Objective:To investigate the clinical manifestations and prognosis of severe coronal virus disease 2019(COVID-19)pneumonia combined with coronary artery disease(CAD)in the elderly.Methods:A total of 351 old patients(&ge;60 years)with severe COVID-19 pneumonia combined with CAD admitted to Tongji Hospital of Wuhan from February 2020 to March 2020 were enrolled in this retrospective study.The patients were divided into CAD group(n=52)and non-CAD group(n=299). The clinical data, the changes of blood tests and cardiovascular complications were observed.Results:Compared with non-CAD group, CAD group showed a longer time of stay in hospital[(12.3±2.6)d and(9.3±2.1)d, t=3.24, P=0.002], and higher incidence of cardiovascular complications, such as myocardial infarction(7.7% and 0.0%, χ2=21.6, P<0.001), heart failure(15.4% and 0.3%, χ2=34.7, P<0.001), arrhythmia(50.0% and 12.4%, χ2=24.45, P<0.001)and all-cause mortality(15.4% and 4.3%, χ2=7.94, P=0.005). The serum levels of interleukin-2 receptor, interleukin 6, CK-MB, cTnI, NT-proBNP, D-dimer and fibrinogen were higher in CAD group than in non-CAD group.The oxygenation index was significantly lower and the blood lactic acid level was higher in CAD group than in non-CAD group. Conclusions:The aged patients with severe COVID-19 pneumonia combined with CAD show obvious inflammatory reaction, high incidence of cardiovascular complications and high mortality.

Objective To investigate the clinical,endoscopic and pathological features of gastritis cystica profunda (GCP).Methods A total of 40 patients with GCP confirmed by pathology who received endoscopic or surgical treatment at Renji Hospital,School of Medicine,Shanghai Jiaotong University from May 2013 to May 2018,were included in the retrospective analysis.The clinical data such as population composition,clinical manifestations,endoscopic findings and pathological results were summarized and analyzed.Results Among the 40 patients were predominantly males (75.0％,30/40),and the mean age of onset was 61.2 years.The most common sites were cardia (32.5％,13/40) and gastric antrum (30.0％,12/40).The clinical symptoms of the patients were atypical and it was difficult to diagnose GCP with routine endoscopy examination.The endoscopic findings were mostly type 0-Ⅱ (50.0％,20/40).GCP with neoplastic lesions accounted for 55％ (22/40).Unconditional logistic regression analysis showed that male (P =0.013,OR =31.093,95％ CI:2.079-464.976) and Helicobacter pylori infection (P =0.041,OR =10.225,95％ CI:1.096-95.411) were risk factors for GCP with neoplastic lesions.Conclusion GCP commonly occurs in middle-aged and elderly men,and varies in different manifestations under white light endoscopy.GCP is not a benign lesion,but can also coexist with neoplastic lesions,which are mostly differentiated intramucosal cancer.

Objective To evaluate the efficacy and safety of fosfomycin-trometamol (FMT)in the treatment of acute uncomplicated lower urinary tract infection (LUTI). Methods The medical records of acute uncomplicated LUTI patients,who had acute uncomplicated LUTI and received FMT or levofloxacin (LEV)in Qingdao Municipal Hospital from January 2015 to October 2017,were collected and analyzed retrospectively. Comparisons were made between the FMT group and the LEV group to investigate the patients＇clinical efficacy,bacteriological efficacy,bacteria isolated from urine cultures,the susceptibility of isolated strains to drugs and the occurrence of adverse reactions. Results Seventy patients entered the FMT group,including 31 males and 39 females,aged from 29 to 68 years with an average age of (51 ± 10) years.56 patients entered the LEV group,including 26 males and 30 females,aged from 31 to 66 years with an average age of (52 ± 10)years.The treatment periods of patients in the two groups were 3 to 7 days. Routine blood tests and liver and renal function tests were normal before the treatment. After the treatments, 59 patients were cured,5 patients improved,and the clinical efficacy was 91.4% (64/70)in the FMT group;while 28 patients were cured,4 patients improved,and the clinical efficacy was 57.1% (32/56)in the LEV group. And the difference was statistically significant (χ2＝20.16,P＜0.001). Positive bacteria were found in urine culture of 46 patients in the FMT group,including 35 strains of Escherichia coli[17 of which were extended-spectrum β-lactamases (ESBL)-producing Escherichia coli ],3 strains of Bacillus proteus [1 of which was ESBL-producing Bacillus proteus],3 strains of Enterococous faecalis,3 strains of Staphylococcus aureus,and 2 strains of Staphylococcus epidermidis. Positive bacteria were found in urine culture of 37 patients in the LEV group,including 29 strains of Escherichia coli (14 of which were ESBL-producing Escherichia coli),3 strains of Bacillus proteus (1 of which was ESBL-producing Bacillus proteus), 2 strains of Enterococous faecalis,1 strain of Staphylococcus aureus,and 2 strains of Staphylococcus epidermidis. Bacteriological efficacy were 91.3% and 56.8% ,for the FMT group and the LEV group, respectively and the difference was statistically significant (χ2＝13.38,P ＜0.001). Thirteen of the 17 ESBL-producing Escherichia coli strains isolated from patients in the FMT group were susceptible to FMT (susceptibility rate:76.5% ). Five of the 14 ESBL-producing Escherichia coli strains isolated from patients in the LEV group were susceptible to LEV (susceptibility rate:35.7% ). And the difference was statistically significant (P＝0.033). The difference of the incidence of adverse reactions was not statistically significant between the FMT group and the LEV group [11.4% (8/70)vs 16.1% (9/56),χ2＝0.575,P＝0.448]. Conclusion FMT was more effective and safer than LEV in the treatment of patients with acute uncomplicated LUTI.

Objective To evaluate the efficacy and safety of fosfomycin-trometamol (FMT)in the treatment of acute uncomplicated lower urinary tract infection (LUTI). Methods The medical records of acute uncomplicated LUTI patients,who had acute uncomplicated LUTI and received FMT or levofloxacin (LEV)in Qingdao Municipal Hospital from January 2015 to October 2017,were collected and analyzed retrospectively. Comparisons were made between the FMT group and the LEV group to investigate the patients＇clinical efficacy,bacteriological efficacy,bacteria isolated from urine cultures,the susceptibility of isolated strains to drugs and the occurrence of adverse reactions. Results Seventy patients entered the FMT group,including 31 males and 39 females,aged from 29 to 68 years with an average age of (51 ± 10) years.56 patients entered the LEV group,including 26 males and 30 females,aged from 31 to 66 years with an average age of (52 ± 10)years.The treatment periods of patients in the two groups were 3 to 7 days. Routine blood tests and liver and renal function tests were normal before the treatment. After the treatments, 59 patients were cured,5 patients improved,and the clinical efficacy was 91.4% (64/70)in the FMT group;while 28 patients were cured,4 patients improved,and the clinical efficacy was 57.1% (32/56)in the LEV group. And the difference was statistically significant (χ2＝20.16,P＜0.001). Positive bacteria were found in urine culture of 46 patients in the FMT group,including 35 strains of Escherichia coli[17 of which were extended-spectrum β-lactamases (ESBL)-producing Escherichia coli ],3 strains of Bacillus proteus [1 of which was ESBL-producing Bacillus proteus],3 strains of Enterococous faecalis,3 strains of Staphylococcus aureus,and 2 strains of Staphylococcus epidermidis. Positive bacteria were found in urine culture of 37 patients in the LEV group,including 29 strains of Escherichia coli (14 of which were ESBL-producing Escherichia coli),3 strains of Bacillus proteus (1 of which was ESBL-producing Bacillus proteus), 2 strains of Enterococous faecalis,1 strain of Staphylococcus aureus,and 2 strains of Staphylococcus epidermidis. Bacteriological efficacy were 91.3% and 56.8% ,for the FMT group and the LEV group, respectively and the difference was statistically significant (χ2＝13.38,P ＜0.001). Thirteen of the 17 ESBL-producing Escherichia coli strains isolated from patients in the FMT group were susceptible to FMT (susceptibility rate:76.5% ). Five of the 14 ESBL-producing Escherichia coli strains isolated from patients in the LEV group were susceptible to LEV (susceptibility rate:35.7% ). And the difference was statistically significant (P＝0.033). The difference of the incidence of adverse reactions was not statistically significant between the FMT group and the LEV group [11.4% (8/70)vs 16.1% (9/56),χ2＝0.575,P＝0.448]. Conclusion FMT was more effective and safer than LEV in the treatment of patients with acute uncomplicated LUTI.

Objective:To investigate the relationship of polymorphism of leptin receptor gene Gln223Arg with asthma and metabolic syndrome.Methods: Collected 120 asthma patients,92 metabolic syndrome patients,54 asthma combined metabolic syndrome patients and 81 normal controls.According to the severity,the asthma patients were divided into mild-medium group and severe group.The serum leptin level was measured by ELISA,the genotypes of leptin receptor were analyzed by the method of polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP),and statistcs of each subject′s MBI,blood pressure,lung function and fasting blood glucose were collected.Results: ①There were significant differences in genotype and allele frequency in leptin receptor gene Gln223Arg between the metabolic syndrome group,asthma combined metabolic syndrome group and normal control group(P<0.05).②The allele frequency and genotype in leptin receptor gene Gln223Arg were significant different between the severe asthma group and normal control group(P<0.05).③The serum leptin level,BMI and systolic blood pressure of AA+AG genotype group were significiant higher than GG genotype group(P<0.05),while the value of FEV1% and FEV1/FVC of lung function were lower than GG genotype group(P<0.05).Conclusion: Leptin receptor gene Gln223Arg polymorphism is correlated with asthma and metabolic syndrome,and by causing leptin resistance,the A allele might be the genetic factor that contribute to individual susceptibility for asthma and metabolic syndrome.

Objective To investigate the clinical characteristics and prognosis in the patients with type 2 diabetes mellitus and invasive pulmonary aspergillosis(IPA) for better management of the disease .Methods Clinical data of 9 cases of type 2 diabetes associated with IPA treated in Qingdao Municipal Hospital from January 2008 to December 2013 were analyzed retrospectively . Results The diagnosis of IPA was proven in 5 and probable in 4 of the 9 patients .The main clinical manifestations were fever , cough and expectoration .The findings of CT scan mainly showed pulmonary nodules along the bronchovascular bundle and cavity signs .Bronchoscopy showed congestion ,edema ,and erosion of bronchial mucosa covered with yellow‐white or brown pus ,partially or completely blocking the lumen .Antifungal treatment was effective for 4 patients .The other five patients died . Conclusions Type 2 diabetes mellitus is a risk factor for developing invasive pulmonary aspergillosis .Early diagnosis and proper treatment are critical for improved prognosis .

Adult ; Aged ; Aspergillosis ; epidemiology ; Female ; Humans ; Lung Diseases, Fungal ; epidemiology ; Male ; Middle Aged

Objective To study the efficacy and safety of implantation of a modified temporary self-expanding metallic stent for cardia achalasia.Methods A total of 30 patients diagnosed as having cardia achalasia were randomly divided into 2 groups,group A (traditional stents) and group B (modified stents)(n =15 in each group).Two days after stent implantation at the cardia by endoscopy,stents were withdrawn with endoscope guided by X-ray.LES Pressure,X-ray images ( including the diameter of the most dilated part of esophageal and the most narrow part of cardia) and the symptoms of dysphagia were compared before and half year after the treatment.The width changes of the most narrow stenting part on the point of stenting and 2 days after removal were compared.The side effects and complications during the treatment were recorded.Results All thirty stents were successfully implanted and removed.Stent dislocation occured in 2 cases in group A,but none in group B.Dysphagia had significant improvement after the treatment in both groups ( P ＜ 0.05 ),but the recurrence rate of group A ( 26.7％ ) was significantly higher than group B (6.67％ ) in 6 months ( P ＜ 0.05 ).LES pressure and X-ray images of both groups significantly improved after treatment ( P ＜ 0.001 ),and those of group B were superior to group A ( P ＜ 0.05 ).There was no difference in adverse reaction between the two groups.No perforation occured in any group.Conclusion Self-expanding metallic stents is safe for patients with cardia achalasia,with implantation convenience,symptomatic improvement,low recurrence,and few complications or dislocation.

ObjectiveTo investigate the correlation between any two of Capsule Endoscopy ScroringIndex (Lewis score),simplified Crohn Disease Activity Index (CDAI) and C-reactive protein (CRP) in small bowel Crohn disease (CD).MethodsA total of 58 consecutive patients with known small bowel CD were enrolled. We evaluated disease activity with Lewis score and simplified CDAI. Correlations among CRP,simplified CDAI and Lewis score were calculated with Spearman's rank order correlation coefficient.The optimal CRP cut-off value was calculated using the ROC curve.ResultsThe Lewis score showed inactive,mild and moderate-severe patients were 13,21 and 24,respectively.CRP of moderate-severe group was significantly higher than that in mild and inactive groups ( P ＜ 0.05 ).The optimal CRP cut-off value that differentiated patients with moderate to severe disease from the others was 13.50 mg/L with sensitivity of 87.5％ and specificity of 82.4％.The area under the ROC curve to analyze the cut-off was 0.849.Lewis score was moderately correlated with CRP (r =0.58,P ＜ 0.01 ),and weakly correlated with the simplified CDAI (r =0.40,P ＜ 0.01 ).ConclusionSerum CRP and the simplified CDAI cannot replace Lewis score for capsule endoscopy in the assessment of disease activity in small bowel CD.However,CRP may be considered as an inflammatory marker for evaluating the moderate to severe capsule endoscopic activity.

ObjectiveTo investigate the long-term (＞1 year) rebleeding rate after capsule endoscopy (CE)-guided intervention in patients with obscure gastrointestinal bleeding (OGIB) and to identify the risk factors of rebleeding.MethodsA total of 307 consecutive patients who underwent CE for OGIB in our hospital from June 2002 to October 2010 were enrolled.Follow-up data were obtained by reviewing medical records,CE database and contacting the patients or their relatives by telephone.We evaluated the rebleeding rates and analyzed risk factors predictive of rebleeding by means of COX ratio hazard model.ResultsThe medium follow-up was 52 months (range13-112 months).Significant lesions were found in 202 patients (65.8％).The overall rebleeding rate after interventional therapy induced by CE findings was 28.0％ (86/307).CE positive patients had higher rebleeding rate than CE negative patients (37.6％ vs 9.5％,log-rank test,P=0.000),while specific therapy could prevent rebleeding,compared with nonspecific therapy (32.9％ vs 23.0％,P=0.042).95.3％ (82/86) rebleeding occurred within 24 months after CE.Multivariate analysis performed by using COX proportional hazards model showed that age over 50 years,CE positive findings,lowest hemoglobin (Hb) level 3 months before CE ≤7 g/dl,receiving nonspecific therapy after CE,hypertension,administration of anticoagulants,antiplatelet medicine or NSAIDs after CE were six risk factors associated with rebleeding.Conclusion Clinicians should be aware of these risk factors for OGIB rebleeding,which can reduce the occurrence of rebleeding and improve OGIB patients' prognosis.Those high risk OGIB patients should be followed up for at least 24 months after CE.