Background:The prevalence of Mycoplasma pneumoniae pneumonia has increased considerably in recent years.To evaluate the efficacy of combined treatment of azithromycin with intravenous immunoglo-bulin (IVIG) or methylp...Background:The prevalence of Mycoplasma pneumoniae pneumonia has increased considerably in recent years.To evaluate the efficacy of combined treatment of azithromycin with intravenous immunoglo-bulin (IVIG) or methylprednisolone in children with refractory Mycoplasma pneumoniae pneumonia (RMPP).Methods:Children with RMPP were randomly allocated to group A [intravenous azithromycin (IA)+ methylprednisolone],group B (IA+IVIG) or group C (IA alone).Following a 7-day treatment,group C patients were randomly separated into two sub-groups:group C1 (IA+methylprednisolone) and group C2 (IA+IVIG).Temperature,respiratory symptoms and signs were examined.The average febrile period after treatment (F2),average total febrile period (F3),infiltration absorption,atelectasis resolution,pleural effusion disappearance were determined.The levels of C-reactive protein (CRP),D-dimer,and lactate dehydrogenase (LDH) were measured.Results:Seven days after enrollment,the average F2 after treatment of group A was the shortest.Compared with the control group C,the combined treatment group A and B showed higher rates of infiltration absorption,atelectasis resolution and pleural effusion disappearance,while lower levels of serum CRP,D-dimer and LDH.Fourteen days after enrollment,all children with combined therapy clinically improved,and presented better laboratory results.Group C1 showed shorter F3 and lower levels of CRP and LDH than those of group C2.Overall,group A showed the shortest F3,also has the lowest CRP and LDH.Conclusions:Azithromycin with IVIG or methylprednisolone was better treatment for children with RMPP than azithromycin alone.IVIG treatment may be beneficial,especially when the efficacy of corticosteroids is insecure,thus could be considered as an alternative of primary therapeutic approaches.展开更多
Background To investigate the clinical features of necrotizing pneumonia (NP) caused by refractoryMycoplasma pneumo-niae pneumonia (RMPP). Methods A retrospective observational study was carried out in patients with N...Background To investigate the clinical features of necrotizing pneumonia (NP) caused by refractoryMycoplasma pneumo-niae pneumonia (RMPP). Methods A retrospective observational study was carried out in patients with NP caused by RMPP who were admitted to our hospital from January 2008 to December 2015, and the clinical manifestations, laboratory data, imaging performances, hospital courses and outcomes were analyzed. Results Twenty-five patients with NP caused by RMPP were collected, with a median age of 5.1 (4.0–7.9) years. The mean duration of fever and hospital stay was 21.0 ± 8.9 and 19.9 ± 9.9 days, respectively. The levels of lactate dehydrogenase (LDH), C-reactive protein, interleukin (IL)-6, IL-10 and interferon-gamma were elevated. Meanwhile, the pleural fluid cell count, LDH and protein were also increased. 80.0% of the patients had pleural effusion;and a high incidence of lobar atelectasis and pulmonary consolidation was found the patients. The mean duration from the onset of symptoms to the discovery of necrotic lesions was 21.0 ± 6.9 days. 80.0% of the patients were administrated corticosteroids, and bronchoalveolar lavage was extracted separately from all patients. Of the 20 patients who presented with pleural effusion, 11 underwent thoracocentesis alone and 2 underwent chest drainage. All patients received prolonged courses of antibiotics (32.2 ± 8.7 days). All patients were dischaged home and recovered without surgical intervention;and chest lesions were resolved or only minimal residual fibrotic changes were residual within 3.0 (2.0–6.0) months. Conclusions Necrotizing pneumonia caused by RMPP is severe, however, self-limiting and reversible. Good outcomes can be achieved with appropriate management.展开更多
AIM: To evaluate the efficacy and safety of tolvaptan to treat refractory ascites in decompensated liver cirrhosis patients with or without further complications, such as hepatorenal syndrome and/or hepatocellular car...AIM: To evaluate the efficacy and safety of tolvaptan to treat refractory ascites in decompensated liver cirrhosis patients with or without further complications, such as hepatorenal syndrome and/or hepatocellular carcinoma.展开更多
More than five decades after it was originally conceptualized as rescue therapy for patients with intractable variceal bleeding,the transjugular intrahepatic portosystemic shunt(TIPS)procedure continues to remain a fo...More than five decades after it was originally conceptualized as rescue therapy for patients with intractable variceal bleeding,the transjugular intrahepatic portosystemic shunt(TIPS)procedure continues to remain a focus of intense clinical and biomedical research.By the impressive reduction in portal pressure achieved by this intervention,coupled with its minimally invasive nature,TIPS has gained increasing acceptance in the treatment of complications of portal hypertension.The early years of TIPS were plagued by poor long-term patency of the stents and increased incidence of hepatic encephalopathy.Moreover,the diversion of portal flow after placement of TIPS often resulted in derangement of hepatic functions,which was occasionally severe.While the incidence of shunt dysfunction has markedly reduced with the advent of covered stents,hepatic encephalopathy and instances of early liver failure continue to remain a significant issue after TIPS.It has emerged over the years that careful selection of patients and diligent post-procedural care is of paramount importance to optimize the outcome after TIPS.The past twenty years have seen multiple studies redefining the role of TIPS in the management of variceal bleeding and refractory ascites while exploring its application in other complications of cirrhosis like hepatic hydrothorax,portal hypertensive gastropathy,ectopic varices,hepatorenal and hepatopulmonary syndromes,non-tumoral portal vein thrombosis and chylous ascites.It has also been utilized to good effect before extrahepatic abdominal surgery to reduce perioperative morbidity and mortality.The current article aims to review the updated literature on the status of TIPS in the management of patients with liver cirrhosis.展开更多
基金This study was funded by Natural Science Foundation of Liaoning Province of China(2013021017).
文摘Background:The prevalence of Mycoplasma pneumoniae pneumonia has increased considerably in recent years.To evaluate the efficacy of combined treatment of azithromycin with intravenous immunoglo-bulin (IVIG) or methylprednisolone in children with refractory Mycoplasma pneumoniae pneumonia (RMPP).Methods:Children with RMPP were randomly allocated to group A [intravenous azithromycin (IA)+ methylprednisolone],group B (IA+IVIG) or group C (IA alone).Following a 7-day treatment,group C patients were randomly separated into two sub-groups:group C1 (IA+methylprednisolone) and group C2 (IA+IVIG).Temperature,respiratory symptoms and signs were examined.The average febrile period after treatment (F2),average total febrile period (F3),infiltration absorption,atelectasis resolution,pleural effusion disappearance were determined.The levels of C-reactive protein (CRP),D-dimer,and lactate dehydrogenase (LDH) were measured.Results:Seven days after enrollment,the average F2 after treatment of group A was the shortest.Compared with the control group C,the combined treatment group A and B showed higher rates of infiltration absorption,atelectasis resolution and pleural effusion disappearance,while lower levels of serum CRP,D-dimer and LDH.Fourteen days after enrollment,all children with combined therapy clinically improved,and presented better laboratory results.Group C1 showed shorter F3 and lower levels of CRP and LDH than those of group C2.Overall,group A showed the shortest F3,also has the lowest CRP and LDH.Conclusions:Azithromycin with IVIG or methylprednisolone was better treatment for children with RMPP than azithromycin alone.IVIG treatment may be beneficial,especially when the efficacy of corticosteroids is insecure,thus could be considered as an alternative of primary therapeutic approaches.
基金This work was partially supported by Grants from Zheji-ang Province Natural Science Foundation of China(LY17H100004,LY18H100002)Social Development Program of Science Technology Department of Zhejiang Province(2015C33127)the Key Projects of Zhejiang Medicine and Health Research Fund(no.2018268955).
文摘Background To investigate the clinical features of necrotizing pneumonia (NP) caused by refractoryMycoplasma pneumo-niae pneumonia (RMPP). Methods A retrospective observational study was carried out in patients with NP caused by RMPP who were admitted to our hospital from January 2008 to December 2015, and the clinical manifestations, laboratory data, imaging performances, hospital courses and outcomes were analyzed. Results Twenty-five patients with NP caused by RMPP were collected, with a median age of 5.1 (4.0–7.9) years. The mean duration of fever and hospital stay was 21.0 ± 8.9 and 19.9 ± 9.9 days, respectively. The levels of lactate dehydrogenase (LDH), C-reactive protein, interleukin (IL)-6, IL-10 and interferon-gamma were elevated. Meanwhile, the pleural fluid cell count, LDH and protein were also increased. 80.0% of the patients had pleural effusion;and a high incidence of lobar atelectasis and pulmonary consolidation was found the patients. The mean duration from the onset of symptoms to the discovery of necrotic lesions was 21.0 ± 6.9 days. 80.0% of the patients were administrated corticosteroids, and bronchoalveolar lavage was extracted separately from all patients. Of the 20 patients who presented with pleural effusion, 11 underwent thoracocentesis alone and 2 underwent chest drainage. All patients received prolonged courses of antibiotics (32.2 ± 8.7 days). All patients were dischaged home and recovered without surgical intervention;and chest lesions were resolved or only minimal residual fibrotic changes were residual within 3.0 (2.0–6.0) months. Conclusions Necrotizing pneumonia caused by RMPP is severe, however, self-limiting and reversible. Good outcomes can be achieved with appropriate management.
基金Supported by The Program of Beijing Science and Technology Commission,No.D131100005313004the Beijing HighLevel Talent Academic Leader/Personnel Training Programs awarded to Ding HG,2011-2-19+1 种基金Li B,2013-3-072and Li L,2013-3-073
文摘AIM: To evaluate the efficacy and safety of tolvaptan to treat refractory ascites in decompensated liver cirrhosis patients with or without further complications, such as hepatorenal syndrome and/or hepatocellular carcinoma.
文摘More than five decades after it was originally conceptualized as rescue therapy for patients with intractable variceal bleeding,the transjugular intrahepatic portosystemic shunt(TIPS)procedure continues to remain a focus of intense clinical and biomedical research.By the impressive reduction in portal pressure achieved by this intervention,coupled with its minimally invasive nature,TIPS has gained increasing acceptance in the treatment of complications of portal hypertension.The early years of TIPS were plagued by poor long-term patency of the stents and increased incidence of hepatic encephalopathy.Moreover,the diversion of portal flow after placement of TIPS often resulted in derangement of hepatic functions,which was occasionally severe.While the incidence of shunt dysfunction has markedly reduced with the advent of covered stents,hepatic encephalopathy and instances of early liver failure continue to remain a significant issue after TIPS.It has emerged over the years that careful selection of patients and diligent post-procedural care is of paramount importance to optimize the outcome after TIPS.The past twenty years have seen multiple studies redefining the role of TIPS in the management of variceal bleeding and refractory ascites while exploring its application in other complications of cirrhosis like hepatic hydrothorax,portal hypertensive gastropathy,ectopic varices,hepatorenal and hepatopulmonary syndromes,non-tumoral portal vein thrombosis and chylous ascites.It has also been utilized to good effect before extrahepatic abdominal surgery to reduce perioperative morbidity and mortality.The current article aims to review the updated literature on the status of TIPS in the management of patients with liver cirrhosis.
