Experts consensus for the diagnosis, treatment, and prevention of coronavirus disease 2019 in the elderly / 中华内科杂志

Coronavirus disease 2019 (COVID-19) can cause great damage to the elderly patients and lead to high mortality. The clinical presentations and auxiliary examinations of the elderly patients with COVID-19 are atypical, due to the physiological ageing deterioration and basal pathological state. The treatment strategy for the elderly patients has its own characteristics and treatment protocol should be considered accordingly. To improve the diagnosis, treatment, and prevention of COVID-19 in the elderly, the Expert Committee of Geriatric Respiratory and Critical Care Medicine, China Society of Geriatrics established the "Expert consensus for the diagnosis, treatment, and prevention of coronavirus disease 2019 in the elderly" . We focused on the clinical characteristics and key points for better treatment and prevention of COVID-19 in the elderly. (1) For diagnosis, atypical clinical presentation of COVID-19 in the elderly should be emphasized, which may be complicated by underlying disease. (2) For treatment, strategy of multiple disciplinary team (mainly the respiratory and critical care medicine) should be adopted and multiple systemic functions should be considered. (3) For prevention, health care model about integrated management of acute and chronic diseases, in and out of hospital should be applied.

Nasal high flow oxygen therapy for chronic obstructive pulmonary disease with hypercapnia / 中华全科医师杂志

Nasal high flow oxygen therapy (HFNC), an open nasal catheter system conveying heated and humidified air or oxygen, has been used to treat hypoxemic respiratory failure. At present, some researches indicated that HFNC can be applied for chronic obstructive pulmonary disease (COPD) with hypercapnia, which attenuates the retention of carbon dioxide by positive end-expiratory pressure effect, washing out anatomical dead space and reducing work of breath. HFNC is proved to decrease respiratory frequency, increase alveolar ventilation and end-expiratory lung volume, and its therapeutic effect is similar to non-invasive ventilation. Application of HFNC managed to be optimized in a way of increasing the flow rate in a single prong and mouth-closed breathing. This article summarizes the application of HFNC in COPD with hypercapnia.

Nasal high flow oxygen therapy for chronic obstructive pulmonary disease with hypercapnia / 中华全科医师杂志

Nasal high flow oxygen therapy (HFNC),an open nasal catheter system conveying heated and humidified air or oxygen,has been used to treat hypoxemic respiratory failure.At present,some researches indicated that HFNC can be applied for chronic obstructive pulmonary disease (COPD) with hypercapnia,which attenuates the retention of carbon dioxide by positive end-expiratory pressure effect,washing out anatomical dead space and reducing work of breath.HFNC is proved to decrease respiratory frequency,increase alveolar ventilation and end-expiratory lung volume,and its therapeutic effect is similar to non-invasive ventilation.Application of HFNC managed to be optimized in a way of increasing the flow rate in a single prong and mouth-closed breathing.This article summarizes the application of HFNC in COPD with hypercapnia.

Correlation Analysis between Carbapenem Consumption and Resistance to Carbapenems Among Gram Negative Bacteria Isolates / 医药导报

Objective To evaluate the correlation between carbapenem consumption and resistance to carbapenems among the frequent gram-negative bacteria and provide the basis for rational use of drugs. Methods Retrospective review was used to calculate the DDDs of carbapenems(impenem and meropenem) per 100 persons per day from the year of 2004 to 2016 and resistant rate of the frequent gram-negative bacteria(Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae,and Escherich-ia coli).The correlation of drug usage and resistance were analyzed by SPSS 17.0 software. Results The study demonstrated that carbapenem usage was strongly correlated with imipenem and meropenem-resistant Acinetobacter baumannii,Klebsiella pneumoniae, while has no significant correlation with Pseudomonas aeruginosa,Escherichia coli. Conclusion The growing problem of gram-negative bacteria resistant to carbapenems was strongly related to the high consumption of carbapenems.It also suggested that opti-mum antibiotic use was necessary to alleviate the threat posed by resistant microorganisms at the hospital level.

Clinical manifestations and pulmonary radiological findings of primary anti-neutrophil cytoplasmic antibody-associated vasculitis / 中华全科医师杂志

Objective To analyze the clinical features and pulmonary radiological findings of primary anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis (AAV).Methods Clinical data of 271 ANCA positive primary AAV patients admitted in Shanghai Ruijin Hospital from January 2003 to November 2015 were retrospectively analyzed.Among 271 patients,there were 211 myeloperoxidase (MPO)-ANCA positive cases (MPO subgroup),52 proteinase 3 (PR3)-ANCA positive cases (PR3 subgroup),and 8 dual positive cases (dual subgroup) according to ANCA classification.The demography,clinical characteristics,pulmonary radiological manifestation and renal function were compared among three subgroups.Results MPO subgroup had more renal (x2 =4.968,P =0.026) and constitutional symptoms (x2.=8.901,P =0.003) than PR3 group,while PR3 group had more ENT symptoms (x2 =19.843,P ＜ 0.001),cough (x2 =6.623,P =0.010),hemoptysis (x2 =8.656,P =0.003),dyspnea (x2 =5.127,P =0.024),buccal and ocular mucosal symptoms (x2 =4.818,P =0.028) than MPO group.In lung radiology,interstitial manifestations were displayed more frequently in MPO than PR3 group (x2 =4.237,P =0.040),while pulmonary nodules was more frequent in PR3 than MPO group (x2 =4.503,P =0.034).Dual subgroup tended to have more nervous,respiratory and renal impairment.Renal function showed that MPO subgroup had higher creatinine (Z =-5.529,P ＜ 0.001),urea (Z =-4.646,P ＜ 0.001) and uric acid levels (Z =-2.331,P =0.020) than PR3 subgroup.Dual subgroup had higher creatinine (Z =-3.251,P =0.001) and urea (Z =-2.882,P =0.004) levels than PR3 subgroup,but there was no difference with MPO subgroup.Conclusion There are significant differences in both clinical and pulmonary radiological manifestations between the MPO and PR3-ANCA subgroup of primary AAV.

A case report of lung cancer presenting as interstitial pneumonia and a review of literatures / 中华全科医师杂志

A case of lung adenocarcinoma was reviewed.Its major symptoms were cough , sputum and progressive dyspnea.High resolution computed tomography presented ground-glass, bilateral fibrosis and some solid opacities.In conjunctions with the related literatures , its clinical manifestations and imaging features were analyzed for a better understanding of lung cancer.

Relationship between pulmonary arterial hypertension and fibrinolysis in elder patients with chronic obstructive pulmonary disease / 中华全科医师杂志

A total of 40 patients with COPD (excluding those with correlated/relevant diseases)were measured for inflammation parameters of erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) after hospital admission and some coagulation/fibrinolysis parameters including D-dimer,thrombinantithrombin (TAT),prothrombin fragment 1 + 2,(tissue plasminogen activator) tPA,plasminogen activator inhibitor 1 (PAI-1),von Willebrand factor (von WF),endothelin receptor A,thromboxane B2,P-selectin and pulmonary arterial pressure (PAP) by ultrasonic cardiography after the settling of the symptons of acute period.All patients were then divided into 2 groups according to PAP [＜ 40 mm Hg (1 mmHg=0.133 kPa) (n=24),＞40 mm Hg (n=16)].The values of CRP and ESRin the group with PAP ＞ 40 mm Hg were significantly higher than those in another group (P =0.044 and P =0.002respectively) while tPA was lower (P =0.04).A moderate positive correlation existed between tPA and TXB2 (r =0.547).Moreover,a highly positive correlation was found between TXB2 and PAl-1 (r =0.929).The results indicated that the COPD patients with pulmonary arterial hypertension (PAH) tend to have a higher level of inflammation,and their fibrinolysis becomes impaired leading to a prothrombotic state.