题展开调研与讨论,形成本专家建议,以期对当下新冠肺炎奥密克戎变异株感染临床治疗与预防起到指导作用.

新型冠状病毒奥密克戎( Omicron )变异株自2021年11月首次发现并传播以来,增速迅猛,已席卷全球,全球已有100 多个国家和地区发现奥密克戎变异株感染病例.新型冠状病毒肺炎(简称新冠肺炎)疫情发生以来,中医药在防治方面发挥了重要作用.为了有效指导临床防治,世界中医药学会联合会急症专业委员会、中国上海中医药大学急危重症研究所、美国中医药针灸学会组织国内外中医药防控新冠肺炎领域临床一线专家及相关学术机构与组织,在参照中华人民共和国国家卫生健康委员会、国家中医药管理局《新型冠状病毒肺炎诊疗方案(试行第九版)》基础上,结合新型冠状病毒奥密克戎变异株感染防治临床经验,就新型冠状病毒奥密克戎变异株感染中医药防治相关问题展开调研与讨论,并最终形成本共识.6

《黄帝内经》中记载的十二经标本脉的脉位与后世医家记载有所差异.通过对标本脉原文的逐字考证及对后世医家注解的分析,整理出标本脉脉动的具体解剖位置或是大概范围,而且得出新的结论:标本脉并非特定的某一个穴位或是某一个点,而是一个区域内的脉动.

Abstract The Omicron variant of severe acute respiratory syndrome coronavirus 2 remains a global problem. Current data indicate that the Omicron variant causes mild clinical symptoms and few severe cases and deaths. Traditional Chinese medicine (TCM) has demonstrated definite efficacy and distinct advantages in the prevention and treatment of coronavirus disease 2019 (COVID-19). Thus, by focusing on the pathogenic characteristics of the Omicron variant, the Emergency Professional Committee of the World Federation of Chinese Medicine Societies, Emergency and Critical Care Institute of the Shanghai University of Traditional Chinese Medicine, and American Traditional Chinese Medicine Society have brought together clinical experts on the TCM prevention and control of COVID-19 to formulate an expert consensus on the prevention and treatment of Omicron variant infections based on the Diagnosis and Treatment Protocol for COVID-19 (Trial Version 9). This review provides a comprehensive Coronavirus disease 2019 (COVID-19) is an acute respiratory infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The main symptoms of interpretation of this expert consensus, covering topics such as discussing the pathogenic characteristics of the Omicron variant from the TCM perspective of “epidemic disease of pathogenic wind,” prevention plans for vulnerable populations, and stratified treatment plans for infected populations. We hope that this review can serve as a reference for the clinical prevention and treatment of the Omicron variant.

持续性血液滤过又名连续肾脏替代疗法(continuous renal replacement therapy,CRRT),是通过模拟正常机体肾脏滤过和重吸收功能以清除体内多余水分和小分子毒物的治疗性过程,具有良好血流动力学稳定性,有利于患者肾功能的保护,因此被广泛应用于急危重症的治疗.但CRRT后患者预后未能明显改善,并出现气阴两虚的证候群,经过益气养阴治疗对其证候群进行干预可改善患者状态和预后.文章从气阴两虚角度出发探讨益气养阴法治疗CRRT后证候群,以期探索中医药在重症方面诊疗的独特优势.

新冠肺炎自2020年爆发以来,中医药取得举世瞩目的救治效果,在全球疫情防控中发挥着重要作用,获得了 WHO的高度肯定.2021年11月新冠肺炎奥密克戎(Omicron)变异株首次出现并迅速传播,我国吉林、上海先后出现爆发并蔓延全国.为了更加有效应对奥密克戎变异株感染,世界中医药学会联合会急症专业委员会、中华医学会急诊分会中西医结合急救学组、中国医师协会急诊医师分会中西医结合急救医学学组、上海中医药学会急诊分会、上海中医药大学急危重研究所等学术机构组织奥密克戎新冠肺炎变异株一线救治专家,根据上海、吉林等奥密克戎感染地区患者中医临床症候,并结合国家《新型冠状病毒诊疗方案(试行第九版)》,就中成药应用相关问题展开调研与讨论,形成本共识,以期对当下新冠肺炎奥密克戎变异株感染乃至以后疫情防控起到临床指导作用.

目的 探讨通腑泻肺汤联合大剂量沐舒坦对脓毒症相关急性呼吸窘迫综合征患者的影响.方法 将92例脓毒症相关的急性呼吸窘迫综合征的患者,随机分为实验组、对照组各46例,各组均给予常规治疗,对照组加用大剂量沐舒坦,实验组在此基础上加用通腑泻肺汤加减治疗,疗程7d.记录治疗前、治疗第3天、第7天肺泡灌洗液炎症因子水平、血气分析结果,评估急性呼吸窘迫综合症临床疗效,计算ICU住院时间、机械通气时间、28天生存率.结果 治疗后第3天、7天,两组患者肺泡灌洗液中CRP,TNF-α、IL-6、IL-8、HMGB-1水平均降低,实验组较对照组降低明显(P＜0.01);两组动脉血氧分压和氧合指数均较前改善,实验组较对照组改善明显(P＜0.01);两组血二氧化碳分压无统计学差异(P=0.51).治疗后两组患者均疗效明显,有效率实验组优于对照组(P=0.02);治疗后实验组较对照组ICU住院时间降低,机械通气时间缩短(均P＜0.01).两组28天生存率无统计学差异(P =0.643).结论 通腑泻肺汤联合大剂量沐舒坦能降低脓毒症相关急性呼吸窘迫综合征患者肺泡灌洗液中炎症因子水平,改善氧合功能,提高ARDS疗效,降低ICU住院时间,缩短机械通气时间,但对28天生存率及血二氧化碳分压无明显影响.

COVID-19 from Traditional Chinese Medicine Perspective, pp. 257-271 (2021) No AccessCase 14: A Critical Case of COVID-19 Treated by Traditional Chinese Medicine Using Dynamic Syndrome DifferentiationLuqi Huang, Hao Li, Wensheng Qi, Zhixu Yang, and Qing MiaoLuqi HuangChina Academy of Chinese Medical Sciences, China, Hao LiChina Academy of Chinese Medical Sciences, China, Wensheng QiChina Academy of Chinese Medical Sciences, China, Zhixu YangChina Academy of Chinese Medical Sciences, China, and Qing MiaoChina Academy of Chinese Medical Sciences, Chinahttps://doi.org/10.1142/9789811228759_0019Cited by:0 (Source: Crossref) PreviousNext AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsRecommend to Library ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetails Recommended COVID-19 from Traditional Chinese Medicine PerspectiveMetrics History PDF download

COVID-19 from Traditional Chinese Medicine Perspective, pp. 129-140 (2021) No AccessCase 6: A Case of COVID-19 with Acute Kidney Injury Treated by Dispersing Lung Qi and Dampness and Activating Blood Circulation and DetoxificationLuqi Huang, Hao Li, Wensheng Qi, Zhixu Yang, and Qing MiaoLuqi HuangChina Academy of Chinese Medical Sciences, China, Hao LiChina Academy of Chinese Medical Sciences, China, Wensheng QiChina Academy of Chinese Medical Sciences, China, Zhixu YangChina Academy of Chinese Medical Sciences, China, and Qing MiaoChina Academy of Chinese Medical Sciences, Chinahttps://doi.org/10.1142/9789811228759_0011Cited by:0 (Source: Crossref) PreviousNext AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsRecommend to Library ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetails Recommended COVID-19 from Traditional Chinese Medicine PerspectiveMetrics History PDF download

COVID-19 from Traditional Chinese Medicine Perspective, pp. 64-73 (2021) No AccessCase 2: Removing Toxin and Clearing Away Heat for a Severe Case of COVID-19 with Heat Transformed from Epidemic Toxin and Blocking the LungsLuqi Huang, Hao Li, Wensheng Qi, Zhixu Yang, and Qing MiaoLuqi HuangChina Academy of Chinese Medical Sciences, China, Hao LiChina Academy of Chinese Medical Sciences, China, Wensheng QiChina Academy of Chinese Medical Sciences, China, Zhixu YangChina Academy of Chinese Medical Sciences, China, and Qing MiaoChina Academy of Chinese Medical Sciences, Chinahttps://doi.org/10.1142/9789811228759_0007Cited by:0 (Source: Crossref) PreviousNext AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsRecommend to Library ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetails Recommended COVID-19 from Traditional Chinese Medicine PerspectiveMetrics History PDF download

COVID-19 from Traditional Chinese Medicine Perspective, pp. 155-174 (2021) No AccessCase 8: Strengthening Healthy Qi to Eliminate Evil Qi, Harmonizing the Pivot for Severe COVID-19Luqi Huang, Hao Li, Wensheng Qi, Zhixu Yang, and Qing MiaoLuqi HuangChina Academy of Chinese Medical Sciences, China, Hao LiChina Academy of Chinese Medical Sciences, China, Wensheng QiChina Academy of Chinese Medical Sciences, China, Zhixu YangChina Academy of Chinese Medical Sciences, China, and Qing MiaoChina Academy of Chinese Medical Sciences, Chinahttps://doi.org/10.1142/9789811228759_0013Cited by:0 (Source: Crossref) PreviousNext AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsRecommend to Library ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetails Recommended COVID-19 from Traditional Chinese Medicine PerspectiveMetrics History PDF download

COVID-19 from Traditional Chinese Medicine Perspective, pp. 141-154 (2021) No AccessCase 7: Clearing Away Toxic Material, Resolving Dampness, Invigorating Qi, and Nourishing Yin Treatment of a Severe COVID-19 Case with AIDSLuqi Huang, Hao Li, Wensheng Qi, Zhixu Yang, and Qing MiaoLuqi HuangChina Academy of Chinese Medical Sciences, China, Hao LiChina Academy of Chinese Medical Sciences, China, Wensheng QiChina Academy of Chinese Medical Sciences, China, Zhixu YangChina Academy of Chinese Medical Sciences, China, and Qing MiaoChina Academy of Chinese Medical Sciences, Chinahttps://doi.org/10.1142/9789811228759_0012Cited by:0 (Source: Crossref) PreviousNext AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsRecommend to Library ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetails Recommended COVID-19 from Traditional Chinese Medicine PerspectiveMetrics History PDF download