2020年 · 第100卷第41期

Stroke is a kind of disease that seriously threatens human health and quality of life. The lifetime risk of stroke among people over 25 is about 25% worldwide, with the highest risk in East Asia, including China, at 39%^[1]。 The burden of stroke is particularly heavy in our country, with the disability-adjusted life years (DALYs) lost due to stroke ranking the highest in the world^[2]The country and the family are burdened heavily^[3]。 After more than 20 years of development, neurointervention has become the main method of treatment of cerebrovascular diseases. Iodine contrast agent is a necessary cerebrovascular contrast agent in the diagnosis, treatment and follow-up angiography of neurointervention^[4]And the complications and adverse reactions caused by contrast agents cannot be ignored. The use of iodine contrast agent in neurointerventional surgery is larger than that in cardiac intervention, and the risk of complications such as acute kidney injury (AKI) and contrast agent-related encephalopathy (CIE) is higher. It is urgent to strengthen the standardized prevention and treatment of related risks.

To date, no specific antiviral drug has been recommended for novel coronavirus pneumonia (COVID-19). Cellular studies have shown that high concentrations of chloroquine diphosphate (CQ) can exert antiviral effects. This study evaluated the safety and efficacy of 2 CQ doses in patients with severe COVID-19. It was a parallel, double-blind, randomized phase IIB clinical trial enrolling 81 adult patients with COVID-19. The trial site is a tertiary medical institution in Manaus, Amazonas, Brazil. The trial was conducted from 23 March to 5 April 2020. Interventions: Patients were assigned to receive either a high dose of CQ (600 mg twice daily for 10 d) or a low dose of CQ (450 mg twice daily on Day 1; once daily thereafter for 4 d). Main indicators and evaluation: The primary indicator was that the mortality rate in the high-dose group was reduced by at least 50% compared with the low-dose group. The data presented here are primarily safety and lethality measures from the start of treatment to Day 13. Secondary measures included the patient's clinical status, laboratory tests, and electrocardiogram findings. Results will continue to be recorded until day 28. Viral RNA detection of respiratory secretions was performed on days 0 and 4.

Thrombosis or failure of artificial arteriovenous fistula (AVG) is a common problem in patients with hemorrhagia. Most patients' thrombosis or failure is caused by venous anastomosis stenosis. However, at present, the interventional methods for hemorrhagia are still relatively limited. The main treatment is percutaneous transluminal angioplasty (PTA). However, the average patency time reported in the literature is only 6 months, and most patients need repeated PTA to ensure the normal use of AVG. Although single treatment with stents is expensive, the long-term patency rate is high. The purpose of this study is to compare the clinical efficacy of PTA or stent treatment after AVG thrombosis or failure. The study was a multicenter randomized controlled clinical trial with a total of 30 centers and 269 patients who were randomly divided into two groups: PTA or stent-covered. The number of reinterventions, treatment costs, and cumulative treatment costs were compared between the two groups over 24 months according to the clinical presentation and treatment outcome of the patients. Through 24-month follow-up, it was found that the stent-covered group could reduce the number of reinterventions by 27% compared with patients in the PTA group (3.7 in the stent-covered group, 5.1 in the PTA group,P =0.005), the total cost of treatment was similar in both groups ($27,483 for covered stents, $28,664 for PTA,P =0.490）。 Further subgroup analysis found that in the AVG thrombosis group, the stent-covered group could significantly reduce the number of reinterventions (3.7 times in the stent-covered group, 6.2 times in the PTA group,P =0.022), and the cumulative treatment cost was also lower ($30,329 in the stent-covered group, $37,206 in the PTA group,P =0.027）。 There were no significant differences in the number of reinterventions and cumulative treatment costs between the stent-covered group and the PTA group in the AVG failure group (3.7 in the stent-covered group, 4.4 in the PTA group,P =0.120； $25,421 in the stent-covered group, $22,610 in the PTA group,P =0.140）。 The results of this study indicate that for patients with AVG thrombosis, the use of covered stents can significantly reduce the number of reinterventions and reduce the cumulative treatment cost; For patients with AVG failure, the number of reinterventions and cumulative treatment costs of the two methods were similar.

In 1986, a new syndrome secondary to the supervirulent Klebsiella pneumoniae (HvKP) was reported in the Taiwan region, characterized primarily by its ability to cause severe infections in young and immunocompetent hosts. Their virulence is explained by efficient iron acquisition and increased capsular production, which confers a typical highly viscous phenotype. In relatively healthy subjects, supervirulent Klebsiella pneumoniae has been associated with community-acquired liver abscesses, occasionally with disseminated disease. Therefore, this article analyzes and summarizes the serotypes, sequence types and clinical characteristics of highly virulent Klebsiella pneumoniae cases complicated by liver abscess in 2019, and conducts literature search with keywords such as "pneumonia", "liver abscess", "Klebsiella pneumoniae" and "Hypermucoviscous". Finally, 3 articles were screened, with a total of 7 cases. The capsular serotype K1 was found in 3 cases, and the sequence type was ST23. There were 4 cases of capsular serotype K2, of which 3 cases were ST375 and 1 case was ST881. The K1 serotype is the main cause of primary liver abscesses and secondary septic embolus, and K2 is associated with secondary liver abscesses, and the expression of these capsular serotype antigens confers major resistance to phagocytosis. Although the isolate of capsular genotype K1 belonging to sequence type ST23 is the most dominant pathogen of the syndrome, recent case analysis suggests that the K2-ST375 isolate may also be an epidemiologically significant super-virulent clone of Klebsiella pneumoniae.