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Objective To evaluate the clinical characteristics and prognostic predictors of patients with diffuse alveolar hemorrhage (DAH) and/or interstitial lung disease (ILD) secondary to microscopic polyangiitis (MPA) in a Chinese general hospital. Methods We retrospectively reviewed the medical records of MPA patients admitted to internal medicine departments between the year 2002 and 2012. The patients were divided into the ILD, DAH, DAH combined with ILD (DAHILD), and no pulmonary involvement (NPI) groups according to pulmonary involvement patterns. The clinical characteristics at diagnosis were analyzed. The risk factors associated with short-term death and long-term death were identified with Logistic regression and Cox analysis.Results Of 193 newly diagnosed MPA patients, 181 patients were enrolled in the research, of which 19 had DAH alone, 96 had ILD alone, 18 had DAH and DAH concurrently, and 48 had NPI. The median of serum creatine level in the DAH group was 449 μmol/L, significantly higher than that in the ILD group (123 μmol/L, Nemenyi = -35.215, P = 0.045) and DAHILD group (359 μmol/L, Nemenyi = -43.609, P = 0.007). The median follow-up time was 67 (range: 1-199) months. Patients in the ILD group were older than those in the DAH group (median: 69 years vs. 57 years, Nemenyi = 43.853, P= 0.005). The patients with both DAH and ILD had combined features of the two subtypes, and the highest mortality (72.2% at the end of follow-up). The elevated white blood cell count was a risk factor for short-term death (OR = 1.103, 95%CI: 1.008-1.207, P = 0.032 for one month; OR = 1.103, 95%CI: 1.026-1.186, P = 0.008 for one year). Old age (HR= 1.044, 95%CI: 1.023-1.066, P < 0.001), cardiovascular system involvement (HR = 2.093, 95%CI: 1.195-3.665, P = 0.010), poor renal function (HR = 1.001, 95%CI: 1.000-1.002, P = 0.032) were risk factors for long-term death. Pulmonary infections (38/54) were the leading causes of death, especially for the patients with ILD. Besides, 49 patients suffered from pulmonary infections in the first year after diagnosis. Conclusions MPA patients who presented with different pulmonary involvement patterns have completely different clinical features. These subtypes probably have different pathogenesis and should be studied separately.
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Humans , Microscopic Polyangiitis/diagnosis , Retrospective Studies , Lung Diseases, Interstitial/complications , Hemorrhage/complications , PrognosisABSTRACT
Objective @#To investigate the influence of abnormal occlusion factors on the incidence of temporomandibular disorders (TMDs) in junior college students and to provide an etiological basis for the prevention and treatment of TMDs.@*Methods @# We examined the temporomandibular joint (TMJ) and dental occlusion in 754 lower grade college students (male 354, female 400) at Zunyi Medical University (Zhuhai campus). A questionnaire was also administered. We analyzed the correlation between TMD and the other three factors (static abnormal occlusion, dynamical abnormal occlusion and oral parafunctional activity) from the perspective of multivariate unconditioned logistic regression and univariate unconditioned logistic regression with dummy variables.@*Results @#The prevalence of TMD was 31.7%. The incidence of TMD was significantly (P<0.05) associated with sleep bruxism (OR=2.070), clenching (OR=2.553), diurnal (OR=2.642) and anterior teeth overbite (OR=1.228). Univariate unconditioned logistics regression analysis by dummy variables was used to analyze the incidence of TMD at different deep overbites (mild, OR=1.558; moderate, OR=2.189; severe, OR=3.236; P<0.05). @*Conclusion@#The risk factors for TMD in lower grade college students included anterior teeth occlusion, sleep bruxism, clenching, and diurnal treatment. Worse deep overbite might increase the risk of TMD.
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Objective:To observe the clinical efficacy and safety of modified Erchentang (Juhong Tanke liquid) on children bronchitis with syndrome of sputum, cough, dys-expectoration, wheezing and pulmonary function. Method:A total of 200 children patients aged below 24 months were randomly divided into control group and observation group by random number table, with 100 cases in each group. Children in each group received basic clinical treatment, while children in treatment group was also given modified Erchentang (Juhong Tanke liquid), 2-5 mL each time, 3 times a day. Both groups were treated for 15 days. Clinical respiratory tract symptom and sign scores, cough, sputum, dys-expectoration and wheezing were evaluated and compared. Pulmonary function was detected before and after treatment for 15 days. Analysis parameters were respiratory rate (RR), tidal volume per kilogram (VT/kg), inspiratory/expiratory (TI/TE), peak time of expiratory flow (TPTEF), time to peak ratio (TPTEF/TE), peak expiratory flow (PEF), volume in peak time of expiratory flow (VPTEF), volume ratio in peak flow (PFV), terminal flows per peak expiratory flow (25/PF), rate of mid-expiratory to mid-inspiratory flow (ME/MI), respiratory resistance (Rrs), functional residual capacity per kilogram (FRC/kg) and compliance per kilogram (Crs/kg). Result:After treatment for 5 days, both groups have obviously alleviation in sputum, cough, dys-expectoration wheezing and airway function. After treatment for 5 days, sputum, cough, dys-expiratory and wheezing in treatment group were all alleviated comparing with those of control group (PConclusion:Modified Erchentang (Juhong Tanke liquid) has shown marked efficacy in children bronchitis to alleviate clinical symptoms and improve pulmonary function, with no adverse reaction, and thus is worth further promotion and application in clinic.
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Objective To assess the outcomes of OASIS iris expander in phacoemulsification surgery of cataract with small pupil.Methods A prospective case-control study was conducted in 22 microcoria cataract patients (22 eyes).And they were randomly divided into group A and B,in which the pupils of group A were dilated by tearing instruments in 13 eyes,and the pupils of group B were dilated using OASIS iris expander in 9 eyes.All patient underwent phacoemulsification with 3.2 mm clear corneal incision and were followed up at postoperative 1 week,1 month,3 months and 6 months.Finally,the best corrected visual acuity (BCVA),intraocular pressure (IOP),corneal endothelial cell counts,pupil size before and after surgery were recorded and analyzed by an independent sample t test.Results All procedures were completed successfully by the same skilled doctor.Intraocular lenses were implanted in capsule completely,and no complications occurred.At 6 months after operation,patients'BCVA in group A (0.41 ± 0.30) and group B (0.77 ± 0.23) was significantly higher than that in group A (0.17 ±0.14) and group B (0.16 ±0.14) before operation,but there was no statistical difference between the two groups (all P ＞0.05);whereas there was no significant change in the IOP of group A and B at 6 months after operation (1 kPa =7.5 mmHg) and before operation [(14.22 ±6.00) mmHg vs.(15.70 ± 5.70) mmHg)] (all P ＞ 0.05).Moreover,corneal endothelial cell counts in group A [(1486 ±718) cells · mm-2] and B [(1246 ±516)cells · mm-2] were significantly smaller than those before operation [(2498 ±564)cells · mm-2 vs.[(2424 ± 640) cells · mm-2],with no significant difference (P=0.091).The postoperative diameter of the pupil in group A [(4.00 ±0.88) mm] and group B [(4.70 ± 1.57) mm] after operation was larger than that in group A [(2.30 ±0.35)mm] and group B [(1.94 ±0.50)mm] before operation,and there was no statistical difference between the two groups (all P ＞0.05).Conclusions OASIS iris expander can help to dilate and hold pupils and does not affect the postoperative visual acuity and intraocular pressure in mlcrocoria cataract phacoemulsification.The postoperative pupils become larger,and it is necessary to pay attention to protect corneal endothelial cell during usage of OASIS iris expander.