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Objective:To analyze the clinical features of chronic active Epstein-Barr virus infection (CAEBV) in order to reduce the rates of underdiagnosis and misdiagnosis of this disease.Methods:The CAEBV related literatures of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Database and Chongqing VIP since the first literature published (May 1987) until August 29, 2020 were searched. The clinical characteristics, laboratory examinations, outcome and causes of death of CAEBV patients were retrospectively analyzed. Statistical analysis was performed by Mann-Whitney U test, chi-square test or Fisher′s exact probability test. Results:A total of 111 patients aged 22.0 (10.0, 39.0) years were included from 46 articles. There were 64 cases (57.7%) in the age ≥18 years group and 47 cases (42.3%) in the age <18 years group. Fever, splenomegaly, hepatomegaly, and lymph node enlargement were common clinical manifestations, with incidences of 95.5%(106/111), 84.7%(94/111), 57.7%(64/111) and 56.8%(63/111), respectively. The incidences of rash and hepatomegaly in the age ≥18 years group were 3.1%(2/64) and 45.3%(29/64), respectively, which were both lower than those in patients aged <18 years group (27.7%(13/47) and 74.5%(35/47), respectively), while the incidence of abnormal liver biochemical indexes was higher (45.3%(29/64) vs 23.4%(11/47)). The differences were all statistically significant ( χ2=13.957, 9.436 and 5.643, respectively, all P<0.05). Of the 70 patients with follow-up outcomes, 38(54.3%) died and 32(45.7%) survived. The causes of death included gastrointestinal bleeding, severe infection, respiratory failure, liver failure, etc. The incidences of splenomegaly in the death and survival groups were 92.1%(35/38) and 68.8%(22/32), respectively. The difference was statistically significant ( χ2=6.266, P<0.05). Of 21 death and 17 survival cases in the age <18 years group, 15(71.4%) and two cases were combined hemophagocytic lymphohistiocytosis (HLH), respectively, with statistical significance ( χ2=13.527, P<0.01). Of the 90 patients whose HLH-related information was available, 38(42.2%) combined HLH and 52(57.8%) without HLH, with 36.8%(14/38) and 65.4% (34/52) of males, respectively. The difference of gender distribution was statistically significant ( χ2=7.187, P=0.007). The treatment regimens of the 111 CAEBV patients during the course of disease were various, but the detailed information was lacking. Conclusions:The clinical manifestations of CAEBV are diverse. CAEBV can be complicated with fatal complications, lacks of effective treatment, and shows poor prognosis. It is necessary to actively carry out related research to improve the understanding of the disease, and explore effective treatment and reduce mortality.
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Objective To investigate the correlation between age and the prognosis of thrombolytic therapy in acute ischemic stroke (AIS).Methods One hundred and fourteen patients with AIS were divided into ≤60 years group,61-70 years group and ≥71 years group according to age.Thrombolysis and post-thrombolysis treatment was done in accordance with 2010 version of Chinese Acute Ischemic Stroke Treatment Guidelines standard.The United States National Institutes of Health Stroke Scale (NIHSS) score was done in patient immediately after treatment,24 h after thrombolysis and 7 d after thrombolysis,and modified Rankin scale (mRS) score was assessed 3 months after thrombolysis The spontaneous intracranial hemorrhage (sICH) and the death of 2 weeks was recorded.Results ≤ 60 years group had 22 males and 10 females;61-70 years group had 26 males and 10 females; ≥71 years group had 20 males and 26 females.In ≥ 71 years group,women accounted for 56.52％ (26/46),which was higher than that in the other 2 groups,and there was significant difference (x2 =0.685,P =0.015).The NIHSS score immediately after treatment,24 h after thrombolysis and 7 d after thrombolysis among 3 groups had no significant difference (P ＞ 0.05).The mRS score at the 3 months after thrombolysis among 3 groups was (1 ± 3),(2 ± 5) and (2 ± 3) scores,respectively,and there was significant difference(P =0.040).Mortality and incidence of sICH in 2 weeks also had significant difference (P =0.049,0.017).Conclusions Despite the differences in the mortality and incidence of sICE among different ages,thrombolytic therapy with recombinant tissue-type plasminogen activator can significantly improve the neurological deficit after 3 months in AIS patients of different ages.
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To analyze the clinical characteristics,complications and management of Brucellosis.As a retrospective review,23 patients with Brucellosis admitted into Peking University First Hospital over a 10-year period were reviewed.Most of them were middle-aged males.Common presenting clinical manifestations included high fever,sweating,arthralgia and headache.Splenomegaly was more common than hepatomegaly.There were liver injury (n =15),transient proteinuria (n =6),secondary hemophagocytic syndrome (n =2) and renal failure with infective endocarditis,pneumonia with infective endocarditis,renal abscess (n =1).Most of them were treated effectively with combination therapy.The clinical features of Brucellosis are both complicated and atypical.
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Objective To investigate the efficacy of bend-assisted laparoseopie fight bemicolectomy for right colon carcinoma in elderly obesity patients. Methods 20 obesity eases undergoing hand-assisted laparoscopic right bemicolectomy were retrospectively reviewed, and compared with 25 obesity cases with transabdominal right hemicolectomy in the same period. The safety, recovery, eradication and stress reaction were compared. Results In hand-assisted laparoscopic group, there were less bleeding loss, rapid recovery to normal temperature and gastrointestinal function,ont of bed activity, short-time hospitalization compared with transabdominal group(P <0.01). There were no differences in operative time, numbers of lymph nodes removed, postoperative complications and length of specimen between two gronps(P > 0.05). CRP, IL-6, adrenocorticotrophic hormone (ACTH) and cortisol were more significantly increased in two groups after operation than before operation (P < 0. 05) , and this increase was moreprominent in transabdominal group than in hand-assisted laparoacopic group (P < 0.05). Conclusion Hand-assis-ted laparoscopic right hemicolectomy is a safe and effective way for elderly obesity patients,especially in postoperative recovery and physical stress reaction.
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Objective To assess the efficacy of emergency hand-assisted laparoscopic hepatectomy for spontaneous rupture of primary hepatocellular carcinoma.Methods A total of 15 eases who underwent emergency hand-assisted laparoscopic hepatectomy for spontaneous rupture of primary hepatocellular carcinoma were retrospectively reviewed.Results All operations were successful.The postoperative mortality rate was.Thirteen cases were followed-up from 11 months to 56 months.The overall 1-,3-year survival rate was 84.6%(11/13),53.8%(7/13)respectively.Conclusion Emergency hand-assisted laparoscopic hepatectomy is a safe and feasible approach for pontaneous rupture of primary hepatocellular carcinoma in clinically selected patients.If the patients condition permits it,emergency hand-assisted laparoscopic hepatectomy should be the treatment of choice.
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Objective To analyze inducing factors of acute left heart failure(AHF) of emergency case.Methods According to different age and gender,the inducing factors of AHF of 211 patients were retrospectively analyzed.Results Infection(42.99%) was the most important inducing factors of AHF in all the four age-groups,but as for patients elder 80,the arrhythmias was also play an important part in inducing factors of AHF.The difference of inducing factors was found among the four age-groups.but the difference of inducing factors was not found between the two gender-groups. Conclusion Since the most important inducing factors of AHF of emergency case was infection,anti-infectives is important for preventing and controlling AHF.
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The out-patient and emergency department is the window of a hospital open to the society,also is the most direct social image of the hospital.So,we must insist on the moral principle of the "ten needs" in the work of the out-patient and emergency department in order to establish a healthy and harmonious physician-patient relationship.The "Ten needs" includes a proper attitude,a sincere communication,a quick response,a correct diagnosis,a flexible treatment,a reasonable prescription,a steady action to the emergency,a well nursing,complex skills and a standard management.