Objective:Our aim was to highlight the clinical characteristics and determine the risk factors associated with severe and non-severe COVID-19 infection.Study Method:A retrospective review was conducted on clinical data obtained from patients with COVID-19 infection, admitted to the emergency department between November 2022 and January 2023. Total of 1684 participants were categorized into severe (312 cases,18.53%) and non-severe (1,372 cases,81.47%) cohorts. Logistic regression was utilized for multivariate analysis, with a P-value less than 0.05 signifying a significant difference between the groups.Results:The study consisted of 952 males (56.53%) and 732 females (43.47%) participants. The age distribution ranged from 18 to 93 years in both cohorts. There were statistically significant differences between the clinical symptoms of the severe and non-severe cohorts (P < 0.05). According to the multivariate statistical analysis, patients with more pronounced clinical manifestations had significantly elevated values related to age(P < 0.05), diabetes(P < 0.01), hypertension(P < 0.01), C-reactive protein (CRP) (P < 0.05), and lactate dehydrogenase (LDH) (P < 0.01) as compared to those presenting with milder symptoms.Conclusion:The primary clinical presentations in both the cohorts were mostly similar. Predominant factors contributing to the severity of COVID-19 infection were age, diabetes, hypertension, elevated CRP levels, and increased LDH.

Purpose This study explores the value of echocardiography in predicting mortality and guiding treatment in patients with acute pancreatitis. Methods This research retrospectively studied patients with acute pancreatitis (AP) who were treated at the Emergency Department of Beijing Shijitan Hospital between January of 2018 and October of 2021.In the 2012 updated Atlanta classification for acute pancreatitis, patients were categorized into two subgroups: the non-SAP group and the severe acute pancreatitis (SAP) group. The comprehensive score indices, blood-related indices, and echocardiography-related indices between the two groups were compared.Furthermore, logistic regression analysis was conducted on SAP indicators and mortality, resulting in the generation of an operating characteristic curve for subjects. The area under the curve was then analyzed to assess predictive efficiency. Results This retrospective study investigated a total of 253 patients, 159 male (62.85%) and 94 female (37.15%). APACHE II, BISAP, MCTSI, SOFA, cTnI, NTproBNP, E’/A’, and SV were independent determinants for SAP; all AUCs were >0.7. The group of patients who did not survive showed notably elevated levels of cTnI, increased scores on various indices (APACHE II, SOFA, BISAP, and MCTSI), and decreased levels on echocardiography-related indices (E'/A′) compared to those who survived. Independent determinants for predicting mortality were identified using a multiple logistic regression model, with APACHE II, SOFA, BISAP, MCTSI, and E'/A′ being significant factors. All AUCs were >0.7. Conclusion Echocardiographic indicators, E'/A′ and SV have acceptable predictive values for SAP and E'/A′ could be an independent predictor for mortality, which provides certain value in guiding clinical treatment for AP patients.

Objective To investigate the role of thyroid hormone in evaluating the severity and prognosis of elderly patients with sepsis. Methods A retrospective analysis was made from a 198 older adult patient cohort with sepsis diagnosed in the emergency ward of our hospital from January 2016 to January 2019. The patients were divided into groups according to the occurrence of septic shock and the 28-day mortality rate. The levels of free triiodothyronine（fT3）, free tetraiodothyronine（fT4） and thyroid stimulating hormone（TSH） were compared. Results The levels of fT3, fT4 and TSH in the patients with septic shock were significantly lower than those in patients with non-septic shock（pg/mL:1.94±0.62 vs. 2.81±0.68; ng/dL:0.79±0.26 vs.1.34±0.41;μU/mL: 0.92±0.46 vs.1.56±0.40, P＜0.001 respectively）. The levels of fT3, fT4 and TSH in the dead group on the 28th day were also significantly lower than those in the survival group（pg/mL:2.12±0.52 vs.2.66±0.81; ng/dL:0.84±0.24 vs.1.27±0.45; μU/mL:1.05±0.41 vs.1.44±0.52, P=0.002, P＜0.001, P=0.001 respectively）. Logistic regression analysis showed that fT4 level was a protective factor for 28-day mortality in the patients with sepsis [0.602（0.124-0.806）,P=0.022]. The receiver operating characteristic（ROC） curve showed that the area under the curve（AUC） of the fT4 for predicting 28-day mortality was 0.658（P＜0.001）, and the AUC of combination of fT4 with SOFA score was 0.789（P=0.006）. The cut-off value of fT4 was 1.14 ng/dL determined by ROC curve, and the 28-day survival rate of patients with fT4≤1.14 ng/dL was significantly lower than that of patients with fT4＞1.14 ng/dL. Conclusions Thyroid hormone may be a new indicator for evaluating the severity and prognosis of elderly patients with sepsis in the future.

目的 评价多形式的健康教育模式对慢性呼吸衰竭患者康复的效果.方法 采用方便抽样的方法,选取2019年5月至2021年5月入院治疗后出院康复中的慢性呼吸衰竭患者作为研究对象,将2019年5月至2020年4月入院的患者作为对照组,将2020年8月至2021年5月入院的患者作为干预组.评估并比较干预前后两组的生活质量、自我护理能力、遵医行为、满意度以及肺功能情况.结果 共纳入120例患者,其中对照组64例,干预组56例.干预后,干预组患者生活质量、遵医行为、自我护理能力和满意度评分分别为(38.90±4.73)分、(50.18±3.86)分、(128.10±11.63)分和(98.07±3.14)分,均优于对照组的(52.81±5.50)分、(41.35±3.48)分、(27.47±4.39)分和(92.94±5.26)分,差异有统计学意义(P<0.001).干预后,对照组与干预组间FVC差异无统计学意义(P>0.05);干预组的FEV1和FEV1/FVC均高于对照组,差异有统计学意义(P<0.05).结论 多形式的健康教育模式在慢性呼吸衰竭患者中的应用可有效提高患者的生活质量、依从性、自我护理能力以及满意度,并且在一定程度上辅助改善患者肺功能,可予以临床推广.

Objective:To investigate the predictive value of emergency bedside echocardiography on acute pancreatitis (AP) severity by assessing cardiac dysfunction.Methods:The clinical data used in this study was prospectively collected from AP patients in the Emergency Department of Beijing Shijitan Hospital, Capital Medical University from June 2018 to December 2020. According to the Atlanta Classification revised at the 2012 Atlanta International Conference, patients were divided into three groups of mild acute pancreatitis (MAP), moderate-severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). The differences of comprehensive score index, blood-related index, and echocardiography-related index were compared among the three groups. Besides, the predictive factors of SAP were analyzed by Logistic regression, receiving operating characteristic (ROC) curves of subjects were drawn, and the area under the curve (AUC) was analyzed to evaluate the predictive efficiency.Results:A total of 116 patients were enrolled in this study. Compared with the non-SAP group (MAP group+MSAP group), acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, Ranson score, procalcitonin, cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NTproBNP), EDD, A-peak, E/A, E'/A', and stroke volume (SV) exhibited significant differences (all P<0.05). There was no significant difference in end-systolic diameter, E-peak, and left ventricular ejection fraction among the three groups ( P>0.05). Logistic regression analysis revealed that SOFA score, Ranson score, cTnI, NTproBNP, E'/A', and SV were important predictors of AP severity (all AUC>0.7). Moreover, the predictive value of echocardiography cardiac function assessment index (E'/A' +SV, AUC=0.969) and score index (SOFA score +Ranson score, AUC=0.989) for SAP was better than that of blood index (cTnI+NTproBNP, AUC=0.732). Conclusions:Echocardiographic indicators E'/A' and SV have acceptable predictive values for SAP, providing certain guiding significance for the clinical treatment of AP patients.

Objective:To analyze the clinical characteristics, antibiotic resistance and prognostic risk factors of patients with Klebsiella pneumoniae bloodstream infection (Kp BSI).Methods:The clinical data of 188 patients diagnosed with Kp BSI from January 1，2017 to December 1，2021 in Beijing Shijitan Hospital, Capital Medical University were retrospectively analyzed.There were 118 patients males (62.8%) with a median age 77.0(63.0, 85.0) years old. The median length of hospital stay was 20.0 days, and 78 patients (41.5%) were admitted to intensive care unit(ICU). There were 121 cases with carbapenem-sensitive Klebsiella pneumoniae (64.4%, CSKP group) and 67 cases with carbapenem-resistant Klebsiella pneumoniae (35.6%, CRKP group).Fifty six patients died within 28 days after admission (death group), and 132 patients survived (survival group).The clinical characteristics and bacterial drug resistance of Kp BSI patients were analyzed, and univariate analysis and multivariate logistic regression analysis were used to explore factors related to the CRKP infection and patient mortality.Results:The most common infection sites were respiratory system, abdominal cavity and biliary tract accounting for 39.4% (74/188), 18.1% (34/188) and 14.4% (27/188), respectively.The common comorbidities were coronary heart disease, hypertension, chronic kidney disease and diabetes, accounting for 63.8% (120/188), 59.6% (112/188), 46.3% (87/188) and 43.1% (81/188), respectively and 118 patients (62.8%) had 3 or more comorbidities. Most patients (146 cases, 77.7%) underwent ≥1 invasive procedures before bloodstream infection;and 90 patients (47.9%) had a history of antibiotic use. CRKP strains showed higher resistance rates to piperacillin, quinolones, cephalosporins and carbapenems. Univariate analysis showed that there were statistically significant differences in age (69.0 vs. 83.0 years), ICU admission 25.6%(31/121) vs. 70.1%(47/67)], invasive procedures [67.8%(82/121) vs. 95.5 %(64/67)], and antibiotic use [37.2% (45/121) vs. 67.2%(45/67)] between the CSKP group and the CRKP group ( Z=-5.73, χ 2=35.22, χ 2=19.15, χ 2=15.53, all P<0.001). Multivariate logistic regression analysis showed that age, ICU admission, invasive procedures and antibiotic use in recent 30 days were independent risk factors for CRKP infection( OR=1.06, P<0.001; OR=3.22, P=0.003; OR=5.93, P=0.009; OR=2.40, P=0.022). The total fatality rate was 29.8%(56/188). Univariate analysis showed that there were statistically significant differences in CRKP infection [19.7%(26/132) vs. 73.2% (41/56)], albumin level (32.6 vs. 27.8 g/L) and sequential organ failure assessment score (SOFA score, 2 vs. 8 score) between the survival group and the death group (χ 2=49.10, Z=-4.64, Z=-10.36,all P<0.001). Multivariate logistic regression analysis suggested that CRKP infection, low albumin and high SOFA score on the day of bloodstream infection were risk factors for death of Kp BSI patients( OR=5.13, P=0.021; OR=0.86, P=0.044; OR=3.04, P<0.001). Conclusion:Kp BSI patients have a high fatality rate and fairly severe drug resistance. CRKP infection, low albumin, high SOFA score on the day of bloodstream infection are associated with poor prognosis in Kp BSI patients.

Abstract Background Hypersensitivity pneumonitis (HP) is a common type among all the interstitial lung diseases, and transbronchial lung cryobiopsy is an alternative diagnostic technique for interstitial lung diseases. In this study, we describe the clinical and pathological features of fibrotic hypersensitivity pneumonitis diagnosed with transbronchial lung cryobiopsy (TBLC). Methods A total of 46 diffused parenchyma lung disease (DPLD) patients received TBLC were included in this study. Medical records including medical history spirometry examinations, 6‐min walk test (6MWT) results, high resolution computed tomographic (HRCT) scans, BAL, and histopathology were collected. Results of HRCT and histopathology were compared and classified, especially. Results Sixteen patients were diagnosed with fibrotic HP, the mean age of whom was 56.3 ± 12.1 years, and 62.5% of them were male. Three of the 16 patients had been misdiagnosed as tuberculosis and received antituberculosis medications, five patients had been diagnosed as unclassifiable pulmonary fibrosis, and five patients had been diagnosed as idiopathic pulmonary fibrosis (IPF). Thirteen (81.3%) patients had a normal lymphocyte count in BAL. The pathological features of usual interstitial pneumonia (UIP) were detected in 11 (68.8%) of the cases, poor defined granulomatous was detected in nine (56.3%) of the cases, and bronchiolocentric fibrosis was detected in two (12.5%) of the 16 cases. Conclusions Fibrotic hypersensitivity pneumonitis should be included in differential diagnosis of pulmonary fibrosis. Pathological characteristics of fibrotic hypersensitivity pneumonitis could be demonstrated from cryobiopsy lung tissue. TBLC is recommended as an alternative diagnostic technique, which may improve the specificity of hypersensitivity pneumonia detection, and UIP is the most frequent pathological finding.

目的 探讨急诊床旁超声心动图心功能评估对重症急性胰腺炎(severe acute pan-creatitis,SAP)死亡风险的预测价值.方法 回顾性收集2017年1月至2021年6月首都医科大学附属北京世纪坛医院急诊科收治的SAP患者临床资料进行研究.记录基本资料,入院后6 h内及心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、氨基末端B型脑利钠肽原(NT-proBNP)、C反应蛋白(CRP)及降钙素原(PCT)检测最高值,入院24 h内超声心动图心功能指标,28 d病死率,急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、Ranson评分最高值.采用二分类Logistic回归分析SAP患者死亡的预测因素,绘制受试者工作特征(ROC)曲线并分析曲线下面积(AUC),评价其预测效能.结果 纳入研究患者78例,APACHEⅡ评分、Ranson评分、SOFA评分、cTnI、乳酸、心率、侧壁二尖瓣环舒张早期峰值流速/舒张晚期峰值流速(E′/A′)、每搏输出量(SV)为SAP患者死亡的预测因素(P<0.05).E′/A′ 对SAP患者死亡风险有较好的预测价值,cut-off值为0.75,敏感度为0.754,特异度为0.877,AUC为0.815(95％CI 0.618～0.912),与预测价值较好的APACHEⅡ评分、SOFA评分、cTnI比较差异无统计学意义(P>0.05),与乳酸、心率比较差异有统计学意义(P<0.05);SV对SAP患者死亡风险有一定预测价值,cut-off值为56.5 mL,敏感度为0.786,特异度为0.625,AUC为0.681(95％CI 0.524～0.838),与E′/A′、APACHEⅡ评分、SOFA评分、cTnI比较差异有统计学意义(P<0.05).E′/A′比SV预测价值高.结论 超声心动图心功能评估指标E′/A′对SAP患者死亡有较好预测价值,对SAP患者临床治疗有一定的指导意义,为SAP患者液体管理提供了新的方向.

目的 分析血培养阳性脓毒症患者的病原菌分布及耐药情况,为临床合理规范使用抗菌药物提供参考.方法 回顾性收集首都医科大学附属北京世纪坛医院2018年3月至2021年9月407例血培养阳性脓毒症患者的临床资料及血培养结果,分析病原菌分布及耐药性.结果 407例血培养阳性脓毒症患者的死亡率为20.15％,死亡率随着年龄增长而增高,感染部位以呼吸系统最常见,革兰氏阴性菌感染及混合感染的患者死亡率较高.共检出病原菌510株,其中革兰氏阴性菌占53.33％,革兰氏阳性菌占39.02％,真菌占7.65％,居于前三位的是凝固酶阴性葡萄球菌、肺炎克雷伯菌、大肠埃希菌(20.59％、19.61％、18.82％).肺炎克雷伯菌对碳青霉烯类药物的耐药率高于大肠埃希菌.葡萄球菌对万古霉素、利奈唑胺和替加环素均敏感.检出7株耐万古霉素的屎肠球菌,未检出对利奈唑胺和替加环素耐药的肠球菌.结论 血培养阳性的脓毒症患者中病原菌种类较多,耐药率较高,应及时监测分析病原菌耐药情况,为临床用药提供依据,从而降低患者死亡率.

This study aimed to investigate the predictive value of pulse oximetry plethysmography (POP) for the return of spontaneous circulation (ROSC) in cardiac arrest (CA) patients.This was a multicenter, observational, prospective cohort study of patients hospitalized with cardiac arrest at 14 teaching hospitals cross China from December 2013 through November 2014. The study endpoint was ROSC, defined as the restoration of a palpable pulse and an autonomous cardiac rhythm lasting for at least 20 minutes after the completion or cessation of CPR.150 out-of-hospital cardiac arrest (OHCA) patients and 291 in-hospital cardiac arrest (IHCA) patients were enrolled prospectively. ROSC was achieved in 20 (13.3%) and 64 (22.0%) patients in these cohorts, respectively. In patients with complete end-tidal carbon dioxide (ETCO2) and POP data, patients with ROSC had significantly higher levels of POP area under the curve (AUCp), wave amplitude (Amp) and ETCO2 level during CPR than those without ROSC (all p < 0.05). Pairwise comparison of receiver operating characteristic (ROC) curve analysis indicated no significant difference was observed between ETCO2 and Amp (p = 0.204) or AUCp (p = 0.588) during the first two minutes of resuscitation.POP may be a novel and effective method for predicting ROSC during resuscitation, with a prognostic value similar to ETCO2 at early stage.

背景 急性心力衰竭(AHF)患者肾功能恶化(WRF)发生风险较高,而虚弱是AHF患者预后不良的危险因素.故明确虚弱与AHF患者WRF的关系对防治AHF患者住院期间发生WRF具有一定参考价值.目的 分析入院时虚弱程度与AHF患者住院期间WRF的关系.方法 选取2017年首都医科大学附属北京世纪坛医院急诊科收治的AHF患者83例,根据住院期间是否发生WRF分为WRF组(n=22)和无WRF组(n=61).比较两组患者一般资料、实验室检查指标、左心室射血分数(LVEF)及入院时Edmonton虚弱量表评分.AHF患者住院期间WRF的影响因素分析采用多因素Logistic回归分析;绘制受试者工作特征(ROC)曲线以评价入院时Edmonton虚弱量表评分对AHF患者住院期间WRF的预测价值.结果 WRF组患者使用呼吸机者所占比例、血尿素氮、血清肌酐及入院时Edmonton虚弱量表评分高于无WRF组(P<0.05).多因素Logistic回归分析结果 显示,入院时Edomonton虚弱量表评分是AHF患者住院期间WRF的独立影响因素〔OR=1.212,95％CI(1.004,1.464),P<0.05〕.ROC曲线分析结果 显示,入院时Edomonton虚弱量表评分预测AHF患者住院期间WRF的曲线下面积为0.68〔95％CI(0.55,0.81)〕.结论 入院时虚弱程度可能是AHF患者住院期间WRF的影响因素,但其对AHF患者住院期间发生WRF的预测价值不高.

目的 探讨脓毒症患者血清白介素(IL)-23、IL-17水平及转化生长因子-β(TGF-β)/Smad信号通路作用.方法 选择2016年12月-2018年12月北京世纪坛医院收治的脓毒症患者97例,其中脓毒症组29例,严重脓毒症组37例,脓毒症休克组31例.另选择同期医院健康体检者80名作为对照组.分析急性生理与慢性健康状况评分II(APACHE II)和序贯性器官衰竭评分(SOFA),采用酶联免疫吸附法测定血清IL-23、IL-17、TGF-β1、Smad2和Smad7含量.结果 脓毒症组、严重脓毒症组和脓毒症休克组APACHE II和SOFA高于对照组,严重脓毒症组和脓毒症休克组高于脓毒症组,且脓毒症休克组高于严重脓毒症组(P<0.05).脓毒症组、严重脓毒症组和脓毒症休克组血清IL-23和IL-17水平高于对照组,严重脓毒症组和脓毒症休克组高于脓毒症组,且脓毒症休克组高于严重脓毒症组(P<0.05).脓毒症组、严重脓毒症组和脓毒症休克组血清TGF-β1、Smad2和Smad7水平高于对照组,严重脓毒症组和脓毒症休克组高于脓毒症组,且脓毒症休克组高于严重脓毒症组(均P<0.05).结论 血清IL-23和IL-17及TGF-β/Smad信号通路可能参与脓毒症发生、发展,且与病情进展密切相关,检测有助于诊断和指导治疗.

目的 研究胸腺五肽辅助比阿培南对老年重症肺炎患者肺功能及血清肺表面活性蛋白(SP)-A及SP-D水平的影响.方法 选取120例老年重症肺炎患者,按照随机数字表法将患者分为观察组与对照组,每组60例.对照组给予比阿培南静脉注射治疗,观察组在比阿培南的基础上联用胸腺五肽治疗.两组疗程均为2w.观察比较两组患者疗效、肺功能改善情况、血清SP-A及SP-D水平,免疫功能水平,相关炎症因子水平及治疗过程中发生的不良反应.结果 治疗后两组疗效均有明显提高(P<0.05),观察组总有效率显著优于对照组(P<0.05);治疗后,两组血清SP-A及SP-D水平均明显升高,且观察组显著高于对照组(P<0.05);治疗后两组血清炎性因子水平均呈现下降趋势且观察组下降程度显著大于对照组(P<0.05);治疗后两组CD3+、CD4+、CD4+/CD8+水平均显著升高,同时CD8+数值显著下降.且观察组CD3+、CD4+、CD4+/CD8+水平明显高于对照组,而CD8+水平显著低于对照组(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05).结论 胸腺五肽辅助比阿培南能显著改善老年重症肺炎患者临床症状,其作用机制可能与其能升高血清SP-A及SP-D水平,降低炎性因子有关,通过加强患者的局部气道防御能力并且改善患者免疫功能来改善患者临床指征.

BACKGROUND:Soluble mesothelin-related peptide (SMRP) is a widely studied tumor marker for diagnosing malignant pleural mesothelioma (MPM). This study discussed the diagnostic value of SMRPs in pleural effusion (PE) for MPM.METHODS:Medline, Embase, Web of Science, and Cochrane library system were systematically searched on the data of SMRPs in PE for MPM diagnosis. Pooled diagnostic sensitivity, specificity, and symmetric receiver operating characteristic curve were calculated.RESULTS:Thirteen studies fulfilled the inclusion criteria and a total of 3359 cases including 759 MPM cases, 1061 non-MM (malignant mesothelioma) malignant PE, and 1539 benign PE were brought into this meta-analysis. The pooled results of SMRPs in PE for diagnosing MPM were as follows: sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.68 (95% confidence interval [CI]: 0.64-0.72), 0.91 (95% CI: 0.86-0.94), 7.8 (95% CI: 5.0-12.0), 0.35 (95% CI: 0.31-0.40), and 22 (95% CI: 14-35), respectively. The area under the summary receiver operating characteristic curves (AUC) was 0.75 (95% CI: 0.72-0.80). Subgroup analyzes revealed that the AUC of cohort group using histological diagnosis could be improved to 0.86 (95% CI: 0.83, 0.89). The Deek's funnel plot asymmetry test showed no publication bias.CONCLUSION:Although the sensitivity of SMRPs was low, PE-SMRPs can be a good indicator of the existence of MPM.

目的 探索不同M型胆碱能受体对脂多糖诱导的脓毒症小鼠模型调控炎症反应的可能机制.方法 C57雄性小鼠随机分为正常对照组、LPS组、哌仑西平组和AF-DX116组.正常对照组小鼠在实验开始0h及0.5h均腹腔注射生理盐水;LPS组、哌仑西平组、AF-DX116组小鼠在实验开始0.5h均腹腔注射LPS制造小鼠脓毒症模型,分别在实验开始0h给予生理盐水、选择性M1型胆碱能受体阻滞剂哌仑西平、选择性M2型胆碱能受体阻滞剂AF-DX116预处理.分别在注射LPS后2h及12 h处死小鼠,获取小鼠肝肺组织,采用流式细胞学技术检测组织巨噬细胞的极化情况;免疫荧光双染法检测巨噬细胞的极化情况;PCR法检测肝肺组织SOCS3基因的表达情况.结果 流式细胞学结果提示,与LPS组比较,哌仑西平预处理后脓毒症小鼠肝肺组织M1型巨噬细胞比例降低,在肺脏12 h组(3.00±0.25 vs.3.98±0.38,P＜0.01)、肝脏2h组(3.50±1.34 vs.5.20±0.59,P＜0.01)及肝脏12 h组(4.50±0.42 vs.5.54±0.52,P＜0.05)中差异有统计学意义;而AF-DX1 16预处理后,可促进脓毒症小鼠模型巨噬细胞向M1型极化,其中在肺脏2h组(5.12±1.94 vs.3.64±0.41,P＜0.01)、肺脏12 h组(4.63 ±1.07 vs.3.98±0.38,P＜0.05)及肝脏12 h组(7.68±1.81 vs.5.54±0.52,P＜0.01)中差异有统计学意义.免疫荧光双染结果提示,哌仑西平预处理组小鼠肝脏及肺脏组织M1型巨噬细胞浸润程度较低,而AF-DX116预处理组小鼠肝肺组织M1型巨噬细胞浸润程度增加.PCR结果提示,与LPS组比较,选择性M1型胆碱能受体阻滞剂哌仑西平预处理可抑制脓毒症小鼠肝肺组织SOCS3分子基因的表达水平(肺脏2h组,4.91±0.35 vs.5.69 ±0.64,P＜0.01),而选择性M2型胆碱能受体阻滞剂AF-DX116预处理则作用相反(肺脏2h组,6.73±0.11 vs.5.69±0.64,P＜0.05).结论 不同的M型胆碱能受体亚型在巨噬细胞的极化过程中发挥了不同的作用.

Transbronchial cryobiopsy (TBCB) is a technique to obtain frozen samples of lung tissue from the distal bronchioles, in which the tissue surrounding the tip of a cryoprobe inserted through the bronchoscope is frozen with a rapid freezing process and abruptly pulled away from adherent tissue. The advantages of TBCB are improved diagnostic yield, reduced trauma, large and high-quality specimens, potentially decreased complications, and lower cost in comparison to surgical lung biopsy (SLB). TBCB is mainly used for the etiological diagnosis of diffuse parenchymal lung diseases (DPLD) (1,2). Additionally, it can be used for biopsy of peripheral lung lesions. TBCB has been widely used as a new diagnostic tool in Europe since 2009 (1), and has been used in some highly specialized interventional centers in China since 2015 (3). However, the procedure of TBCB has not been standardized. There are still disagreements among pulmonologists internationally and in China regarding operation methods, biopsy sites, number of biopsy specimens, types of frozen probes, freezing time and specimen handling, and there is urgent need for procedural standardization of TBCB for effectiveness and safety. This work is an evidence- and expert-based consensus on the procedure and technique of TBCB, which is a collaborative effort of the Working Committee on Interventional Pulmonology, Respiratory Physicians’ Branch of Chinese Medical Doctor Association, Committee of Interventional Pulmonology, Chinese Society for Tuberculosis, Chinese Medical Association, and the Chinese Western Association of Interventional Pulmonology. We hope it will contribute to the transition of the etiologic diagnosis of DPLD from the clinico-radiologic (CR) model to the clinico-radiologic-pathologic (CRP) model, which hopefully will increase the rate of etiologic diagnosis of DPLD, and improves the effectiveness, safety and standardization of the procedure and technique of TBCB to ensure diagnostic yield.

To compare pharmacologic effects of pirenzepine and AF-DX116, a selective competitive antagonist for M1 and M2 subtype muscarinic cholinergic receptors (mAChRs), respectively, with atropine, a non-selective competitive antagonist for mAChRs, on Lipopolysaccharide (LPS). Male C57BL/6 mice were used to establish models of LPS-induced experimental endotoxemia. Mice were intraperitoneally injected 10 min prior to LPS injection with control (saline), atropine, pirenzepine and AF-DX116, respectively. Overall survival time was estimated using Kaplan-Meier plots. Inflammatory cytokine tumor necrosis factor-α (TNF-α) was monitored at various intervals after LPS injection and individual reagent administration. Pathological alternations in lungs and liver were analyzed. Pirenzepine and atropine pretreatment improved survival rate of LPS-induced septic shock; in contrast, AF-DX116 accelerated death from sepsis. Moreover, TNF-α plasma level was decreased in response to pirenzepine or atropine, whereas increased in response to AF-DX116. Pirenzepine and atropine relieved whereas AF-DX116 accelerated LPS-induced pulmonary and hepatic injury. Pirenzepine reduced proportion of M1 subtype of macrophages, while AF-DX116 promoted polarization of macrophages to M1 subtype. Pirenzepine pretreatment reduced while AF-DX116 enhanced expression of SOCS3 at mRNA level. The administration of pirenzepine and atropine may have beneficial effects on septic shock.

目的 研究北京世纪坛医院近5年急诊留观患者的流行病学特点,以更好地加强该地区急诊专业的学科建设、提高医疗服务质量.方法 回顾性选取首都医科大学附属北京世纪坛医院2014年1月1日-2018年12月31日就诊的急诊留观患者作为研究对象,统计分析其疾病谱及流行病学特点.结果 19 518例急诊留观患者中,男性(49.08％)和女性(50.92％)比例为1∶1.04;46～65岁组患者女性比例(47.28％)最低,＞80岁组的女性患者比例(55.38％)高于46～65岁组和66～80岁组,差异有统计学意义(P＜0.05).在所有患者中＞65岁老年患者比例为59.66％,2014年-2018年各年度老年患者就诊比例分别为53.86％、53.19％、57.00％、65.40％、68.79％,呈增高趋势(P=0.011).呼吸系统疾病(24.20％)、循环系统疾病(23.67％)、消化系统疾病(14.47％)、神经系统疾病(12.75％)和内分泌系统疾病(7.08％)为主要疾病类型;第一诊断排名前10位的疾病分别为细菌性肺炎(14.72％)、急慢性心力衰竭(7.86％)、高血压急症(5.00％)、心律失常(4.02％)、冠状动脉粥样硬化性心脏病(3.92％)、慢性阻塞性肺疾病(3.01％)、脑血管疾病(2.68％)、消化道出血(2.66％)、糖尿病急症(2.43％)和腹腔感染(1.73％),占所有患者比例的48.02％.5年中冬季(12月-2月)总就诊人数为6 145人次,为全年患者最多季节,占总就诊人数的31.48％.结论 根据疾病谱特点,应加强呼吸、循环、神经、消化、内分泌等各专科急症的培训;重视老年患者的救治;在冬季就诊高峰期,合理安排医护工作时间,优化诊疗流程.