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Risk factors for ventilator-associated pneumonia among patients undergoing major oncological surgery

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《医学前沿（英文）》 2017年第11卷第2期页码 239-246 doi: 10.1007/s11684-017-0509-8

摘要：

Patients undergoing major oncological surgery for head and neck cancer (SHNC) have a particularly high risk of nosocomial infections. We aimed to identify risk factors for ventilator-associated pneumonia (VAP) in patients undergoing SHNC. The study included 465 patients who underwent SHNC between June 2011 and June 2014. The rate of VAP, risk factors for VAP, and biological aspects of VAP were retrospectively evaluated. The incidence of VAP was 19.6% (n=95) in patients who required more than 48 h of mechanical ventilation. Staphylococcus (37.7%), Enterobacteriaceae (32.1%), Pseudomonas(20.8%), and Haemophilus (16.9%) were the major bacterial species that caused VAP. The independent risk factors for VAP were advanced age, current smoking status, chronic obstructive pulmonary disease, and a higher simplified acute physiology score system II upon admission. Tracheostomy was an independent protective factor for VAP. The median length of stay in the ICU for patients who did or did not develop VAP was 8.0 and 6.5 days, respectively (P=0.006). Mortality among patients who did or did not develop VAP was 16.8% and 8.4%, respectively (P<0.001). The potential economic impact of VAP was high because of the significantly extended duration of ventilation. A predictive regression model was developed with a sensitivity of 95.3% and a specificity of 69.4%. VAP is common in patients who are undergoing SHNC and who require more than 48 h of mechanical ventilation. Therefore, innovative preventive measures should be developed and applied in this high-risk population.

关键词： ventilator-associated pneumonia (VAP) pneumonia risk factors surgery for head and neck cancer (SHNC)

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Analysis of antibiotic usage for viral community-acquired pneumonia in adults

Rongmeng Jiang, Bing Han, Chang Dou, Fei Zhou, Bin Cao, Xingwang Li

《医学前沿（英文）》 2021年第15卷第1期页码 139-143 doi: 10.1007/s11684-019-0736-2

摘要： The rationale for the antibiotic treatment of viral community-acquired pneumonia (CAP) in adults was analyzed to develop a clinical reference standard for this condition. Clinical data from 166 patients diagnosed with viral pneumonia across 14 hospitals in Beijing from November 2010 to December 2017 were collected. The indications for medications were evaluated, and the rationale for the use of antibiotics was analyzed. A total of 163 (98.3%) patients with viral pneumonia were treated with antibiotics. A combination of C-reactive protein (CRP) and procalcitonin (PCT) was used as markers to analyze the possible indications for antibiotic use. With threshold levels set at 0.25 µg/L for PCT and 20 mg/L for CRP, the rate of unreasonable use of antibiotics was 55.2%. By contrast, at a CRP level threshold of 60 mg/L, the rate of antibiotic misuse was 77.3%. A total of 39 of the 163 (23.9%) patients did not meet the guidelines for drug selection for viral CAP in adults. The unreasonable use of antibacterial drugs for the treatment of viral CAP in adults is a serious concern. Clinicians must reduce the unnecessary use of antibiotics.

关键词： adult antibiotic viral pneumonia

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Proteomics study of Mycoplasma pneumoniae pneumonia reveals the Fc fragment of the IgG-binding protein

《医学前沿（英文）》 2022年第16卷第3期页码 378-388 doi: 10.1007/s11684-021-0840-y

摘要： Macrolide and corticosteroid resistance has been reported in patients with Mycoplasma pneumoniae (MP) pneumonia (MPP). MP clearance is difficult to achieve through antibiotic treatment in sensitive patients with severe MPP (SMPP). SMPP in children might progress to airway remodeling and even bronchiolitis/bronchitis obliterans. Therefore, identifying serum biomarkers that indicate MPP progression and exploring new targeted drugs for SMPP treatment require urgency. In this study, serum samples were collected from patients with general MPP (GMPP) and SMPP to conduct proteomics profiling. The Fc fragment of the IgG-binding protein (FCGBP) was identified as the most promising indicator of SMPP. Biological enrichment analysis indicated uncontrolled inflammation in SMPP. ELISA results proved that the FCGBP level in patients with SMPP was substantially higher than that in patients with GMPP. Furthermore, the FCGBP levels showed a decreasing trend in patients with GMPP but the opposite trend in patients with SMPP during disease progression. Connectivity map analyses identified 25 possible targeted drugs for SMPP treatment. Among them, a mechanistic target of rapamycin kinase (mTOR) inhibitor, which is a macrolide compound and a cell proliferation inhibitor, was the most promising candidate for targeting SMPP. To our knowledge, this study was the first proteomics-based characterization of patients with SMPP and GMPP.

关键词： severe Mycoplasma pneumoniae pneumonia children proteomics Fc fragment of the IgG-binding protein mechanistic target of rapamycin kinase inhibitor

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microbiota and important taxa predicting clinical prognosis in patients with severe community-acquired pneumonia

《医学前沿（英文）》 2022年第16卷第3期页码 389-402 doi: 10.1007/s11684-021-0856-3

摘要： Few studies have described the key features and prognostic roles of lung microbiota in patients with severe community-acquired pneumonia (SCAP). We prospectively enrolled consecutive SCAP patients admitted to ICU. Bronchoscopy was performed at bedside within 48 h of ICU admission, and 16S rRNA gene sequencing was applied to the collected bronchoalveolar lavage fluid. The primary outcome was clinical improvements defined as a decrease of 2 categories and above on a 7-category ordinal scale within 14 days following bronchoscopy. Sixty-seven patients were included. Multivariable permutational multivariate analysis of variance found that positive bacteria lab test results had the strongest independent association with lung microbiota (R²=0.033; P=0.018), followed by acute kidney injury (AKI; R²=0.032; P=0.011) and plasma MIP-1β level (R²=0.027; P=0.044). Random forest identified that the families Prevotellaceae, Moraxellaceae, and Staphylococcaceae were the biomarkers related to the positive bacteria lab test results. Multivariable Cox regression showed that the increase in α-diversity and the abundance of the families Prevotellaceae and Actinomycetaceae were associated with clinical improvements. The positive bacteria lab test results, AKI, and plasma MIP-1β level were associated with patients’ lung microbiota composition on ICU admission. The families Prevotellaceae and Actinomycetaceae on admission predicted clinical improvements.

关键词： severe community-acquired pneumonia lung microbiota clinical improvements 7-category ordinal scale Prevotellaceae

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Mouth the mirror of lungs: where does the connection lie?

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《医学前沿（英文）》 2016年第10卷第4期页码 405-409 doi: 10.1007/s11684-016-0476-5

摘要：

Periodontitis is the chronic destructive disease of the periodontium (Gums) caused by host bacterial interactions. The effect of such host bacterial interactions in oral cavity also evokes a systemic response. Numerous studies have found common mechanisms of destruction for periodontal diseases and other chronic diseases like diabetes mellitus, atherosclerosis, respiratory diseases, and adverse pregnancy outcomes. Oral colonization by respiratory pathogens appears to be a risk factor for development of respiratory diseases and oral interventions aimed at reducing oral bacterial count have resulted in reduced incidence of these reparatory illness. This reflects the importance of oral hygiene among patients with respiratory illness. This review highlights the association between periodontal diseases and respiratory diseases.

关键词： periodontitis respiratory diseases acute pneumonia COPD

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新冠病毒肺炎肺部超声的特点及其在病情评估中的价值——一项回顾性观察研究 Article

朱凤雪, 赵秀娟, 王天兵, 王振洲, 郭辅政, 薛海岩, 常盼盼, 梁汉生, 倪文涛, 王雅心, 陈雷, 姜保国

《工程（英文）》 2021年第7卷第3期页码 367-375 doi: 10.1016/j.eng.2020.09.007

摘要：

肺部超声（lung ultrasound, LUS）在新冠病毒肺炎（简称新冠肺炎）病情严重程度评估中的价值不明确。本研究旨在探讨新冠肺炎的LUS影像学特征，并分析LUS征象与新冠肺炎疾病严重程度的关系。本研究为在同济医院进行的一项回顾性观察研究，连续入选48例新冠肺炎患者，并将其分为32例非危重患者和16例危重患者。出现症状后0~7 d、8~14 d和15~21 d进行LUS检查并记录ROX（respiratory rate oxygenation）指数、疾病严重程度和CURB-65评分。根据LUS检查方案，将肺部分为12个区域，计算LUS评分（0~36分）。出现症状后0~7 d评估胸部计算机断层扫描（computed tomography, CT）评分（0~20分）。观察LUS评分与CURB-65和ROX指数的相关性。通过LUS发现新冠肺炎患者38例。新冠肺炎的LUS征象包括B线（34/38, 89.5%）、实变（6/38,15.8%）和胸腔积液（2/38, 5.3%）。多发病变（32/38, 84.2%）和双肺病变（28/38, 73.7%）较多。与非危重患者相比，危重患者的LUS评分更高[12 (10~18) vs 2 (0~5), p < 0.001]。LUS评分与出现症状后0~7 d（r = −0.85, p < 0.001）、8~14 d（r = −0.71, p < 0.001）和15~21 d（r = −0.76, p < 0.001）的ROX指数负相关。LUS评分与CT评分为正相关（r = 0.82，p < 0.001）。从出现症状后0~7 d到17~21 d，通过LUS发现肺部病变的病例数从27例（81.8%）减少至20例（46.5%），LUS评分从4 (2~10)分明显降至0 (0~5) 分（p < 0.001）。因此，LUS在新冠肺炎患者中能简便、实时、安全地检测肺部病变，LUS有助于在危重患者中评估新冠肺炎的严重程度。

关键词：新冠病毒肺炎肺部超声肺炎

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利用深度学习系统筛查新冠病毒肺炎 Article

徐小微, 蒋贤高, 马春莲, 杜鹏, 李旭坤, 吕双志, 俞亮, 倪勤, 陈燕飞, 苏俊威, 郎观晶, 李永涛, 赵宏, 刘俊, 徐凯进, 阮凌翔, 盛吉芳, 裘云庆, 吴炜, 梁廷波, 李兰娟

《工程（英文）》 2020年第6卷第10期页码 1122-1129 doi: 10.1016/j.eng.2020.04.010

摘要：

实时逆转录聚合酶链反应（RT-PCR）检测早期新冠病毒肺炎（COVID-19）患者的痰液或鼻咽拭子中的病毒RNA阳性率较低。同时，COVID-19的计算机断层扫描（CT）影像学的临床表现有其自身的特点，不同于甲型流感病毒性肺炎（IAVP）等其他类型的病毒性肺炎。本研究旨在应用深度学习技术，建立COVID-19、IAVP及健康人群肺部CT的早期筛查模型。本研究共采集618份CT样本，其中219份样本来自110例COVID-19患者（平均年龄50岁，其中男性63例，占57.3%），224份样本来自224例IAVP患者（平均年龄61岁，其中男性156例，占69.6%），175份样本来自健康人群（平均年龄39岁，其中男性97例，占55.4%）。所有CT样本均来自浙江省三家COVID-19定点收治医院。我们首先利用胸部CT图像集的三维（3D）深度学习模型分割出候选感染区域，然后利用位置敏感机制深度学习网络将这些分离的图像归类为COVID-19、IAVP以及与感染无关（ITI）的图像，并且输出相应置信度得分。最后，用Noisy-OR贝叶斯函数计算每份CT病例的感染类型及总置信度。测试数据集的实验结果表明，从整体CT病例来看，本研究利用深度学习系统建立的COVID-19患者的早期筛查模型的总体准确率为86.7%。该模型有望成为一线临床医生诊断COVID-19的一种有效的辅助方法。

关键词： COVID-19 位置敏感机制深度学习网络计算机断层扫描

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China’s local governments are combating COVID-19 with unprecedented responses – from a Wenzhou governance perspective

Fanghua Gong, Yong Xiong, Jian Xiao, Li Lin, Xiaodong Liu, Dezhong Wang, Xiaokun Li

《医学前沿（英文）》 2020年第14卷第2期页码 220-224 doi: 10.1007/s11684-020-0755-z

摘要： The COVID-19 caused by a novel strain of coronavirus has been spreading rapidly since its onset in Wuhan, the capital city of central China’s Hubei Province, in December 2019. It is highly communicable through human-to-human transmission. China has been making unprecedented efforts in treating the confirmed cases, identifying and isolating their close contacts and suspected cases to control the source of infection and cut the route of transmission. China’s devotion in handling this epidemic has effectively and efficiently curbed communication domestically and across the border. Representative measures adopted by Wenzhou, the worst hit city out of Hubei Province, are examined to elucidate those massive undertakings with the aim of enhancing international understanding and building global rapport in fighting this evolving epidemic situation.

关键词： COVID-19 novel coronavirus pneumonia 2019-nCoV epidemic management

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2018—2019年我国北方地区奶牛临床型乳房炎源肺炎克雷伯菌的分子特征 Article

宋士凯, 何文娟, 杨大伟, Manar Benmouffok, 王瑶, 李基云, 孙城涛, 宋祥彬, 马士珍, 蔡畅, 丁双阳, 吴聪明, 沈张奇, 汪洋

《工程（英文）》 2022年第10卷第3期页码 146-154 doi: 10.1016/j.eng.2021.01.015

摘要：

肺炎克雷伯菌是奶牛乳房炎的重要诱因，常引起奶牛的产奶量降低和死亡率增高。目前尚缺乏奶牛乳房炎源肺炎克雷伯菌分子特征的研究数据，限制了对其在食品生产链中传播风险的评估。本研究于2018—2019 年从我国北方地区患临床型乳房炎奶牛中采集了6301 份奶样，共分离到183 株肺炎克雷伯菌，两年的平均分离率分别为3.03%和2.80%。与人类临床肺炎克雷伯菌分离株相似，奶牛临床型乳房炎源肺炎克雷伯菌分离株可分为肺炎克雷伯菌(KpI，143 株）、准肺炎克雷伯菌（KpII-B，37 株）和变栖肺炎克雷伯菌（KpIII，3 株）三个种群。在KpI 分离株中检测到超广谱β-内酰胺酶（ESBL）的编码基因bla_SHV-2a、bla_CTX-M-14和bla_CTX-M-15，以及可能与奶牛致病性和宿主适应性有关的编码基因clpC、lpfA、lacI、lacZ、lacY和fecABDEIR。KpI 菌株比KpII-B 和KpIII 菌株表现出更高的流行率以及抗生素耐药基因和毒力基因携带率，表明它可能对奶牛的危害更大。此外，还发现奶牛KpI菌株与人医临床分离的KpI菌株在种群结构上存在明显差异，且奶牛源KpI菌株中很少见到与人类侵袭性感染相关的基因，表明奶牛源KpI菌株对人类健康的威胁较小；奶牛KpII-B 分离株与人类感染分离株具有较高的核苷酸序列一致性，且它们携带固氮基因nif的比例都很高，表明奶牛和人类KpII-B 分离株与植物源性KpII-B 菌株之间存在一定关联。

关键词：临床型乳房炎肺炎克雷伯菌分子特征种群结构抗生素耐药性

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流感与COVID-19患者的免疫球蛋白G糖基化差异 Article

Marina Kljaković-Gašpić Batinjan, Tea Petrović, Frano Vučković, Irzal Hadžibegović, Barbara Radovani, Ivana Jurin, Lovorka Đerek, Eva Huljev, Alemka Markotić, Ivica Lukšić, Irena Trbojević-Akmačić, Gordan Lauc, Ivan Gudelj, Rok Čivljak

《工程（英文）》 2023年第26卷第7期页码 54-62 doi: 10.1016/j.eng.2022.08.007

摘要：

The essential role of immunoglobulin G (IgG) in immune system regulation and combatting infectious diseases cannot be fully recognized without an understanding of the changes in its N-glycans attached to the asparagine 297 of the Fc domain that occur under such circumstances. These glycans impact the antibody stability, half-life, secretion, immunogenicity, and effector functions. Therefore, in this study, we analyzed and compared the total IgG glycome—at the level of individual glycan structures and derived glycosylation traits (sialylation, galactosylation, fucosylation, and bisecting N-acetylglucosamine (GlcNAc))—of 64 patients with influenza, 77 patients with coronavirus disease 2019 (COVID-19), and 56 healthy controls. Our study revealed a significant decrease in IgG galactosylation, sialylation, and bisecting GlcNAc (where the latter shows the most significant decrease) in deceased COVID-19 patients, whereas IgG fucosylation was increased. On the other hand, IgG galactosylation remained stable in influenza patients and COVID-19 survivors. IgG glycosylation in influenza patients was more time-dependent: In the first seven days of the disease, sialylation increased and fucosylation and bisecting GlcNAc decreased; in the next 21 days, sialylation decreased and fucosylation increased (while bisecting GlcNAc remained stable). The similarity of IgG glycosylation changes in COVID-19 survivors and influenza patients may be the consequence of an adequate immune response to enveloped viruses, while the observed changes in deceased COVID-19 patients may indicate its deviation.

关键词：流行性感冒 COVID-19 病毒感染糖基化免疫球蛋白G 肺炎

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朱增勇：新冠肺炎疫情下的生猪生产恢复及产业形态分析（2020年2月27日）

2022年04月18日

关键词：动物养殖

特力阿扎维林治疗新冠病毒肺炎的疗效和安全性——试验方案 Protocol

吴效科, 于凯江, 王永晨, 徐万海, 马红丽, 侯艳, 李悦, 蔡本志, 朱丽影, 张敏, 胡晓丽, 高敬书, 王宇, 秦慧超, 赵鸣雁, 张勇, 李康, 杜智敏, 杨宝峰

《工程（英文）》 2020年第6卷第10期页码 1199-1204 doi: 10.1016/j.eng.2020.06.011

摘要：

根据2019年12月的报道，新冠病毒肺炎（coronavirus disease 2019, COVID-19）是由一种新型冠状病毒引起的肺炎。到目前为止，还没有发现能够治疗这种病毒的有效药物。本研究是一项在黑龙江省10个研究中心正在进行的多中心双盲随机对照试验（randomized controlled trial, RCT），其目的是研究与安慰剂相比，特力阿扎维林（triazavirin, TZV）治疗COVID-19患者的疗效和安全性。共计划招募240名COVID-19患者参加这项试验。咽拭子病毒核酸检测为阳性的受试者被随机（1∶1）分为两组：使用标准治疗加TZV或标准治疗加安慰剂，进行为期7 d的治疗和为期21 d的随访。主要结局是受试者临床改善的时间。次要结局包括临床改善率、退热时间、肺内炎症明显吸收的平均时间和人数比例、病毒核酸转阴率、病死率以及重症和危重症患者的转化率。整个试验过程将对不良事件，严重不良事件，肝功能、肾功能以及合并用药进行监测和记录。本试验的结果可为临床医生治疗COVID-19提供循证医学的证据和建议。

关键词：新冠病毒肺炎肺炎严重急性呼吸综合征冠状病毒2 特力阿扎维林疗效安全性

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新冠病毒肺炎临床试验核心指标集（COS-COVID） Article

金鑫瑶, 庞博, 张俊华, 刘清泉, 杨忠奇, 封继宏, 刘学政, 张磊, 王保和, 黄宇虹, Alice Josephine Fauci, 马玉玲, Myeong Soo Lee, 元唯安, 谢雁鸣, 唐健元, 高蕊, 杜亮, 张硕, 祁寒梅, 孙宇, 郑文科, 杨丰文, 蔡慧姿, 王可仪, 欧益, 黄明, 朱彦, 喻佳洁, 田金徽, 赵敏, 胡镜清, 姚晨, 李幼平, 张伯礼

《工程（英文）》 2020年第6卷第10期页码 1147-1152 doi: 10.1016/j.eng.2020.03.002

摘要：

自2019年12月新型冠状病毒肺炎（Coronavirus Disease 2019, COVID-19）暴发以来，已有大量相关临床研究完成注册或已启动。然而，不同研究间临床结局指标存在显著的异质性，同时一些不关键的指标会造成研究资源的浪费。本研究旨在构建COVID-19临床试验核心结局指标集（core outcome set, COS），为相关临床研究方案设计、开展和证据转化提供参考。本研究的实施参照《有效性试验核心结局指标（COMET）手册》（1.0版），研究组成员包括呼吸系统和危重医学、中医学、循证医学、临床药理学、统计学专家以及医学杂志编辑等。通过检索临床试验注册网站（chictr.org.cn和clinicaltrials.gov）中COVID-19相关临床研究方案，提取方案中的结局指标，形成指标池。78个COVID-19临床试验方案纳入研究，收集结局指标259个，合并规范后确定132个结局指标，涉及7个指标域。经遴选，形成了包括58个结局指标在内的初始指标清单。经过两轮德尔菲调查和一轮共识会议，最终确立针对COVID-19不同临床分型的核心指标集（COS-COVID）。COS-COVID包括1个轻型指标（病毒核酸检测转阴时间）、4个普通型指标（住院时间、复合事件发生率、临床症状积分和病毒核酸检测转阴时间）、5个重型指标（复合事件发生率、住院时间、PaO₂/FiO₂、机械通气时间和病毒核酸检测转阴时间）、1个危重型指标（全因死亡率）及1个康复期指标（肺功能）。COS-COVID作为目前临床评价COVID-19干预效果最具临床价值及操作性的指标集合，对证据评估和决策具有重要意义。随着对疾病认知的不断深入和COS-COVID应用的反馈，课题组将对本核心指标集进行进一步完善并更新。

关键词：核心指标集 COVID-19 2019-nCoV 冠状病毒疾病临床试验