Coronavirus disease 2019 (COVID-19) can cause great damage to the elderly patients and lead to high mortality. The clinical presentations and auxiliary examinations of the elderly patients with COVID-19 are atypical, due to the physiological ageing deterioration and basal pathological state. The treatment strategy for the elderly patients has its own characteristics and treatment protocol should be considered accordingly. To improve the diagnosis, treatment, and prevention of COVID-19 in the elderly, the Expert Committee of Geriatric Respiratory and Critical Care Medicine, China Society of Geriatrics established the "Expert consensus for the diagnosis, treatment, and prevention of coronavirus disease 2019 in the elderly" . We focused on the clinical characteristics and key points for better treatment and prevention of COVID-19 in the elderly. (1) For diagnosis, atypical clinical presentation of COVID-19 in the elderly should be emphasized, which may be complicated by underlying disease. (2) For treatment, strategy of multiple disciplinary team (mainly the respiratory and critical care medicine) should be adopted and multiple systemic functions should be considered. (3) For prevention, health care model about integrated management of acute and chronic diseases, in and out of hospital should be applied.

Objective To study the role of interictal epileptiform discharge (IED) in reducing recurrent epilepsy after withdrawal of antiepileptic drugs (AED).Methods One hundred epilepsy pa tients with no seizure for ≥2 years were divided into IED group (n=51) and IED free group (n=49) according to the classification of epilepsy seizure developed by the International Association for the Prevention of Epilepsy in 1981.The patients were further divided into elderly group (n=21) and non-elderly group (n=79) and were followed up for at least 1 year by return visit or telephone.Results No significant difference was found in the incidence of IED in the 100 epilepsy patients with different types of seizure,such as myospasm,simple partial seizure and ≥2 seizures.However,the incidence of IED was significantly higher than that of myotonia,myospasm,absence and simple partial seizure (P＜0.05).Epilepsy recurred in 37 patients (72.5％) of IED group and in 16 patients (32.7％) of IED-free group.Logistic regression analysis showed that the course of epilepsy and IED were the risk factors for recurrent epilepsy after withdrawal of AED (OR=1.165,95％CI:1.022-1.329,P=0.022;OR=2.794,95％CI:1.040-7.509,P=0.042) and the course of epilepsy was longer in elderly group than in non-elderly group (10.10±7.55 years vs 5.97±4.04 years,P=0.001).Conclusion The seizure type and course of epilepsy are the relia ble predictors of recurrent epilepsy in patients with no seizure for a long time after withdrawal of AED,and are thus of clinical significance.

Objective To investigate the role of the neuropsychological tests and functional imaging in differentiation between multiple system atrophy parkinsonism-predominant (MSA-P) and multiple system atrophy predominant cerebellar ataxia (MSA-C) or idiopathic Parkinson' s disease (PD).Methods We collected three groups of patients including MSA-P (n =8),MSA-C (n =13),idiopathic PD (n =13),and control group (n =13) between December 2012 and November 2013 in General Hospital of People's Liberation Army.We then compared the scores of neuropsychological assessment and parameters obtained from diffusion tensor imaging (DTI) examination among the four groups.Results (1) MSA-P group had longer time-consuming of trail-making test((103.7 ± 25.9) s) and lower graphic symbol test scores (20.9 ±6.1) than that of the MSA-P group ((80.9 ± 29.1) s ; 28.1 ± 7.4) and PD group ((72.0 ± 19.6) s ;29.0 ± 9.4 ; all P ＜ 0.05).(2) Mean diffusivity (MD) in both putamen (8.01 ± 0.76,7.91 ± 0.74) and the left substantia nigra (8.31 ± 0.43),thalamus (8.30 ± 0.69),external capsule (8.12 ± 0.32) of MSA-P group was significantly different from that of MSA-C group (7.27 ± 0.42,7.34 ± 0.3 1,7.58 ±0.81,7.81 ±0.34,7.70 ±0.44) and PD group (7.35 ±0.43,7.45 ±0.43,7.66 ±0.45,7.72 ±0.40,7.56 ± 0.37) ; Significantly higher MD in both middle cerebellar peduncle (8.54 ± 0.74,8.28 ± 0.71),medulla oblongata (8.32 ± 0.61) was demonstrated in MSA-C group than that of MSA-P group (8.54 ±0.74,8.28 ±0.71,8.32 ±0.61),PD group (7.25 ±0.70,7.30 ±0.66,7.65 ±0.50) and control group (6.94±0.39,7.08 ±0.32,7.44 ±0.41; all P＜0.01).(3) Fractional anisotropy (FA) in the left external capsule (0.45 ± 0.35) and right thalamus (0.28 ± 0.27),occipital lobe (0.47 ± 0.87) in MSA-P group was significantly different from that in MSA-C group (0.48 ± 0.36,0.23 ± 0.24,0.49 ± 0.49 ; P ＜0.05) ; FA in the left occipital lobe (0.46 ± 0.10) in PD group was significantly different from that in MSAP group (0.56 ± 0.82 ; P ＜ 0.01).Conclusion Trail-making test,graphic symbol test and DTI can be used to differentiate MSA-P type from MSA-C type or PD.

Objective To investigate the effect and mechanisms of radix salviae miliorrhizae (RSM)on acute lung injury (ALI)caused by inhalation of high concentration rocket liquid propellant unsymmetrical dimethylhydrazine (UDMH)and dinitrogen tetroxide (N_2O_4). Methods Forty-two rats were divided into three groups:the control group,the inhalation group and the inhalation plus treatment group (RSM group).The latter two groups were inhaled with UDMH 0.98 g/m3 for ten minutes and N_2O_4 0.19 g/m3 for ten minutes.After the inhalation,the rats in RSM group were treated with 9 g?kg -1 RSM intravenously immediately,and were injected into peritoneal cavity with RSM at a dose of 3 g?kg -1 at the 3 hours after the first injection.The rats in other group were treated with equivalent saline.All rats were killed after the observation for six hours.Lung wet to dry ratio (W/D),LDH and total protein in bronchoalveolar lavage fluid (BALF),the activities of superoxide dismutase (SOD)and glutathione peroxidase (GSH-Px)in lung tissue,and the malondialdehyde (MDA)of plasma were measured.Histopathology was observed.Results The lung W/D ratio,LDH and total protein in BALF,MDA of plasma were increased in the inhalation group,while the activities of SOD and GSH-Px in lung tissue were decreased.The histopathology of the inhalation groups rats showed that exudation within alveolar space and interstitial thicken of septa was prominent.In the RSM group,above index were improved,and the degree of lung injury in histopathology was relieved.The lung W/D were related to the activities of SOD and GSH-Px in lung tissue,correlation coefficient were-0.661(P

1.2 ng/ml on the third day as a threshold,the sensitivity,and specificity in predicting the prognosis of VAP were 81.0%,and 87.5%,respectively. CONCLUSIONS The results suggested that serum PCT be important for the diagnosis of VAP.PCT concentration over 1.2 ng/ml as a threshold is more sensitive and specific to distinguishing different outcomes.And the sensitivity and specificity of PCT are better than that of IL-6,IL-8.

ObjectiveTo investigate the change of the level of testosterone and CD4+/CD8+ T cell in long-term mechanical ventilation patients with chronic obstructive pulmonary disease (COPD) and their correlation.MethodsThe level of testosterone, count of CD4+ and CD8+ T cell were measured in 42 COPD patients accepted long-term mechanical ventilation and other 34 stable COPD patients. The ratio of CD4+/CD8+ was calculated.The correlation between testosterone and CD4+/CD8+ was analyzed.ResultsCompared with the stabel COPD, there were significantly differences in the level of testosterone and the ratio of CD4+/CD8+ in long-term mechanical ventilation COPD group(P<0.05), but there was not relationship between them.ConclusionThe level of testosterone and the ratio of CD4+/CD8+ were significantly decreased in COPD patients with long-term mechanical ventilation. There is no correlation between the level of testosterone and the ratio of CD4+/CD8+.

ObjectiveTo probe the clinical features,diagnosis and treatment of idiopathic generalized myokymia.MethodsSeven patients with idiopathic generalized myokymia were analysed retrospectively.ResultsAll 7 patients showed prominent myokymia characterized by undulating and vermicular movements spreading across the muscle surface. The myokymia in gastrocnemius muscles in all cases. The myokymia also appeared in both upper extremities in 5 patients,and in faces,waist,back,abdomen and all extremities in 2 patients. Muscle rippling movement was induced and increased by exercise,and persistent during sleep. The vermicular myokymia could be observed easily in the relaxation of the muscles. Electromyography tests showed myokymic discharges in 5 patients,but normal in 2 patients. 5 patients of them were cured with carbamazepine and phenytoin sodium.ConclusionThere are typical clinical features and effective treatment in the patients with idiopathic generalized myokymia.

Adolescent ; Child ; Diagnosis, Differential ; Dystonic Disorders ; diagnosis ; drug therapy ; physiopathology ; Female ; Humans ; Male

Objective To screen the influencing factors related to prolonged mechanical ventilation (PMV). Methods Series of parameters of 154 elderly patients with pneumonia or COPD exacerbation were collected before using ventilator, after weaning of ventilator or at the 21st day of ventilating, respectively. Results By single factor analysis, PMV related to not only age, lying on bed, white blood cell, neutrophil, P (A-a)O 2, BUN, Cr, upper digestive tract bleeding, heart rate(HR), and blood pressure(BP) before using ventilator, but also related to heart function and consciousness after ventilator weaning or ventilating for 21 days. By multiple factor analysis, age, P (A-a) O 2 , heart function when ventilating for 21 days were related to PMV. Age≥82.0, P (A-a)O 2 ≥95.0 mm Hg, heart function≥grade 3 were high risk factors of PMV. Furthermore, it was found that the accuracy rate for meeting with those three parameters among 8 elderly patients with PMV was 87.5%. Conclusions Age, P (A-a)O 2 and heart function when ventilating for 21 days might be the independent factors of PMV.

Objective To explore the strategies of prevention and treatment of MRSA infection in ICU patients. Methods The clinical data of 6 patients with MRSA infection occurring at the same time in ICU were reviewed retrospectively. Results Vancomycin was given in 4 cases, 250mg twice daily, and teicoplanin was given in one case, 400mg once daily. MRSA cultures were negative in 5 cases after antibiotic treatment. Conclusions MRSA infection occurs frequently in ICU patients, and it spreads readily. Antibiotic treatment, isolation and bacteriological monitoring are very important measures for control of MRSA infection in ICU patients. [HS(1*2/3]