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Background: Acute pancreatitis is a serious threat to human health and gastrointestinal dysmotility is a common complication for acute pancreatitis patients, resulting in delayed feeding, oral feeding intolerance, paralytic ileus, and abdominal compartment syndrome. Currently, there are limited treatment for this complication. Neostigmine is known to increase gastrointestinal motility and has been used to treat gastrointestinal dysmotility after surgery. However, research in treating acute pancreatitis with neostigmine is currently limited., Methods: This trial is a randomized, placebo-controlled, double-blinded, mono-centric trial that will test the hypothesis that neostigmine can improve gastrointestinal motility in patients with severe acute pancreatitis. Up to 56 patients will be randomized in this study receiving 0.5 mg/1 ml of neostigmine methylsulfate injection twice per day or 1 ml of saline injection twice per day. Defection time (aim 1), mortality and organ failure (aim 2), borborygmus, starting of enteral nutrition and intra-abdominal pressure (aim 3), and length of ICU and hospital stay (aim 4) will be assessed., Discussion: Findings from this study will provide data supporting the usage of neostigmine for treating severe acute pancreatitis patients with gastrointestinal dysmotility., Trial Registration: This study is registered on chictr.org.cn with the identifier as ChiCTR2200058305. Registered on April 5, 2022., (© 2023. The Author(s).)

Objective To summarize the clinical characteristics and chest CT findings of coronavirus disease 2019(COVID-19)patients in Peking Union Medical College Hospital(PUMCH). Methods A total of 13 patients with COVID-19 confirmed at PUMCH from January 20 to February 6,2020 were selected as the research subjects.Their epidemiological histories,clinical characteristics,laboratory tests,and chest CT findings were analyzed retrospectively.The location,distribution,density,and other accompanying signs of abnormal lung CT lesions were recorded,and the clinical types of these patients were assessed. Results The clinical type was "common type" in all these 13 patients aged(46.8±14.7)years(range:27-68 years).Ten patients had a travel history to Wuhan or direct contact with patients from Wuhan,2 cases had recent travel histories,and 1 case had a travel history to Beijing suburb.The white blood cell(WBC)count was normal or decreased in 92.3% of the patients and the lymphocyte count decreased in 15.4% of the patients.Twelve patients(92.3%)had a fever,among whom 11 patients were admitted due to fever and 2 patients(15.4%)had low fever.Eight patients(61.5%)had dry cough.The CT findings in these 13 patients were all abnormal.The lesions were mainly distributed along the bronchi and under the pleura.The lesions were relatively limited in 8 patients(affecting 1-3 lobes,predominantly in the right or left lower lobe),and diffuse multiple lesions of bilateral lungs were seen in 5 patients.The CT findings mainly included ground glass opacities(GGOs)( n =10,76.9%),focal consolidation within GGOs( n =7,53.8%),thickened vascular bundle passing through the lesions( n =10,76.9%),bronchial wall thickening( n =12,92.3%),air bronchogram( n =10,76.9%),vacuole signs in the lesions( n =7,53.8%),fine reticulation and interlobular septal thickening( n =3,23.1%),reversed halo-sign( n =2,15.4%),crazy-paving pattern( n =2,15.4%),and pleural effusion( n =2,15.4%). Conclusions Most of our patients diagnosed with COVID-19 at PUMCH had a travel history to Wuhan or direct contact with patients from Wuhan.The first symptoms of COVID-19 mainly include fever and dry cough,along with normal or reduced counts of WBC and lymphocytes.CT may reveal that the lesions distribute along the bronchi and under the pleura;they are typically localized GGOs in the early stage but can become multiple GGOs and infiltrative consolidation in both lungs in the advanced stage.Scattered vacuole signs may be visible inside the lesions in some patients.

Background: A new coronavirus pneumonia caused by 2019 new coronavirus (2019-nCoV) is spreading in China. Here we summarized the patients we accepted in the fever outpatient department., Methods: Patients with epidemiologic history, respiratory symptoms or fever were required to go to the fever clinic for screening. Patients were finally laboratory-confirmed 2019-nCoV infection by real-time reverse transcription-polymerase chain reaction (RT-PCR) using nasal and pharyngeal swabs. Epidemiologic features, clinical presentation, laboratory findings and image features were collected and analyzed., Results: Totally, 16 patients were diagnosed as 2019-nCoV infection. The median age of the patients was 39.00 (35.25-55.75) years old, and the ratio of men and women was 9:7. Fifteen (93.75%) patients had clear epidemiologic history. The most common symptoms of the patients were fever (87.50%) and cough (n=8, 50.00%). The mean white blood cell count in the patients was (4.97±1.71) ×10 9 /L, and it was lower than 4.00×10 9 /L in 4 (25.00%) patients. The median neutrophil and lymphocyte count were 2.70 (1.84-3.27) ×10 9 /L and (1.52±0.53) ×10 9 /L respectively. The mean C-reactive protein level was 19.11±17.39 mg/L. Patients were likely had normal procalcitonin, creatinine, alanine aminotransferase, creatine kinase and lactate dehydrogenase levels at diagnosis. Fourteen (87.50%) patients had pneumonia in chest CT scan., Conclusions: No specific symptom was helpful in the diagnosis of 2019-nCoV infection, but relatively low WBC and lymphocyte level might be suggestive to diagnosis. Most patients had fever and pneumonia, however, there were indeed some patients without fever and pneumonia. Screening procedure should not only focus on fever patients. The origin, transmission route, key targets of the virus and mechanism of infection deserved more studies., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd.2020.03.33). The authors have no conflicts of interest to declare. Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was approved by the institutional review board committee of Peking Union Medical College Hospital (No. S-K1041) and informed consent was taken from all the patients. Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/., (2020 Journal of Thoracic Disease. All rights reserved.)

The source of secondary lower respiratory tract bacterial infections in influenza patients is not fully understood. A case-control study was conducted during the 2017-2018 influenza epidemic period in Beijing, China. Nasopharyngeal swabs were collected from 52 virologically confirmed influenza patients and 24 healthy medical staff. The nasopharyngeal microbiota taxonomic composition was analysed using high-throughput sequencing of the 16S rRNA gene V3-V4 regions. The super-dominant pathobiontic bacterial genus (SDPG) was defined as that accounting for >50% of sequences in a nasopharyngeal swab. We attempted to isolate bacteria of this genus from both nasopharyngeal swabs and lower-respiratory tract samples and analyse their genetic similarities. We observed a significantly lower taxonomy richness in influenza cases compared with healthy controls. A SDPG was detected in 61% of severe cases but in only 24% of mild cases and 29% of healthy controls. In 10 cases, the species isolated from lower-respiratory tract infection sites were identified as belonging to the nasopharyngeal microbiota SDPG. Genetically identical strains were isolated from both nasopharyngeal swabs and lower-respiratory tract infection sites, including 23 Acinetobacter baumannii strains from six severe cases, six Klebsiella pneumoniae strains from two severe cases, five Pseudomonas aeruginosa strains from one severe and one mild case, and four Corynebacterium striatum strains from two severe cases. The SDPG in the nasopharyngeal microbiota are the likely cause of subsequent infection in influenza patients.

Background: Most research on the seasonality of acute coronary syndrome (ACS) has been were reported from hospital-based data. We aimed to investigate the seasonal distribution of ACS in Beijing and to elucidate the relations between ACS occurrence and climatic parameters in a prehospital setting., Methods: We retrospectively reviewed the electronic prehospital medical records from the Beijing's emergency medical service system spanning August 1, 2005, to July 31, 2007. Case data were analyzed by month and season with χ² test. The effects of climatic factors on the occurrence of ACS were analyzed by Poisson regression with generalized linear model., Results: During the 2-year study period, a total of 7037 ACS events were identified, including 4135 male patients (58.8%) and 2902 female patients (41.2%). Significant variations were observed in the monthly (P < .001) and seasonal (P < .001) distribution of ACS. The highest seasonal incidence occurred in winter and lowest in autumn. Significant negative correlations were noticed between the number of ACS events and daily mean temperature (P < .001) and between the number of ACS events and barometric pressure (P < .001). Comparing to the baseline level (temperature of 25°C to approximately 31°C; barometric pressure of 1026 to approximately 1048 hectopascal (hPa)), an increase of 41.3% of daily ACS incidence was associated with temperature lower than 2°C (-10.0°C to approximately 2.0°C), and an increase of 19.8% was associated with barometric pressure under 1006 hPa (991.0 to approximately 1006 hPa)., Conclusions: There are clear monthly and seasonal rhythms of ACS in Beijing metropolitan area. Temperature and barometric pressure are negatively related with the occurrence of ACS., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Many studies have identified strong correlations between winter months and acute, unintentional carbon monoxide (CO) poisoning. In this study, we aimed to investigate the incidence pattern of acute domicile-related CO poisoning in Beijing and its relation with climatic factors., Methods: Data on CO poisoning were collected from the emergency medical service system during August 1, 2005, to July 31, 2007, in Beijing. Variations of the monthly and seasonal distribution of CO poisoning occurrences were examined with χ(2) testing. Climatic data including temperature, barometric pressure, humidity, wind speed, and visibility were obtained from the Beijing Meteorological Bureau. Correlations between the occurrence of CO poisoning and mean of each meteorological parameter spanning 3 days were analyzed with partial correlation test, with related parameters controlled., Results: Significant differences were found among the cases occurring each month of the year (P < .001). The monthly caseload reached the peak and the nadir in January and in September, respectively. During the cold period, 3331 patients were recorded, accounting for 88.4% of the total cases of the 2-year study period. Among the 5 climatic parameters, only temperature had a significant inverse correlation with the occurrence of CO poisoning (P < .001, r = -0.467)., Conclusions: The incidences of CO poisoning were highest during winter, particularly during the time period when charcoal or coal use for indoor heating would be most prevalent in Beijing., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objective: To investigate the circadian and seasonal patterns in the presentation of acute upper gastrointestinal bleeding (AUGIB) in Beijing, China., Methods: Medical records of the Beijing Emergency Medical Service System (EMSS) for 1 August 2005 to 31 July 2007 were reviewed; all patients diagnosed with AUGIB were included in the study., Results: 2580 patients were recorded in the EMSS system with a diagnosis of AUGIB during the study period. 1888 (73%) were male and 692 (27%) were female. Mean age was 53+/-20 years for male patients and 63+/-21 years for female patients. Significant differences in the presentation of AUGIB were noticed between seasons (p<0.001) and months (p<0.001). The number of cases in cold months (from December to April) was significantly higher than that in warm months (June to September). There was a significant circadian rhythm; there were fewer cases during daytime hours compared with night-time hours (p<0.001)., Conclusions: The presentation of AUGIB in Beijing has a clear seasonal and circadian rhythm. Circadian and seasonal rhythms associated with AUGIB may aid in identifying modifiable risk factors in individuals and populations.

Background: Previous in-hospital studies suggest that there are significant circadian rhythms associated with the incidence of acute coronary syndromes (ACSs). No study to date has examined the presentation of ACS in the prehospital setting. Our goal was to examine circadian, day-of-week, and age patterns of occurrence in ACS in a large, urban emergency medical services (EMS) system., Methods: We retrospectively reviewed the electronic prehospital medical records from the Beijing's EMS system spanning August 1, 2005, to July 31, 2007. Data were analyzed by hour of the day and day of the week. chi(2) tests were performed to compare the difference., Results: Seven thousand thirty-two cases of ACS were identified by the EMS system physicians during the 2-year study period, including 536 cases of acute myocardial infarction. A significant variation of circadian distribution of ACS was observed in both 24-hour (P < .001) and 2-hour (P < .001) interval time course. Two peaks were observed in the morning from 0800 to 1000 and approaching midnight from 2200 to 2400. Increases of 50% and 60.8% in the morning and evening peaks were found, respectively, when compared with the early morning baseline (nadir). No significant difference was found among the accumulated cases in 2 years on each day in a week (P = .203)., Conclusions: Our study shows that, in the Beijing metropolitan area, the presentation of ACS has significant circadian rhythm characterized by 2 peaks within 24 hours, the morning peak is 0800 to 1000, and the late evening peak is 2200 to 2400. No significant weekly rhythm was observed in the present study., (Copyright 2010 Elsevier Inc. All rights reserved.)