Community-acquired pneumonia(CAP)is one of the common infections threating human health.To optimize CAP treatment strategy,the global professional organizations updated the guidelines,mainly in the following four aspects:(1)CAP severity of the classification.(2)The place accepts Initial treatment.(3)The importance of monitoring drug-resistant strains.(4)Atypical pathogens become more and more important.The position of antibacterial drugs in the treatment guidelines for CAP changed.The effect of fluoroquinolone in most guidelines has been affirmed treatment of.Since CAP should cover atypical pathogens,atypical pathogens resistant in China is analyzed to update guideline in the future as a reference guide.

Objective To explore whether the patients aged over 65 years with obstructive sleep apnea hypopnea syndrome (OSAHS) are able to tolerate continuous positive airway pressure (CPAP)while compared with patients aged less than 65 years.And to investigate the factors that affect compliance to CPAP in OSAHS patients.Methods A total of 147 OSAHS patients diagnosed with overnight polysomnography (PSG) were divided into two groups:≥65 years old group (n=46),<65 years old group (n = 101 ).Clinical data and PSG parameters were included in a computerized database.The pressure level of CPAP,the duration of respirator use were followed up.Results Compared with <65 years old group,there were higher prevalences of COPD (16% vs.4%,P=0.02),cardiovascular disease (23% vs.10%,P=0.04),apnea (43% vs.26%,P=0.03),regular alcohol consumption (61% vs.38%,P=0.007) and lower incidence of snoring (31% vs.54%,P= 0.03),shorter total sleeping time (378 min vs.423 min,P=0.001),longer wake after sleep onset periods (162 min vs.115 min,P=0.004),lower sleep efficiency (69% vs.77%,P<0.001),higher percentage of stage 1 sleep (29% vs.20%,P=0.001),lower percentage of stage 3-4 sleep (6% vs.9%,P=0.016) and rapid eye movement (REM) sleep (12% vs.15%,P=0.001) in ≥65 years old group.The percentages of acceptance to CPAP at 3 months,6 months,1 year,2 years and 3 years were 91%,89%,84%,82% and 82% respectively in ≥65 years old group,and were 92%,86%,81%,72% and 67% in <65 years old group.Average use time of CPAP were (5.1±1.5) h/night in ≥65 years old group,and were (3.9±1.2) h/night in <65 years old group (P=0.022).By analysis of multivariate logistic regression,a high pressure CPAP was associated with higher objective CPAP compliance in OSAHS patients.Conclusions Compliance to CPAP in older OSAHS patients is not decreased when compared to younger adults.A high CPAP pressure is the only significant independent predictor of better CPAP compliance.

Objective To investigate the clinical and pathological features of 21 elderly patients with tuberculosis detected at autopsy. Methods Retrospectively analyzed the data of underlying diseases,clinical characteristics,clinical diagnosis,and causes of death for these 21 elderly patients with tuberculosis detected at autopsy. Results All the 21 patients were man,mean age was(88.0±6,9)years and had one or more concomitant diseases.Cough,sputum and fever were frequent due to other complicated respiratory infection.Anemia,hypoalbuminemia,decreased body mass index,increased erythrocyte sedimentation rate were very common in elderly patients,sputum acid-fast bacillus was positive in 11.8%cases.There was no primary tuberculosis.There were 9 secondary tuberculosis,3 disseminated pulmonary tuberculosis,19 tuberculous pleurisy and 9 non-pulmonary tuberculosis detected at autopsy.Compared with the result of autopsy,the clinical and radiography diagnosis accuracies were poor.Only 5 patients were clinically diagnosed as tuberculosis.All 5patients received antitubereulous chemotherapy,2 of them ceased therapy due to liver or renal toxicity. Conclusions Tuberculosis is a systemic disease in elderly patients.Because of medical aspects of ageing,co-morbid states,ignorance and mis-perception of symptoms,and atypical manifestation of disease,the diagnosis is difficult in this population.Our study confirms the importance of considering tuberculosis as a diagnosis in elderly even in the absence of typical clinical radiological presentations.

Objective To explore the elinical characteristics and the effects of thrombolytic and anti-coagulation therapy on pulmonary embolism(PE)in over 60-year-old patients. Methods The clinical findings,diagnostic techniques,effects of thrombolytic and anti coagulation therapy in 72 patients with PE aged over 60-year were analyzed retrospectively. Results Each one of 72 patients in this study suffered from two or more chronic diseases.Hypertension(56.9%)and deep venous thrombosis(DVT)in lower limbs(53.6%)were the most common thrombosis risk factors in the study.The clinical findings were atypical in elderly patients with PE.Different degree of dyspnea was the main characteristics(91.7%).Other findings were cough(30.6%),chest pain(27.8%),cyanosis (18.1%),faint(13.9%)and emptysis(12.5%).The objective signs showed edema of lower extremity (44.4%),moist rales(31.9%),P2 accentuation(18.1%),vascular murmur(5.6%).Blood gas analysis in 61 cases showed that 53 patients suffered from hypoxemia(86.9%)along with 37 cases of hypocapnia(60.7%).The alveolar-arterial oxygen gradient was increased in 27/31 cases(87.1%)and blood D-dipolymer was positive in 50/61 cases(82.0%).Spiral CT pulmonary angiogram(CTPA)in 62 cases and radioactive nuclear ventilation perfusion scan in 16 cases demonstrated PE in 58(93.5%) and 16(100%)patients respectively.The cure rate of thrombolytic therapy combined with anti-coagulation versus anti-coagulation therapy alone was 86.2%versus 30.2%(P=0.000).There was no haemorrhagia phenomenon during thrombolytic and anti-coagulation therapy. Conclusions The most common risk factors of PE in the elderly are hypertension and DVT in Iower limbs.The clinical symptoms are atypical and variable.Dyspnea is the main characteristics.Thrombolytic with anti-coagulation therapy is safe and effective,but anti-coagulation therapy alone has no benefit.

Objective To explore the causes of misdiagnosis of lung abscess and its clinical pathological characters. Methods The clinical data of autopsy-proven lung abscess in Beijing Hospital from 1980 to 1995 were reviewed. Results Twelve patients consisted of 11 males and 1 female. Their age ranged from 60 to 88 years. None of them was clinically diagnosed lung abscess before death. Concomitant dieases were severe and complex, mostly coronary disease, hypertension, COPD, cerebrovascular disease and diabetes mellitus. The clinical presentation and chest X-ray of lung abscess in the elderly were deceptively nonspecific and variable. Over 2 types of pathogens were isolated from sputum culture, mostly klebsiella pneumoniae, pseudomonas aeruginosa, candida. The autopsy showed 3 cases with a isolated lung abscess and 9 cases with lung multi-abscess. Conclusions The reasons for misdiagnosis of lung abscess in the elderly might be the variability of clinical presentation, the other concomitant disease. Frequent pursuit of chest CT scan in suspected cases is guarranted .

Objective To investigate the effect of silent information regulator 1 (SIRT1)on cigarette smoke extract (CSE)-induced apoptosis of human alveolar epithelial cell (AECs).Methods The expression levels of SIRT1 protein were examined by Western Blotting in A549 cells that were treated with CSE at different concentrations.The impairment models of A549 cells induced by CSE were established.The concentration of CSE was 20.0％ and the treatment time of CSE was 24 hours.A549 cells were pretreated with 20 μmol/L resveratrol(Res)or 5 mmol/L nicotinamide (NAM) for 2 h before CSE treatment.The protein levels of SIRT1,Bax and Bcl2 were further explored by Western blotting.The proportion of apoptotic A549 cells was measured using MTT.Results The expression of SIRT1 was reduced after treatment with CSE in a dose-dependent manner(P＜0.05).Compared with the control group,the group of CSE treatment with 2.5％,5.0％,10.0％,20.0％and 40.0％ CSE for 24h showed that the expression of SIRT1 in A549 cells was decreased by 25.6％(P＜0.05),35.2％(P＜0.05),38.7％ (P＜0.05),57.9％ (P＜0.05)and 64.0％(all P＜0.05)separately; that A549 cell viability was decreased in a dose-dependent manner; and that A549 cell viability was decreased by 10.2％(t=2.035,P＜0.05),18.4％(t=4.269,P＜0.05),27.7％ (t=5.963,P＜0.05),59.0％(t=21.140,P＜0.05)and 88.1％(t=58.827,P＜0.05)separately.CSE plus 20 μmol/L Res pretreatment reversed the expression levels of SIRT1,Bax and Bcl2 in A549 cells (all P＜0.05)and reduced the apoptosis of A549 cells.The effects of CSE on inhibiting SIRT1 pathways were aggravated by NAM (an inhibitor of SIRT1) in the A549 cells (P＜ 0.05).Conclusions SIRT1 plays important role in regulating the apoptosis of human alveolar epithelial A549cell induced by CSE.SIRT1 may inhibit apoptosis by up-regulating Bcl2 expression and downregulating Bax expression,which has a protective effect on A549 cells apoptosis induced by CSE.

Objectives To investigate the incidence rate of asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome(ACOS)in elderly male patients with stable COPD by following-up,and to explore the characteristics and clinical significance of pulmonary function for ACOS.Methods According to GOLD and Spain's guidelines for the diagnosis and treatment of COPD,we screened ACOS patients in 299 elderly male patients with stable COPD by following up in Beijing Hospital between 2003 and 2014.All patients were divided into 2 groups of 51 ACOS patients and 248 non-ACOS patients with COPD.All patients underwent pulmonary function tests and bronchial dilation test in the stable condition.The differences in pulmonary functions were compared between stable ACOS patients and non-ACOS patients with COPD.Results Among 299 elderly male patients with stable COPD,ACOS patients accounted for 17.1 ％ (51/299).Compared with nonACOS patients with stable COPD,ACOS patients had significantly lower baseline values in forced expiratory volume in 1 seconds(FEV1) [(61.0 ± 14.5) ％ pred vs.(74.4 ± 20.0) ％ pred],in forced expiratory volume in 3 seconds(FEV3) [(71.6± 14.3)％ pred vs.(82.7± 19.6)％ pred]and in forced vital capacity(FVC) [(84.6 ± 16.4)％ pred vs.(93.8 ± 20.6)％ pred],and also had significantly higher values in residual volume(RV)[(139.4±55.8)％ pred vs.(118.8±46.6)％ pred]and in RV/total lung capacity(TLC) [(52.7±10.7)％ pred vs.(48.1±10.9)％ pred],all P＜0.05.After bronchodilation test,there was no significant difference in FEV1,FEV3 and FVC between the two groups(all P＞0.05).Patients with stable ACOS had lower value in forced expiratory flow rat (FEF25％±75％)than those with non-ACOS in baseline [FEF25％-75％ ％ pred(26.8± 11.5) ％ vs.(36.1 ±17.5) ％ (P＜0.05)],and the improvement of small airway function was significantly better in ACOS patients than in non-ACOS patients after bronchodilation test (P＜0.05).Conclusions ACOS is very common in the elderly patients with COPD,stable ACOS patients have lower time vital capacity as compared with non-ACOS patients with stable COPD.But after bronchodilation test,the two groups have similar ventilation function,and the small airway function in ACOS patients improves more significantly.The ACOS patients have unique characteristics of pulmonary functions and suitable treatment may improve the prognosis.

Objective: To explore the function of serum leptin in COPD patients with malnutrition, and to investigate the relationship between leptin and TNF-?. Methods: A total of 81 subjects (47 COPD patients and 34 control subjects) participated in this study. The 47 COPD patients were divided into 2 groups: group COPD Ⅰ (patients without malnutrition during stable disease, n=29), group COPDⅡ(patients with malnutrition during stable disease, n=18).To eliminate the effect of sex differences, all the patients and controls were male. Body mass index (BMI), percent ideal body weight (IBW%), triceps skin-fold thickness (TSF), mid-upper arm circumference (MAC), mid-upper arm muscle circumference(MAMC),serum leptin and tumor necrosis factor-?(TNF-?) levels, serum prealbumin (PA), serum transferrin (TF), serum albumin(Alb),total lymphocytes count (TLC), forced expiratory volume in one second (FEV_1), maximal inspiration pressure(MIP)and maximal expiration pressure(MEP)were measured in all participants. Leptin levels were measured by radioimmunoassay. TNF-? levels were measured by ELISA. The between group difference and correlation of these parameters were analysed. Results: (1)Serum leptin levels were significantly lower in group COPDⅡ (4.07?3.42 ?g/L) than in group COPD Ⅰ(9.72?6.67 ?g/L)and controls(8.21?5.41 ?g/L, P

50% cases of risk class Ⅱhad the history of hospitalization due to pneumonia. Conclusions The important risk factors of CAP are the history of hospitalization due to pneumonia, except the aged and concomitant disease. In more than half of CAP cases of the pathogens can not be separated. It is importants to facilitate and promote the experience initial therapy in CAP management.

Objective To explore the diagnosis and treatment of non traumatic chylothorax in non-Hodgkin's lymphoma (NHL) and to understand the differences in diagnosis and treatment between chylothorax and pseudochylothorax. Methods The patient aged 83 years was confrimed as chylothorax and NHL after lymph node biopsy.We reviewed literatures about chylothorax in NHL to analyse the possible mechanism,its diagnosis and treatment. Results The patient was sufferring from unilateral chylothorax diagnosed as true chylothorax by thoracentesis,and progressed to bilateral chylothorax after 1 year.PET/CT examination showed intrathoracic and right cervical lymph nodes enlargement and an increasing metabolic activity.Cervical lymph node biopsy revealed diffuse large B cell type non-Hodgkin's lymphoma.The patient refused any other treatment except the diet therapy and died after 19 months.We searched 19 cases with NHL chylothorax in associated literatures about the treatments including radiotherapy (6/6 improved),chemotherapy (6/11 improved),thoracic duct ligation (I/1 improved),thoracic duct ligation and drug pleurodesis(1/1 improved). Conclusions PET/CT is useful in finding the hidden clues of chylothorax in NHL.There is no standard mangement for NHL chylothorax and the treatment must be individualized. The overall prognosis of NHL chylothorax is similar to that of non-Hodgkin's lymphoma and the patient needs early diagnosis and general treatment in order to prolong the survival time.