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Objective:To investigate the difference of adverse events in patients with chronic obstructive pulmonary disease (COPD) who underwent on-pump coronary artery bypass grafting (ONCABG) and off-pump coronary artery bypass grafting (OPCABG).Methods:The clinical data of COPD patients undergoing CABG surgery admitted to Beijing Anzhen Hospital affiliated to Capital Medical University from January 2021 to December 2021 were retrospectively analyzed. According to whether they received cardiopulmonary bypass or not, they were divided into ONCABG group (64 cases) and OPCABG group (154 cases). The preoperative and postoperative clinical data were analyzed. The whole group was divided into 4 subgroups (ON1、ON2、OP1、OP2) according to whether receiving cardiopulmonary bypass or not and FEV160% as the cut-off point, to investigate the difference of postoperative adverse events.Results:A total of 218 patients were included, ranging in age from 45 to 76 years old, with a mean age of (63.81±7.72) years, including 149 males (68.35%). There was no significant difference in the incidence of postoperative adverse events between the ONCABG and OPCABG groups ( P>0.05). In subgroup analysis, the incidence of postoperative pulmonary infection (72.73% vs. 45.65%, P<0.05) and postoperative atrial fibrillation (59.09% vs. 32.61%, P<0.05) was higher in ON1 (FEV1≤60% ONCABG, 22 cases) group than in OP1 (FEV1≤60% OPCABG, 46 cases) group. Conclusion:The incidence of postoperative pulmonary infection and atrial fibrillation in COPD patients with FEV1≤60% was higher in ONCABG than in OPCABG.
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Objective:To describe the characteristics and management of right-sided infective endocarditis (RSIE) during pregnancy.Methods:The clinical manifestation, blood culture, echocardiography, diagnosis, treatment, and maternal and infant outcomes of seven patients with RSIE during pregnancy from Capital Medical University Affiliated Beijing Anzhen Hospital from January 2009 to March 2020 were retrospectively collected and described.Results:The incidence of RSIE during pregnancy was 0.27‰ (7/25 832). All patients had a history of congenital heart disease, with a mean age of (26.0±2.7) years and a mean gestational age at onset of (28.7±6.6) weeks. Cardiac murmur, fever, dyspnea, cough, expectoration, and pulmonary rales were the common symptoms. Seven cases were complicated by anemia, seven with hypoproteinemia, six with hypoxemia, five with pulmonary hypertension, and five with positive blood culture. Echocardiography indicated that vegetations were mainly attached to the pulmonary valves (four cases), followed by the tricuspid valves (three cases) and the right ventricular outflow tract (three cases). Four patients were diagnosed with septic pulmonary embolism by chest X-ray. All patients were treated with intravenous antibiotics. Cesarean section was performed on five cases in the third trimester and one in the second trimester due to intrauterine death. The other case underwent vaginal delivery in the third trimester. Cardiac surgery was conducted during the hospitalization in four cases and not in the other three. The mean length of stay was 26 days (12-76 days). Six cases were cured, and one died after discharge. Among the six neonates, one had asphyxia and was died after withdrawal of treatment. The remaining five infants survived and developed well during the follow-up of 5 years (3-10 years).Conclusions:Pregnancy complicated by RSIE is a rare and critical condition, requiring early diagnosis to make optimal treatment strategies, reducing maternal and infant fatality.
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Objective To investigate the value of phase-contrast magnetic resonance imaging (PC-MRI)in evaluating pulmonary artery blood flow and right ventricular(RV)function in elderly patients with chronic obstructive pulmonary disease (COPD).Methods Twenty-four elderly patients with COPD admitted to Beijing Anzhen Hospital between February 2016 and June 2017 were enrolled in this retrospective study.Based on pulmonary artery pressure evaluated by right heart catheterization,COPD patients were divided into a pulmonary hypertension group (PH group,n =12)and a non-PH group(n=12).Pulmonary artery blood flow velocity and volume,pulmonary arterial compliance and right heart function parameters including ejection fraction,end diastolic volume,endsystolic volume and cardiac output,and 6-min walking distance evaluated by PC-MRI were compared between the two groups.Results There were significant differences in peak flow velocity[(88.1 ±16.0)cm/s vs.(59.8± 13.8) cm/s,P =0.005],flow volume [(80.7± 22.0) ml/s vs.(53.2± 26.7)ml/s,P=0.012],main pulmonary artery compliance[(42.3± 14.6)vs.(22.7± 10.8),P =0.001],right ventricular ejection fraction [(48.4 ± 13.4) ％ vs.(37.6 ± 11.1) ％,P =0.000],end-diastolic volume[(64.6±22.5)ml vs.(72.5±22.8)ml,P =0.030]and end-systolic volume[(50.6±33.1)ml vs.(41.7±33.1)ml,P =0.040]between the non-PH and PH groups,while there was no significant difference in cardiac output between the non-PH and PH groups[(34.2±10.8)ml vs.(34.4±8.3)ml,P =0.080].Pearson's correlation analysis showed that 6-minute walking distance had good correlations with right ventricular ejection fraction(r =0.49),forced expiratory volume in 1 s(FEV1)(r=0.60)and main pulmonary artery diameter(r=0.61).Conclusions PC-MRI is a noninvasive imaging method for quantitative analysis of pulmonary artery dynamics and right heart function for the elderly with COPD,and it can provide information for evaluating therapeutic effects and prognosis.
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Objectives To evaluate the effectiveness and safety of peramivir trihydrate in patients with influenza.Methods This was a randomized,double-blind,double-dummy,placebo and positive control,multicenter clinical trial,comparing peramivir trihydrate with oseltamivir and placebo.The inclusive criteria were 15-70 years old,onset within 48 h,positive rapid influenza antigen test,and febrile(＞38℃) accompanied with at least two associated symptoms.The severe cases complicated with chronic pulmonary and cardiac diseases,malignancies,organ transplantation,hemodialysis,uncontrolled diabetes,immunocompromised status,pregnancy and coexistence of bacterium infections were excluded.All patients were randomized 2:2:1 to receive peramivir,oseltamivir and placebo respectively.The primary endpoint was the disease duration,the secondary endpoints included time to normal axillary temperature and normal living activities,viral response,and adverse effects.Results Following informed consent,133 patients were included in this study.Four patients were exclude due to missing medical records,not fitting inclusion or exclusion criteria and poor compliance.A total of 129 patients were finally analyzed,including 49 cases,54 cases and 26 cases in peramivir group,oseltamivir group and placebo group.The median disease duration were 96 (76,120)hours,105(90,124) hours,and 124 (104,172)hours in three groups respectively(P＞0.05).The time to normal axillary temperature,normal living activities and viral response were not significantly different in three groups(P＞0.05).Conclusion The value of antiviral therapy in patients with mild influenza needs to be further determined.
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Objective To investigate the value of echocardiography in assessing the right heart function of patients with chronic obstructive pulmonary disease (COPD). Methods Forty-four COPD patients who were treated in Beijing Anzhen Hospital of Capital Medical University, from April 2016 to April 2017, were selected as COPD group; and 12 healthy physical examiners were included in healthy control group during the same period. Patients were divided into COPD with pulmonary hypertension (PH) group and COPD without PH group. All subjects were routinely examined by transthoracic echocardiography. The parameters of right heart function of all subjects were measured by echocardiography according to 2010 guideline of American Society of Echocardiography (ASE). Independent sample t test was used to compare echocardiographic routine parameters and recommended parameters of ASE guideline between COPD group and healthy control group. One-way analysis of variance was used to compare the routine parameters of echocardiography and the recommended parameters of the ASE guide in the patients of COPD with PH group and COPD without PH group and the healthy control group. SNK-q test was used for comparison between groups. Results The right ventricle diameter (RVD) in group COPD was wider than that in healthy control group [(20.68±4.21) mm vs (18.17±1.75) mm], and the difference was statistically significant (t=2.92, P=0.005). There was no significant difference in the right ventricular outflow tract (RVOT), main pulmonary artery diameter (MPAD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left ventricular ejection fraction (LVEF) between the COPD group and the healthy control group. Compared with the healthy control group, the diameter of right ventricle basal segment in the COPD group increased [(35.92±8.12) mm vs (27.75±3.17) mm], tricuspid annular plane systolic excursion (TAPSE) decreased [(19.61±4.08) mm vs (22.67±2.67) mm], right ventricular index of myocardial performance (RIMP) increased [(0.52±0.10) cm/s vs (0.43±0.04) cm/s)], and the differences were statistically significant (t=3.39, P=0.001; t=-2.44, P=0.019; t=4.31, P ＜ 0.001). There was no significant difference in right atrium area, E/A, E/E' and S' between COPD group and healthy control group. There was no significant difference in RVOT, RVD, MPAD, LVEDD, LVESD and LVEF in the patients of COPD with PH group and COPD without PH group and in the healthy control group. There was no significant difference in the right atrium area, E/A, E/E', TAPSE and S'. The right ventricular basal segment diameter and RIMP of COPD with PH group and COPD without PH group were higher than those of healthy control group [(37.99±9.66) mm, (34.47±6.70) mm vs (27.75±3.17) mm; (0.54±0.13) cm/s, (0.51±0.08) cm/s vs (0.43±0.04) cm/s]. The differences were statistically significant (q=6.960, 4.905, 5.796, 4.348, all P＜0.05). However, there was no significant difference in right ventricular basal segment diameter and RIMP between COPD with PH group and COPD without PH group. The RVWT of COPD with PH group was higher than that of COPD without PH group [(5.29±0.69) mm vs (4.54±0.70) mm], and the difference was statistically significant (t=3.313, P=0.002). Conclusions The method recommended in the ASE guidelines for this study was more sensitive than conventional methods for the detection of changes in the structure of the right heart. The change of the right ventricular structure was the first manifestation of right heart involvement in COPD patients, and then the systolic function of the right ventricle diminished. The long-term effect of pulmonary hypertension was thickening of the right ventricular wall at the early stage and then enlargement of the right ventricle.
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Objective To analyze the clinical features,etiology and prognostic factors of nosocomial candidemia in Beijing Anzhen Hospital.Methods A total of 174 cases of nosocomial candidemia identified during the period from January 2003 to December 2013 in Anzhen Hospital were reviewed retrospectively.The underlying conditions,risk factors,clinical manifestations and outcome were described and analyzed.The prognostic factors were analyzed by both univariate analysis including t-test and Chisquare test,and multivariate regression analysis.Results The 174 patients included 108 (62.1％) males and 66 (37.9％) females.The mean age of patients was 53.9±27.3 years,specifically:＜18 years (31/174,17.8％),18-＜ 65 years (56/174,32.2％),and ≥ 65 years (87/174,50.0％).About one-third (59/174,33.9％) of the patients were treated in ICU,followed by cardiac surgery ward (58/174,33.3％),respiratory medicine ward (21 / 174,12.1％),general surgery ward (14/174,8.0％),neurology ward (7/174,4.0％),vascular surgery (6/174,3.4％),and orthopedic ward (3/174,1.7％).Fever was documented in all cases,including 37.5-37.9 ℃ in 3 (1.7％) cases,38.0-38.9 ℃ in 81 (46.6％) cases,39.0-39.9 ℃ in 85 (48.9％) cases,and ≥ 40.0 ℃ in 5 (2.9％) cases.Increased peripheral blood WBC (＞10×109/L) was reported in 162 (93.1％) cases.The percentage of neutrophils (＞75％) was reported in 166 (95.4％) cases.Thrombocytopenia (＜ 100 × 109/ L) was documented in 24 (13.8％) cases.The most frequently isolated pathogen was C.albicans (99/174,56.9％),followed by C.parapsilosis (37/174,21.3％),C.glabrata (20/174,11.5％),C.krusei (11/174,6.3％),C.tropicalis (4/174,2.3％),and other Candida spp.(3/174,1.7％).The death rate was 50.0％ (87/174).Univariate analysis showed that old age,thrombocytopenia,hypoalbuminemia,renal insufficiency,indwelling urinary catheter were associated with death of candidemia patients.Multivariate analysis showed that hypoalbuminemia,bacterial co-infection,and indwelling urinary catheter were independent risk factors of death in nosocomial candidemia.Conclusions Nosocomial candidemia is more common in the patients treated in ICU and surgery ward.The most common pathogen of nosocomial candidemia is C.albicans associated with high mortality.Old age,hypoalbuminemia,bacterial co-infection,and indwelling urinary catheter are associated with death in nosocomial candidemia.
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Objective To investigate the clinical features,pathogenic distribution and drug susceptibility of patients with infective endocarditis (IE).Methods Clinical data of IE patients were collected,who were admitted to Capital Medical University Affiliated Beijing Anzhen Hospital from January 2012 to March 2015.Results Three hundred and three IE patients were enrolled with age of (43 ± 16)years old.Fever (85.5％)and cardiac murmur (62.4％)were the most common clinical presentations.Congenital heart diseases was the leading underlying diseases in IE patients.Non rheumatic valve diseases (13.5％) followed.Vegetations were found in 90.4％ (274/303) patients.Streptococcus which accounted for 44.2％ was the major pathogen of IE.Staphylococcus (28.9％) was the second common pathogen.Gramnegative bacteria were diversified in categories.Gram-positive cocci were consistently sensitive to vancomycin and linezolid.Conclusions Congenital heart disease is the main underlying disease related to IE.Streptococcus is still the primary pathogen.Gram-positive cocci keep good sensitivity to vancomycin and linezolid.
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Objective To investigate the clinical distribution and antibiotic resistance of the nonfermenting bacterial strains isolated in Beijing Anzhen Hospital from 2008 to 2012.Methods The bacteria were identified by VITEK-compact system and Phoenix 100 system. Antimicrobial susceptibiity was tested by dilution method. Results A total of 2 450 strains of nonfermentative gram-negative bacteria were isolated from clinical specimens. Acinetobacter baumannii, Pseudomonas aeruginosa and Stenotrophomonas maltophilia accounted for 57.2%,25.5% and 10.0%.Specimens were mostly collected from respiratory tract (80.9%),followed by blood (8.1%)and wound exudates (3.9%).The strains were mainly collectd from ICU (50.0%),cardiac surgery ward (17.0%)and respiratory medical ward (11.5%).The prevalence of imipenem-resistant A.baumannii was 62.3%,79.2%,70.4%,76.1%,67.8% from 2008 to 2012.The prevalence of imipenem-resistant P.aeruginosa was 28.7%,25.0%,27.6%,31.1% and 32.0%.S.maltophilia strains showed the highest susceptibility to trimethoprim-sulfamethoxazole and levofloxacin.Conclusions The high prevalence of antibiotic-resistant non-fermenting bacteria poses a great challenge to clinicins. The rational treatment choice should be based on the result of suseptibility testing.
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<p><b>BACKGROUND</b>Exposure of adult mice to more than 95% O2 produces a lethal injury by 72 hours. Nuclear factor kappa B (NF-κB) is a transcriptional factor that plays a key role in the modulation of cytokine networks during hyperoxia-induced acute lung injury (ALI). Osteopontin (OPN) is a phosphorylated glycoprotein produced principally by macrophages. Studies have reported that exogenous OPN can maintain the integrity of the cerebral microvascular basement membrane and reduce brain damage through inhibiting NF-κB activities in the brain after subarachnoid hemorrhage. However, it is not clear whether OPN can reduce lung injury during ALI by inhibiting transcriptional signal pathways of NF-κB and consequent inhibition of inflammatory cytokines. Thus we examined the effects and mechanisms of recombinant OPN (r-OPN) on ALI.</p><p><b>METHODS</b>Ninety-six mice were randomly divided into phosphate buffered saline (PBS) and r-OPN groups. Mice were put in an oxygen chamber (>95% O2) and assessed for lung injury at 24, 48, and 72 hours. Expressions of NF-κB, matrix metalloproteinases 2 and 9 (MMP-2 and MMP-9), and tissue inhibitors of MMP-2 and MMP-9 (TIMP-1, TIMP-2) mRNA in lungs were examined with RT-PCR. Expression and distribution of NF-κB protein in lungs were measured with immunohistochemistry.</p><p><b>RESULTS</b>Exposure to hyperoxia for 72 hours induced more severe lung injury in the PBS group compared with the r-OPN group. Expression of NF-κB mRNA in the PBS group exposed to hyperoxia for 48 and 72 hours was significantly higher than the r-OPN group (P < 0.05). With 72-hour exposure, expression of TIMP-1 mRNA in the r-OPN group was significantly higher than that of the PBS group (P < 0.05). Expression of TIMP-2 mRNA in the r-OPN group at 48 and 72 hours was significantly higher than those in the PBS group (P < 0.05). After 72-hour exposure, expression of NF-κB protein in airway epithelium in the PBS group was significantly higher than that in the r-OPN group (P < 0.05).</p><p><b>CONCLUSION</b>r-OPN can inhibit the release and activation of MMPs through inhibition of the expression of NF-κB and promotion of the expression of TIMPs, and alleviate hyperoxia-induced ALI.</p>
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Animals , Mice , Acute Lung Injury , Genetics , Metabolism , Hyperoxia , Metabolism , Matrix Metalloproteinase 2 , Genetics , Metabolism , Matrix Metalloproteinase 9 , Genetics , Metabolism , NF-kappa B , Genetics , Metabolism , Osteopontin , Genetics , Metabolism , Tissue Inhibitor of Metalloproteinase-1 , Genetics , Metabolism , Tissue Inhibitor of Metalloproteinase-2 , Genetics , MetabolismABSTRACT
Objective To report the clinical and myopathological features in a patient with common variable immunodeficiency (CVID) with myositis.Methods A 33 years old man suffered from recurrent respiratory infection with fever over 10 years.The symptoms improved after anti-infection therapy.At the same time he presented with fatigue.Two years ago he developed general muscle weakness,hypertrophy and myotonia,especially in the hands,neck and thighs.Genetic test for myotonic dystrophy protein kinase (DMPK) and zinc finger protein 9 (ZNF9) was performed.Laboratory tests,electromyography,muscle ultrasound and muscle biopsy were performed.In addition to standard histological and enzyme histochemical stainings,immunohistochemical method was used with primary antibodies of mouse anti human monoclonal antibodies including CD8 for T-lymphocytes,CD20 for B-lymphocytes,CD68 for macrophages and MHC-Ⅰ for muscle membrane.Results Electromyography revealed myogenic changes and abound with myotonic potentials.There was muscle hypertrophy in muscle ultrasound.Lung biopsy showed chronic inflammatory changes.Serum hypoimmunoglobulin and anemia were found.Muscle biopsy showed muscle fiber necrosis and regeneration with lymphocyte and macrophage infiltration.There were no gene mutations in DMPK and ZNF9 gene.Conclusion Muscle hypertrophy and myotonia appeared in CVID with myositis.