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Resumen Introducción: La bronquiolitis obliterante postinfecciosa es una enfermedad pulmonar poco frecuente; existen limitados reportes en Sudamérica. Caso clínico: En esta serie se reportan 10 pacientes con esta enfermedad diagnosticados en el Instituto Nacional de Salud del Niño-Breña (Lima-Perú). La mediana de edad al diagnóstico fue de 19 meses. Todos los pacientes presentaron el antecedente de infección respiratoria aguda grave. Los síntomas más frecuentes fueron tos, dificultad respiratoria, sibilancias e hipoxemia; el patrón de atenuación en mosaico fue la característica más frecuente en la tomografía. Todos tenían serología positiva para adenovirus. Se administró tratamiento con pulsos de metilprednisolona, azitromicina, hidroxicloroquina y corticoides inhalados. Ningún paciente falleció durante el seguimiento. Conclusiones: En los niños previamente sanos con antecedente de infección respiratoria aguda grave y sintomatología obstructivo bronquial persistente se debe considerar el diagnóstico de bronquiolitis obliterante postinfecciosa. Este es el primer reporte en Perú con un régimen terapéutico adaptado a nuestra institución.
Abstract Background: Postinfectious bronchiolitis obliterans is a rare lung disease; there are limited reports in South America. Case report: We report 10 patients with this disease diagnosed at the Instituto Nacional de Salud del Niño-Breña (Lima-Peru). The median age at diagnosis was 19 months and all patients had a history of severe acute respiratory infection. The most frequent symptoms were cough, respiratory distress, wheezing, and hypoxemia. The mosaic attenuation pattern was the most frequent on the tomography. All the patients had positive serology for adenovirus. The treatment received was methylprednisolone pulses, azithromycin, hydroxychloroquine, and inhaled corticosteroids. No patient died during the follow-up. Conclusions: In previously healthy children with a history of severe acute respiratory infection and persistent bronchial obstructive symptoms, the diagnosis of postinfectious bronchiolitis obliterans should be considered. This is the first report in Peru with a therapeutic regimen adapted to our institution.
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Objective:To investigate the clinical characteristics of pathological phimosis and analyze the correlation between pathological phimosis and balanitis xerotica obliterans(BXO) in children.Methods:The clinical data of 45 children who underwent circumcision and histopathologic evaluation in our hospital from July 2018 to August 2022 were retrospectively analyzed. According to the results of the pathological examination, lichen sclerosis et atrophicus cases were classified as the BXO group, and other cases were classified as the non-BXO group. The two groups' age, history, and symptoms were recorded and compared. The management of meatal stenosis and the effect of topical steroids were described.Results:There were 33 patients in the BXO group, aged (7.42±2.46)years old, of which 91% (30/33) were 5-11 years old. There were 12 patients in the non-BXO group, aged (10.42±2.88) years old. The difference of age between the two groups was statistically significant ( P< 0.05). But there was no significant difference between the BXO group and non-BXO group in the history of balanoposthitis(28 cases vs. 7 cases), history of foreskin dilated(15 cases vs. 3 cases), frequent urination (18 cases vs. 10 cases), urgent urination(12 cases vs. 4 cases), urination pain(17 cases vs. 3 cases), dysuria(21 cases vs. 5 cases), pruritus(25 cases vs. 7 cases), penile pain(7 cases vs. 1 case), ballooning(7 cases vs. 6 cases), and spraying (14 cases vs. 2 cases)( P > 0.05). All 8 cases of meatal stenosis were in the BXO group. Three cases underwent meatal dilatation and indwelling catheter was left for 5-10 days, and topical steroid was used on the third day after surgery. The remaining cases were treated with topical steroids after a pathological diagnosis of BXO. Among the 4 cases with partial urethral meatus involvement, 3 had good results after treatment, and 1 had no significant improvement and underwent meatal dilatation twice later. In 1 case, meatal stenosis was found two weeks after surgery, but no meatal abnormality was found during operation. All patients recovered smoothly during a median follow-up of 12.2 (5.4, 21.8) months. Conclusions:BXO is the main cause of pathologic phimosis in boys, and the diagnosis is based on histopathology. The main complication of BXO is meatal stenosis, which should be detected as early as possible and treated in time.
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Objective:To explore application effect of early respiratory training schemes based on 4E mode (Engage, Educate, Execute, Evaluate) in children with bronchiolitis obliterans (BO) and provide evidence for the clinical implementation of early respiratory rehabilitation in children with BO.Methods:This was a quasi-experimental study. The children with BO who were admitted to 2 wards of the Department of Respiratory Medicine of Hunan Children's Hospital from January 1 to December 31, 2021 were selected as the research objects. They were randomly divided into the control group and the experimental group, with 23 cases in each group. The control group received routine treatment, nursing and rehabilitation guidance. The experimental group established a multidisciplinary team based on the control group, and used the early respiratory training program based on the 4E model to implement intervention. The clinical symptom severity scale was used to evaluate the improvement of the clinical symptoms of the children within 24 hours of being diagnosed as BO, the day of discharge, and 1 and 3 months after discharge for re-examination, and the hospitalization time of the children and the incidence of adverse events related to respiratory training were counted by using medical records and questionnaires.Results:The clinical symptom severity scores of the experimental group within 24 hours of admission diagnosis and the day of discharge were (20.00 ± 2.51) and (11.30 ± 2.46)points respectively, while those of the control group were (20.57 ± 2.21) and (11.70 ± 2.42) points respectively, with no statistically significant difference ( t=0.81, 0.54, both P>0.05). The clinical symptom severity scores of the experimental group were(10.52 ± 2.31) and (8.55 ± 1.06) points, lower than (12.32 ± 1.39) and (12.45 ± 2.19) points of the control group when they returned to the hospital for re-examination 1 and 3 months after discharge, with a statistically significant difference ( t=3.14, 7.25, both P<0.05). The experimental group was hospitalized for (11.78 ± 1.17) days, which was showter than (13.74 ± 1.63) days in the control group, with a statistically significant difference ( t=4.68, P<0.05). No respiratory training-related adverse events occurred in both groups of children during hospitalization. During home respiratory training after discharge, 1 and 2 respiratory training-related adverse events occurred in the experimental group 1 and 3 months after discharge, respectively, compared with 6 and 9 in the control group. The difference was statistically significant ( χ2=4.64, 5.94, both P<0.05). Conclusions:Early respiratory training solutions based on the 4E mode can improve the clinical symptoms of BO children, shorten the hospitalization time, reduce the number of adverse events related to respiratory training, and promote the recovery of children.
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Lower extremity arteriosclerosis obliterans is a clinical manifestation of atherosclerosis in the lower extremities.At present, the main treatment methods include stent implantation, balloon angioplasty.However the incidence of restenosis after interventional surgery is high, which seriously affects the effect of surgical treatment and the prognosis of patients.This article reviews the mechanism, influencing factors and the latest progress in the prevention and treatment of vascular restenosis after arteriosclerosis obliterans of the lower extremity orteriosclerosis obliterans intervention, which is of important clinical significance to the early prevention and treatment of instent restenosis.
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OBJECTIVE@#To evaluate the effectiveness and safety of Rotarex catheter system in treating femoropopliteal artery stenosis accompanied with thrombosis.@*METHODS@#From Jun. 2017 to Dec. 2019, the clinical data of 32 femoropopliteal artery stenosis accompanied with thrombosis cases treated with Rotarex catheter system were retrospectively analyzed. There were 23 males and 9 females aged from 50 to 89 years and the mean age was (70.7±10.3) years. Six cases had acute course of disease (≤2 weeks), 17 cases had subacute course of disease (>2 weeks, ≤3 months), and 9 cases had chronic course of disease (>3 months). Mean lesion length was (23.4±13.7) cm, mean occlusion length was (19.9±13.3) cm, and in-stent occlusion 7 cases. The superficial femoral artery (SFA) was involved in 13 cases, the popliteal artery (PA) was involved in 8 cases, and both SFA and PA were involved in the other 11 cases. All the cases were treated with Rotarex catheter system. When necessary, suction with large lumen catheter was enabled. Residual stenosis was treated with percutaneous transluminal angioplasty (PTA). Drug-coated balloon (DCB) was only used in patients with financial status, and stent was used only when it was necessary. Heparin was used for 24 h after procedures, and after that, antiplatelet agents were used. Doppler ultrasonography was taken during the followed-up.@*RESULTS@#Technical success was 100%, and mean procedure time was (107.4±21.5) min. 8F (1F≈0.33 mm) and 6F Rotarex catheter were used in 27 and 5 cases respectively. In 27 cases, forward flow was obtained immediately after debulking with Rotarex catheter, and in the other 5 cases, suction with large lumen catheters were used. PTA was used in all 32 cases. DCB were used in 8 cases, of which 4 were used in in-stent stenosis. Twelve cases were implanted stents. There were no perioperative deaths. The only one procedure related complication was distal embolism. We took out the thrombus with guiding catheter. In all cases, mean hospital stay were (4.6±1.5) d. The ankle brachial index increased from 0.32±0.15 to 0.86±0.10 after treatment (t=-16.847, P < 0.001). The Rutherford stages decreased significantly (Z=-4.518, P < 0.001). All the patients were followed up for 6.0-36.0 months, and the median time was 16.0 months. 2 cases stopped antiplatelet agents, which resulted in acute thrombosis. Another percutaneous mechanical thrombectomy and PTA were taken in one of them. Two cases died of cardiovascular disease during the follow-up, and no amputation was observed. Target lesion restenosis occurred in 7 cases during the follow-up, and target lesion revascularization (TLR) was taken in two of them.@*CONCLUSION@#In treating femoropopliteal artery stenosis accompanied with thrombosis, Rotarex catheter can remove thrombus effectively, and that can expose underlying lesions and reduce stent use and complications rates. It is a safe and effective method.
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Male , Female , Humans , Middle Aged , Aged , Aged, 80 and over , Femoral Artery/surgery , Retrospective Studies , Constriction, Pathologic , Platelet Aggregation Inhibitors , Treatment Outcome , Thrombosis , CathetersABSTRACT
OBJECTIVE@#To investigate the effects of Tongxinluo (TXL) on thromboangiitis obliterans (TAO) and the underlying mechanisms.@*METHODS@#Ninety male C57/BL6J mice were randomly divided into 6 groups according to a random number table: the sham group, TAO model group, Compound Danshen Tablet (CDT) group, and the high-, medium-, and low-dose TXL groups. All mice except the sham group were injected with sodium laurate (0.1 mL, 5 mg/mL) in the femoral artery to establish TAO mouse model. After modeling, mice in the sham and TAO model groups were intragastrically administered 0.5% (w/v) sodium carboxymethylcellulose, mice in the CDT group were intragastrically administered 0.52 g/kg CDT, and mice in the TXL-H, TXL-M, and TXL-L groups were intragastrically administered 1.5, 0.75, and 0.38 g/kg TXL, respectively. After 4 weeks of gavage, the recovery of blood flow in the lower limbs of mice was detected by Laser Doppler Imaging. The pathological changes and thrombosis of the femoral artery were observed by morphological examination. The expressions of tumor necrosis factor α (TNF-α) and inducible nitric oxide synthase (iNOS) in the femoral artery wall were detected by HE staining. Levels of thromboxane B2 (TXB2), 6-keto-prostaglandin F1α (6-keto-PGF1α), endothelin-1 (ET-1), interleukin (IL)-1β and IL-6 were measured using enzyme-linked immunosorbent assay (ELISA). Levels of activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT) and fibrinogen (FIB) were detected by a fully automated biochemical analyzer.@*RESULTS@#TXL promoted the restoration of blood flow in the lower limbs, reduced the area of thrombosis in the femoral artery, and alleviated the pathological changes in the femoral artery wall. Moreover, the levels of TXB2, ET-1, IL-6, IL-1β, TNF-α and iNOS were significantly lower in the TXL groups compared with the model group (P<0.05 or P<0.01), while the level of 6-keto-PGF1α was significantly higher (P<0.01). In addition, APTT, PT, and TT were significantly prolonged in TXL groups compared with the model group (P<0.05 or P<0.01), and FIB levels were significantly decreased compared with the model group (P<0.01).@*CONCLUSIONS@#TXL had a protective effect on TAO mice, and the mechanism may involve inhibition of thrombosis and inflammatory responses. TXL may be a potential drug for the treatment of TAO.
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Mice , Male , Animals , Thromboangiitis Obliterans/chemically induced , Interleukin-6/metabolism , Tumor Necrosis Factor-alpha/metabolism , ThrombosisABSTRACT
Occupational exposure to diacetyl can lead to bronchiolitis obliterans. In this paper, two patients with severe obstructive ventilation disorder who were exposed to diacetyl at a fragrance and flavours factory were analyzed. The clinical manifestations were cough and shortness of breath. One of them showed Mosaic shadows and uneven perfusion in both lungs on CT, while the other was normal. Field investigation found that 4 of the 8 workers in the factory were found to have obstructive ventilation disorder, and 2 had small airway dysfunction. This paper summarizes the diagnostic process of patients in order to improve the understanding of airway dysfunction caused by occupational exposure to diacetyl and promote the development of relevant standards.
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Humans , Diacetyl/adverse effects , Occupational Diseases/diagnosis , Occupational Exposure/adverse effects , Lung , Bronchiolitis Obliterans/diagnosisABSTRACT
Introduction: Buerger's disease (BD) generally affects men, young people, and smokers, but it can also affect women. Its incidence is rare in Latin America. Case report: A 40-year-old Colombian woman, active smoker and user of psychoactive substances, attended the emergency department of a tertiary care center due to symptoms of 3 days consisting of retraction of the corner of the mouth, drooling, and involuntary tongue movements. The patient, who had a history of uncontrolled diabetes and recent acute ischemia of the right upper limb due to acute thrombosis, required surgical management and subsequent use of oral anticoagulation. She later developed necrotic changes in the distal phalanges of the right hand that required ablative therapy. Since age, sex and limb involvement were not typical for BD, collagenosis, vasculitis or thrombophilia were ruled out, but after excluding these disorders, BD with atypical features was considered. The patient was discharged with oral anticoagulation, aspirin, combined analgesia, physiotherapy, and recommendation for smoking cessation. Conclusions: Age, sex, smoking and comorbidities such as diabetes are risk factors for BD. Imaging and histopathology are the gold standard for the definitive diagnosis of this entity. Multidisciplinary management, lifestyle changes, smoking cessation, pain control, good wound healing and social support are key aspects for better clinical outcomes in patients with BD.
Introducción. La enfermedad de Buerger (EB) afecta generalmente a hombres, jóvenes y fumadores, y aunque también puede afectar a mujeres, su incidencia es rara en Latinoamérica. Presentación del caso. Mujer colombiana de 40 años, fumadora activa y consumidora de sustancias psicoactivas, quien acudió al servicio de urgencias de una institución de tercer nivel por síntomas de 3 días de evolución consistentes en retracción de la comisura bucal, babeo y movimientos involuntarios de la lengua. La paciente, que tenía antecedente de diabetes no controlada y reciente isquemia aguda de miembro superior derecho por trombosis aguda, requirió manejo intervencionista y subsecuente uso de anticoagulación oral. Posteriormente, desarrolló cambios necróticos en falanges distales de mano derecha y requirió terapia ablativa. Dado que la edad, el género y la afectación de las extremidades no eran típicos para EB, se procedió a descartar colagenosis, vasculitis o trombofilia, pero tras excluir estas patologías se consideró EB con características atípicas. La paciente fue dada de alta con anticoagulación oral, aspirina, analgesia combinada, fisioterapia y recomendación de suspender el consumo de tabaco. Conclusiones. La edad, el género, el tabaquismo y las comorbilidades como diabetes son factores de riesgo para EB. La imagenología e histopatología son estándar de oro en el diagnóstico definitivo de esta entidad. El manejo multidisciplinario, los cambios en el estilo de vida, la cesación del tabaquismo, el control del dolor, la buena cicatrización de heridas y el apoyo social son aspectos importantes para obtener mejores resultados clínicos en pacientes con EB.
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La infección por SARS-CoV-2 en la población pediátrica gene-ralmente se manifiesta con síntomas leves; sin embargo, en pacientes con co-morbilidades puede haber compromiso pulmonar grave. Se presenta el caso de un lactante de tres meses de edad con una infección por SARS-CoV-2, con sintomatología respiratoria persistente por 8 semanas después de la infección inicial, con RPC persistentemente positiva, requiriendo varias hospitalizaciones, oxígeno suplementario y ventilación mecánica invasiva. Se encontraron hallazgos clínicos y radiológicos compatibles con una bronquiolitis obliterante asociada a la infección por SARS-CoV-2. Hubo una adecuada respuesta clínica, después del inicio de tratamiento de primera línea para bronquiolitis obliterante, y una evolución favorable durante el seguimiento hasta la fecha, evidenciando la importancia de tener en cuenta esta asociación en la práctica clínica.
SARS-CoV-2 infection in the pediatric population usually manifests with mild symptoms; however, in patients with comorbidities, there may be a severe pulmonary compromise. We present the case of a 3-month-old patient with acute SARS-CoV-2 infection, with persistent respiratory symptoms up to 8 weeks after the initial infection, with a persistently positive PCR test, requiring several hospitalizations, supplemental oxygen, and even invasive mechanical ventilation. Clinical and radiological manifestations were found consistent with bronchiolitis obliterans associated with SARS-CoV-2 infection. An adequate clinical response was documented after starting first-line treatment for bronchiolitis obliterans with satisfactory evolution during follow-up to date, evidencing the importance of considering this association in clinical practice.
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Resumen El aumento de la expectativa de vida de niños y adolescentes con enfermedades respiratorias crónicas ha llevado a implementar estrategias como la rehabilitación respiratoria (RR). El presente artículo profundiza en las distintas indicaciones de la RR en distintos niveles de atención médica, distinto grado de dependencias tecnológicas y diversas patologías como: Fibrosis Quística, Bronquiolitis Obliterante, Enfermedades Neuromusculares, anomalías de caja torácica y escoliosis.
The increase in the life expectancy of children and adolescents with chronic respiratory diseases has led to implement strategies such as respiratory rehabilitation (RR). This article delves into the different indications of RR at different levels of medical care, different level of technological dependencies and different pathologies such as: Cystic Fibrosis, Bronchiolitis Obliterans, Neuromuscular Diseases, Rib cage abnormalities and Scoliosis.
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Humans , Child , Adolescent , Respiration Disorders/rehabilitation , Respiratory Therapy , Bronchiolitis Obliterans/rehabilitation , Chronic Disease , Cystic Fibrosis/rehabilitationABSTRACT
Rejection after lung transplantation, including acute rejection (AR) and chronic rejection manifested with chronic lung allograft dysfunction (CLAD), is the main factor affecting the long-term survival of allografts. Exosome, a type of extracellular nanovesicle for intercellular communication among eukaryotic cells, could carry complex biological information and participate in various physiological and pathological processes. Exosome has become a critical immune medium in rejection, regulates the incidence and development of rejection through multiple pathways, and also plays a key role in the monitoring and management of rejection. In this article, the type of rejection after lung transplantation, the mechanism underlying the role of exosome in regulating rejection, exosome acting as biomarkers and the application in rejection treatment were reviewed, aiming to provide a novel direction for comprehensive diagnosis and treatment of rejection following lung transplantation.
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Objective:To investigate the high-resolution CT features and risk factors of secondary bronchiolitis obliterans (BO) in children with adenovirus pneumonia.Methods:In this study, a case-control study method was adopted, and 44 children with BO secondary to adenovirus pneumonia in Dongguan Children′s Hospital Affiliated to Guangdong Medical University from January 2015 to October 2020 were selected as the observation group, and 45 children with simple adenovirus pneumonia during the same period were selected as the control group. The differences in the chest high-resolution CT imaging characteristics of the two groups of children were compared. The risk factors of secondary BO in children with adenovirus pneumonia were analyzed by single factor and multiple factor logistic regression.Results:In the lung CT examination of children in the observation group, the detection rates of mosaic perfusion sign, bronchial wall thickening, bronchiectasis, lung consolidation and clear lung were significantly higher than those in the control group, and the difference was statistically significant (all P<0.05); Logistic regression model showed that prolonged heat course, high heat peak, mechanical ventilation treatment and prolonged mechanical ventilation time were independent risk factors of secondary BO children with adenovirus pneumonia (all P<0.05). Conclusions:Children with BO secondary to adenovirus pneumonia have typical high-resolution CT features, which is of high practical value for clinical diagnosis. Prolonged heat course, high heat peak, mechanical ventilation treatment and prolonged mechanical ventilation were independent risk factors of secondary BO in children with adenovirus pneumonia.
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Objective:To analyze the clinical effect of thin-walled low-chronic outward force (COF) stent in the treatment of femoral popliteal artery occlusive disease.Methods:Retrospective analysis was made on the clinical data of 76 consecutive patients with femoral popliteal artery occlusive disease (76 limbs) of lower extremities admitted to Renji Hospital affiliated to Shanghai Jiaotong University Medical College from June 2018 to May 2019, all of whom underwent Pulsar-18 stent(Biotronic, Germany) implantation. The clinical symptoms and stent patency rate were analyzed.Results:All 76 patients were successfully implanted with stents, and the Rutherford grade of postoperative clinical symptoms was significantly decreased, while the ankle brachial index (ABI) was significantly increased ( P<0.05). After 24 months of follow-up, the patency rates of femoral popliteal artery stents in phase Ⅰ at 3, 6, 12 and 24 months were 97.0%(64/66), 95.4%(62/65), 82.8%(53/64) and 79.4%(50/63), respectively. The patency rates of femoral popliteal artery stents in phase Ⅱ at 6, 12 and 24 months were 100%(65/65), 95.3%(61/64) and 90.5%(57/63), respectively. The stent patency rate was lower in complex femoral popliteal artery occlusion. Conclusions:The thin-walled and low-COF stent has good clinical results and patency in treatment of femoral popliteal artery occlusive disease. Good vessel prepare and drug-coated balloon may lower the in-stent restenosis.
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Male genital lichensclerosus has a hidden onset, which is easy to be ignored by doctors and patients. However, as the disease progresses, it can cause anterior urethral stricture, urinary fistula, perineal abscess and induce squamous cell carcinoma, which is extremely harmful. In February 2019, Rongcheng People’s Hospital treated a case of male genital sclerosing lichenoidosis with urethral stricture, perineal abscess and squamous cell carcinoma. After a variety of imaging, endoscopic examination and multiple pathological biopsy, the final diagnosis was confirmed, and then the cancer tissue was removed.
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Objective:To investigate the clinical characteristics and treatment of bronchiolitis obliterans syndrome (BOS) after hematopoietic stem cell transplantation (HSCT) in children.Methods:Clinical data of 7 patients with BOS after HSCT in the Department of Hematology and Oncology, Children′s Hospital, the First Affiliated Hospital of Zhengzhou University from September 2015 to June 2019, who had a survival of longer than 100 days were retrospectively analyzed.Results:At the last follow-up visit, the incidence of BOS was 4.6%(7/152 cases), including 5 males and 2 females.The median time from HSCT to the diagnosis of BOS was 15 (9-27) months.Among the 7 cases, 5 cases had dry cough and shortness of breath after activity, and 2 cases had no obvious clinical symptoms.Pulmonary function was moderate in 5 cases and severe in 2 cases of obstructive ventilatory disorder.High-resolution CT showed mosaic sign in 5 cases and bronchial wall thickening in 4 cases.Bronchoalveolar lavage (BAL) was performed in 4 cases, and flocculent secretion was found in the bronchus.Membranous substance was formed in the bronchus in 3 cases, and some lumens were completely occluded and dredged by foreign body forceps.After treatment with Fluticasone, Azithromycin and Montelukast sodium (FAM regimen), the pulmonary function of 5 cases(71.4%) was significantly improved, but ineffective in 2 cases.Conclusions:BOS after HSCT in children mainly begins with dry cough and shortness of breath after activity.Regular screening of pulmonary function is beneficial to identify asymptomatic children.BAL can clear inflammatory cytokines, which is conductive to the following drug treatment.If necessary, foreign forceps should be used to dredge the occluded bronchus to relieve symptoms quickly.FAM regimen is an effective treatment method, and timely adjustment of treatment according to the disease situation can improve the prognosis.
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Objective:To explore the predictive value of ankle brachial index (ABI), HEART and thrombolysis in myocardial infarction (TIMI)scores for restenosis in patients with lower extremity arteriosclerosis obliterans (LEASO) after stent implantation.Methods:A retrospective study of 100 patients who were admitted to the Heyuan City People′s Hospital for stent implantation for LEASO from January 2015 to January 2020 and met the inclusion criteria were collected, and the patients were divided into restenosis group ( n=28) and patency group ( n=72) according to whether they were restenosis after operation. The clinical data of the two groups of patients were compared, including gender, age, disease course, history of cardiovascular and cerebrovascular diseases, smoking history, regular medication after surgery, number of stents, total length, bilateral lesions, total occlusion of lower extremities, length of vascular lesions, high-sensitivity C-reactive protein (hs-CRP), fasting blood glucose, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, fibrinogen, hemoglobin, platelet count and red blood cell count, and ABI, HEART, TIMI scores were compared, the relationship between ABI, HEART and TIMI scores and postoperative restenosis was further analyzed. Measurement data were expressed as mean±standard deviation ( ± s), and two independent samples t-test was used for comparison between groups; enumeration data were compared between groups by Chi-square test. Based on independent risk factors in multivariate Logistic regression analysis, a nomogram prediction model was constructed using R 3.3.2 software and software package rms. Correlations were analyzed using bivariate Pearson linear correlation analysis. The receiver operating characteristic curve (ROC) was used to evaluate the predictive value of each score and nomogram model for postoperative restenosis, and the results were expressed as the area under the curve (AUC) and the 95% confidence interval (95% CI) of the area. Results:Patients in the restenosis group and the patency group had a history of smoking, the proportion of irregular postoperative medications, the number of implanted stents, the total length of implanted stents, hs-CRP, fibrinogen, total cholesterol, red blood cell count levels, and ABI, HEART, TIMI scores were significantly different ( P<0.05). Pearson correlation analysis showed that ABI score ( r=-0.527, P=0.001) was negatively correlated with postoperative restenosis, and the HEART score ( r=0.604, P=0.010) and TIMI score ( r=0.719, P=0.005) were positively correlated with postoperative restenosis. A history of smoking, irregular medication after surgery, number of implanted stents>2, total length of implanted stent>212 mm, hs-CRP>2 mg/L, fibrinogen>3.7 g/L, ABI score ≤0.58, HEART score>6.30, and TIMI score>4.30 were independent risk factors for postoperative restenosis. The ABI, HEART, and TIMI scores predict the AUC of the ROC curve for postoperative restenosis of 0.813, 0.789, and 0.798, cutoff points were 0.58, 6.30 and 4.30 score, sensitivities were 95.64%, 91.17% and 92.51%, specificities were 64.18%, 55.43% and 58.62%, respectively. The consistency index (C-index) and ROC curve AUC of the nomogram prediction model were 0.811 (95% CI: 0.721-0.901) and 0.818 (95% CI: 0.732-0.904), respectively, indicating a good degree of discrimination. Conclusions:ABI, HEART and TIMI scores are independent risk factors for restenosis after stent implantation in LEASO patients. ABI, HEART and TIMI scores can effectively predict the risk of restenosis after stent implantation in patients.
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Objective:To investigate the clinical characteristics and risk factors of postinfectious bronchiolitis obliterans(PIBO)after severe adenovirus pneumonia(SAP).Methods:We retrospectivly analyzed 78 children who were hospitalized for SAP at Shenzhen Children′s Hospital from April 2015 to April 2020.The cases were divided into PIBO group( n=26) and non-PIBO group( n=52) based on the diagnosis results.The general conditions, clinical characteristics, and laboratory data from two groups were analyzed, and the risk factors for PIBO were explored. Results:A total of 78 children were included in this study.There were 18 (69.2%) males and eight (30.8%) females in PIBO group; the average age of onset in PIBO group was younger than that in non-PIBO group[(11.77±3.24)months vs.(15.08±6.48)months, P=0.027]. The cough duration[(11.35±7.35)days vs.(7.15±5.67)days, P=0.010], and heat duration[(13.12±6.78)days vs.(8.62±4.76)days, P=0.007] were longer in PIBO group than those in non-PIBO group.The white blood cell count[(12.46±7.23)×10 9/L vs.(9.17±3.66)×10 9/L), P<0.05], platelet count[(390.12±209.03)×10 9/L vs.(284.69±83.33)10 9/L, P<0.05], C-reactive protein[(37.04±32.16)mg/L vs.(18.14±18.33)mg/L, P<0.05], procalcitonin[(3.51±3.33)μg/L vs.(1.09±1.37)μg/L, P<0.05], lactate dehydrogenase(LDH)[(1 155.88±842.94)IU/L vs.(414.00±218.94)IU/L, P<0.01] were all higher in PIBO group than those in non-PIBO group; The roportion of patients with mycoplasma pneumoniae infection[5(19.2%) cases vs.4(7.7%) cases, P<0.05], admitted to PICU[18(69.2%) cases vs.8(15.4%) cases, P<0.01] , using invasive mechanical ventilation[10(38.5%) cases vs.5(9.6%) cases, P<0.01], using hormones[23(88.5%) cases vs.21(40.4%) cases, P<0.01], and using human immunoglobulin[20 (76.9%) cases vs.10(19.2%) cases, P<0.01] were higher in PIBO group than those in non-PIBO group.The multivariate Logistic regression using stepwise method showed that older age ( OR=0.942, 95% CI 0.890-0.997) was a protective factor for PIBO, while higher LDH levels ( OR=1.005, 95% CI 1.002-1.008), using intravenous corticosteroids ( OR=6.622, 95% CI 0.924-47.436), and using human immunoglobulin ( OR=9.681, 95% CI 1.742-53.802) were the risk factors for PIBO in SAP ( P<0.05). The receiver operating characteristic curve was constructed through the combination of age of onset, LDH level, using intravenous hormone, and using human immunoglobulin.The area under the curve reached 0.954.The overall best cut-off value of the prediction model was 0.272, the sensitivity was 92.3%, and the specificity was 86.5%.When LDH=462 IU/L, the area under the curve reached the maximum value of 0.882, the sensitivity was 100.0%, and the specificity was 61.5%. Conclusion:SAP children with characteristics such as younger age, long cough and fever duration, high inflammatory index, LDH level higher than 462 IU/L, admitted to PICU, mechanical ventilation and need hormones and human immunoglobulin, should be alert to the risk of PIBO.
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Objective:To explore the risk factors of antiplatelet drug compliance after stent implantation in patients with lower extremity arteriosclerosis obliterans, and to construct an online prediction model tool.Methods:Retrospective analysis of the clinical data of patients with lower extremity arteriosclerosis obliterans who received lower extremity arterial stent implantation in Department of Vascular Surgery, Provincial Hospital Affiliated to Shangdong First Medical University from January 2019 to January 2021 was carried out. 90 patients with poor compliance and 90 patients with good compliance were selected into the observation group and the control group, respectively. Univariate analysis was used to screen the influencing factors of antiplatelet drug compliance, and the variables with statistical significance were substituted into the binary Logistic regression to carry out independent risk factor test to screen the risk factors of cross-over antiplatelet drug compliance and establish the prediction model.Results:Married ( OR = 0.316, 95% CI 0.135-0.738), number of follow-up visits during the follow-up period ( OR = 0.866, 95% CI 0.760-0.987), the amount of medication ( OR = 0.755, 95% CI 0.654-0.919) were the protective factors for the compliance of antiplatelet drugs in patients with lower extremity arteriosclerosis obliterans after stent implantation. Advanced age ( OR = 1.136, 95% CI 1.066-1.211), male ( OR = 3.727, 95% CI 1.533-9.060), junior high school and below education level ( OR = 4.949, 95% CI 1.501-16.313), the average monthly income less than 3 000 yuan ( OR = 15.774, 95% CI 4.487-55.495) and the monthly expenditure on medicine more than 500 yuan ( OR = 15.323, 95% CI 3.527-66.569) were the risk factors for the compliance of antiplatelet drugs in patients with lower extremity arteriosclerosis obliterans after stent implantation. The consistency index of this prediction model was 0.895, the area under the ROC curve was 0.875. Conclusion:The antiplatelet medication adherence prediction model established has high accuracy and good clinical application values.
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Objective:To analyze the clinical features of bronchiectasis in children after severe adenovirus pneumonia and to provide clinical clues for the early diagnosis of bronchiectasis in children after severe adenovirus pneumonia.Methods:A retrospective study was made to analyze the clinical data of 26 children with bronchiectasis after severe adenovirus pneumonia treated in Guangzhou Women and Children′s Medical Center, Guangzhou Medical University from May 2016 to May 2021.Results:A total of 26 cases were reported, including 18 males and 8 females.The median onset age of severe adenovirus pneumonia was 23.0 (15.0, 48.0) months.A total of 23 cases suffered concurrent infections, and bacterial co-infection was the most common (16 cases). High resolution computed tomography (HRCT) showed multiple lobar solids in the lung with/without pleural effusion.During the acute phase, most of the cases were treated with intravenous immunoglobulin (21 cases), mechanical ventilation (20 cases), and systemic glucocorticoids (19 cases). The median age at diagnosis of bronchiectasis was 29.5 (21.0, 56.8) months, and the median time that the patients took to develop into acute adenovirus pneumonia was 6.0 (3.3, 13.0) months.Six cases suffered bronchiectasis alone, and 20 cases had bronchiectasis combined with post-infectious bronchiolitis obliterans (PIBO). Of these 20 cases, 3 cases developed bronchiectasis and PIBO simultaneously, and the remaining 17 cases developed bronchiectasis after PIBO.In the included 26 cases, diffuse bronchiectasis predominated (24 cases), most frequently involving the left lower lobes (21 cases) and right lower lobes (21 cases). Cylindrical bronchiectasis was the most common type (23 cases). All the patients had recurrent cough and wheezing during follow-up, and only 3 cases coughed up pus sputum without hemoptysis.All children had acute exacerbations, which were mostly caused by bacteria (21 cases). Nineteen cases combined with PIBO and 1 case with only bronchiectasis were rehospitalized.There was no cases of surgical resection or death.Conclusions:Bronchiectasis after severe adenovirus pneumonia mostly occurs in patients with or without PIBO.Multiple lobe involvement and co-infection may be a risk factor for PIBO patients to develop bronchiectasis.The clinical manifestations are mostly recurrent cough and wheezing, while sputum and hemoptysis are less common.Pediatricians should promptly perform chest HRCT for early diagnosis of the disease.
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Pulmonary rehabilitation is a multidisciplinary and comprehensive intervention for patients with chronic respiratory diseases, including exercise training, behavior change and self-management.It aims to improve the physical and psychological condition of people with chronic respiratory diseases and to promote the long-term adhe-rence to health-enhancing behaviors.Pulmonary rehabilitation has been extensively applied to adults with chronic respiratory diseases such as chronic obstructive pulmonary disease, and it also has been adopted for children with respiratory related diseases.Pulmonary rehabilitation strategies vary for different diseases.Individualized pulmonary rehabilitation programs should be made according to the underlying diseases of children.In this manuscript, the application of exercise training in children with asthma, cystic fibrosis, bronchiectasis, bronchopulmonary dysplasia, bronchiolitis obliterans, neuromuscular diseases complicated with respiratory problems and severe pneumonia were reviewed.