Objective ：To evaluate the applicable value of respiratory impedance for the stage 0 of chronic obstructive pulmonary disease （COPD）. Methods：Respiratory impedance was measured by impulse oscillometry （lOS） in 4...Objective ：To evaluate the applicable value of respiratory impedance for the stage 0 of chronic obstructive pulmonary disease （COPD）. Methods：Respiratory impedance was measured by impulse oscillometry （lOS） in 41 cases at stage 0 of COPD （NHLBI/WHO, 2001 Standard） and their conventional pulmonary function values were compared with 42 healthy subjects. Both groups had no significant deviation in age, stature and avoirdupois, etc. Master-Screen pulmonary function test system （Jaeger Co, Germany） were used to determine IOS parameters including viscous resistance of 5Hz, 20 Hz and 35Hz （R5, R20, R35）, reactance of 5Hz, 35 Hz （X3, X35）, resonant frequency （Fres） ,total respiratory impedance （Zrs） and routine pulmonary function values including forced expiratory volume in one second to predicted value （FEV1 % ）, forced expiratory volume in one second to forced vital capacity ratio（ FEV1/ FVC% ）, maximal mid expiratory flow （MMEF%）,V23% and V50%. Results：Both groups had no significant deviation in FEV1%, FEV1/FVC% and X35（P〉0.05）. It was increased significantly in viscous resistance of 5Hz, 20 Hz and 35Hz （R5, R20, R35） in COPD group than that in healthy group （P〈0.01）. So were Fres and Zrs （P〈0.01）. MMEF%,V25%,V50% and reactance of 5Hz （X5） in COPD group were marked lower than that in healthy group （P〈0.01）. The sensitivity of MMEF%, V25%,V50% was higher than others, but its specificity was lower. In parameters of IOS, Fres was the most sensitive index for diagnosis of the small airway function and its specificity was higher than that of MMEF%, V25% ,V50%. Conclusion：In the risk case at the stage 0 of COPD, MMEF%, V25% and V50% could be decreased, but Fres, R5 ,R5-20 could be increased in spite of FEV1% and FEV1/FVC% in normal range.展开更多
Objective To investigate the optimal dosage of pirfenidone for the treatment of pulmonary fibrosis induced by bleomycin in Wistar rats, and the alteration of expressions of transforming growth factor beta-1 （ TGF-β1...Objective To investigate the optimal dosage of pirfenidone for the treatment of pulmonary fibrosis induced by bleomycin in Wistar rats, and the alteration of expressions of transforming growth factor beta-1 （ TGF-β1 ）, tissue inhibitor of metalloproteinase-1 （ TIMP-1 ）, and matrix metalloproteinase-13 （ MMP-13 ） in lung tissue. Methods Male Wistar rats were endotracheally instilled with bleomycin or normal saline. Pirfenidone （25-800 mg · kg^-l · d^-1 ）, dexamethasone （3 mg/kg）, or 1% carboxymethylcellulose sodium were given daily by feed 2 days before instillation of bleomycin. Groups T7 and T14 were fed pirfenidone 50 mg · kg^-1 · d^-1 at 7 days or 14 daYs after bleomycin instillation. Lungs were harvested at 28 days after bleomycin instillation. Patholological changes in luffg tissues were evaluated with HE staining. Lung collagen was stained by sirius red and measured by content of hydroxypro- line. Expression of proteins of TGF-β1 TIMP-1, and MMP-13 were detected by Western blotting. Results At doses of 25, 50, and 100 mg· kg^- 1 · d ^- 1, pirfenidone had significant anti-fibrotic effects for bleomy- cin-induced rat pulmonary fibrosis, and these effects were most significantly attenuated at the dosage of 50 mg · kg^-1 ·d^ -1（ HE： P 〈 0. 01, P 〈 0.01, and P = 0.064; sirius red： P 〈0.05, P 〈 0.01, and P 〈 0.05 ; hydroxyproline： P = 0.595, P 〈 0.01, and P = 0.976）. Pirfenidone at a dosage of 50 mg · kg^- l · d^-1 inhibited protein expression of TGF-131 and TIMP-1 in lung tissue in the early phase （0.79 and 0.75 times of control group）, but had no effect on ex- nr^eelnn nf MMP-13. Conclusion Low dose pirfenidone, especially at dosage of 50 mg · kg^-1 · d^-1, has significant anti-fibrotic effects on bleomycin-induced rat pulmonary fibrosis. Pirfenidone partially inhibits the enhancement of the expression of TGF-131 and TIMP-β1 in lung tissue.展开更多
Objective To investigate the antagonistic effects of different doses of Lianhua Qingwen on pulmonary injury induced by fine particulates PM2.5 in rats. Methods Fine particulates suspended in the environment were colle...Objective To investigate the antagonistic effects of different doses of Lianhua Qingwen on pulmonary injury induced by fine particulates PM2.5 in rats. Methods Fine particulates suspended in the environment were collected. Forty-eight healthy adult wistar rats were randomly divided into 6 groups with 8 rats in each group. Four groups of rats were exposed to PM2.5 by intratracheally dripping suspensions of fine particulates PM2.5(7.5 mg/kg) as dust-exposed model rats. Among them 24 rats in three groups received Lianhua Qingwen treatment(crude drug) at a dose of 2 g/kg, 4 g/kg, 8 g/kg per day for 3 days before dust exposure and were defined as low-dose, middle-dose and high-dose Lianhua Qingwen treatment groups respectively. The other dust-exposed model rats without treatment were assigned as PM2.5 control group. The un-exposed rats were set as saline control group(1.5 ml/kg saline) and blank control group. All rats were killed after 24 hours of the exposure. Lung tissue, serum and bronchoalveolar lavage fluid(BALF) were collected. The levels of malonaldehyde(MDA), lactate dehydrogenase(LDH), and glutathione peroxidase(GSH-PX) in blood serum and BALF, and superoxide dismutase(SOD) in blood surum were measured using fluorescent quantitation PCR; Expression of NF-E2-related factor 2(NRF-2), heme oxygenase 1(HO-1) and quinone oxidoreductase 1(NQO1) in lung tissues were measured using Western blot. Pathological changes of lung tissues in each group were also examined. Results Pathology revealed thickened alveolar septum, congestion of capillary, interstitial edema and infiltration of lymphocyte and neutrophil surrounding bronchiole in the PM2.5 control group, which weresignificantly relieved in the Lianhua Qingwen treatment groups. Compared to the blank and saline control groups, the PM2.5 control group had significantly higher levels of LDH and MDA(p<0.01) and lower level of GSH-PS(p<0.01) in BALF, significantly higher levels of LDH and MDA(p<0.05) and lower level of GSH-PS(p<0.05) in rat serum. The levels of MDA in blood serum and BALF were significantly lower in each treatment group than that in PM2.5 control group(all P<0.05). In both middle-dose and high-dose treatment group the measurements of LDH in serum and BALF as well as GSH-PX in serum were significant difference from those of PM2.5 control group(all P<0.05). Expressions of NRF-2, HO-1 and NQO1 in lung tissues were significantly different among middle-dose and high-dose treatment group compared with those in PM2.5 control group(all P<0.05). Conclusion Fine particulates PM2.5 in environment may induce pulmonary oxidative lesions in rats. Middle-dose and high-dose Lianhua Qingwen has antagonist effece on the injuries induced by fine particulates.展开更多
Objective To explore the effects of dermabrasion combined with ReCell on large superficial facial scars caused by burn, trauma and acnes. Methods Nineteen patients with large superficial facial scars were treated b...Objective To explore the effects of dermabrasion combined with ReCell on large superficial facial scars caused by burn, trauma and acnes. Methods Nineteen patients with large superficial facial scars were treated by the same surgeon with dermabrasion combined with ReCell？. According to the etiology, patients were classified into post-burning group （n=5）, post-traumatic group （n=7） and post-acne group （n=7）. Fifteen patients completed the follow-ups, 5 patients in each group. Healing time, complication rate, the preoperative and 18-month-post-operative assessments using Patient Satisfaction Score （PSS）, Vancouver Scar Scale （VSS）, and Patient and Observer Scar Assessment Scale （POSAS） of each group were analyzed to compare the effect of the combined therapy on outcomes.Results The healing time of post-burning group （19.6±4.0 days）, post-traumatic group （15.8±2.6 days）, and post-acne group （11.4±3.1 days） varied remarkably （F=7.701, P=0.007）. The complication rates were 60%, 20%, and 0 respectively. The post-operative POSAS improved significantly in all groups （P〈0.05）, where the most significant improvement was shown in the post-acne group （P〈0.05）. The post-operative PSS and VSS improved only in the post-traumatic group and post-acne group （all P〈0.05）, where the more significant improvement was also shown in the post-acne group （P〈0.05）. Conclusions The combined treatment of dermabrasion and ReCell has remarkable effect on acne scars, moderate effect on traumatic scars and is not suggested for burn scars. POSAS should be applied to assess the therapeutic effects of treatments for large irregular scars.展开更多
Trauma is a major factor that contributes to the risk for acute respiratory distress syndrome(ARDS).Biomarkers that predict the risk,diagnosis,treatment response and prognosis of ARDS after trauma have been widely inv...Trauma is a major factor that contributes to the risk for acute respiratory distress syndrome(ARDS).Biomarkers that predict the risk,diagnosis,treatment response and prognosis of ARDS after trauma have been widely investigated.In addition to their applications in clinical diagnosis and treatment,these biomarkers provide important insights into our understanding of the pathogenesis of ARDS.This review begins with a brief introduction regarding the incidence and pathogenesis of trauma-associated ARDS.Then,we focus on reviewing the clinical trials that have been designed to investigate the value of biomarkers in ARDS after trauma.Biomarkers with a confirmed value in ARDS have been organized on the basis of key pathogenic processes that are central to ARDS and are described in detail.Among these,angiopoietin 2(Ang-2),L-selectin,Clara cell protein 16(CC16),soluable receptor for advanced glycation end products(s RAGE),Surfactant protein D(SP-D),histones,mt DNAs and some biomarker panels had a certain association with the diagnosis and prognosis of trauma-related ARDS.Further investigations are needed regarding the design of trials,the best sampling approaches and the optimal combinations of the biomarker panels.展开更多
Objectives To investigate the overall prevalence of cardiovascular disease （CVD） in subjects hospitalized for chronic obstructive pulmonary disease （COPD）,and explore the prevalence of the major CVD complications ...Objectives To investigate the overall prevalence of cardiovascular disease （CVD） in subjects hospitalized for chronic obstructive pulmonary disease （COPD）,and explore the prevalence of the major CVD complications and trends in patients with COPD over a 10-year period.Methods Medical records in the PLA General Hospital,Beijing Union Medical College Hospital,and Beijing Hospital from 2000/01/01 to 2010/03/03 were retrospectively reviewed.A total of 4960 patients with COPD were reviewed in the study （3570 males,mean age,72.2 ± 10.5 years; 1390 females,mean age,72.0 ± 10.4 years）.Results The prevalence of CVD in COPD patients was 51.7％.The three most prevalent CVDs were ischemic heart disease （28.9％）,heart failure （19.6％）,and arrhythmia （12.6％）.During the 10-year study period,the prevalence of various CVDs in COPD patients showed a gradual increasing trend with increasing age.There was higher morbidity due to ischemic heart disease （P ＜ 0.01） in male COPD patients than in the female counterparts.However,heart failure （P ＜ 0.01）and hypertension （P ＜ 0.01） occurred less frequently in male COPD patients than in female COPD patients.Furthermore,the prevalence of ischemic heart disease decreased year by year.In addition to heart failure,various types of CVD complications in COPD patients tended to occur in younger subjects.The prevalence of all major types of CVD in women tended to increase year by year.Conclusions The prevalence of CVD in patients hospitalized for COPD in Beijing was high.Age,sex and CVD trends,as well as life style changes,should be considered when prevention and control strategies are formulated.展开更多
In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a n...In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.展开更多
Background:Many healthcare workers were infected by coronavirus disease 2019(COVID-19)early in the epidemic posing a big challenge for epidemic control.Hence,this study aims to explore perceived infection routes,influ...Background:Many healthcare workers were infected by coronavirus disease 2019(COVID-19)early in the epidemic posing a big challenge for epidemic control.Hence,this study aims to explore perceived infection routes,influencing factors,psychosocial changes,and management procedures for COVID-19 infected healthcare workers.Methods:This is a cross-sectional,single hospital-based study.We recruited all 105 confirmed COVID-19 healthcare workers in the Zhongnan Hospital of Wuhan University from February 15 to 29,2020.All participants completed a validated questionnaire.Electronic consent was obtained from all participants.Perceived causes of infection,infection prevention,control knowledge and behaviour,psychological changes,symptoms and treatment were measured.Results:Finally,103 professional staff with COVID-19 finished the questionnaire and was included(response rate:98.1%).Of them,87 cases(84.5%)thought they were infected in working environment in hospital,one(1.0%)thought their infection was due to the laboratory environment,and 5(4.9%)thought they were infected in daily life or community environment.Swab of throat collection and physical examination were the procedures perceived as most likely causing their infection by nurses and doctors respectively.Forty-three(41.8%)thought their infection was related to protective equipment,utilization of common equipment(masks and gloves).The top three first symptoms displayed before diagnosis were fever(41.8%),lethargy(33.0%)and muscle aches(30.1%).After diagnosis,88.3%staff experienced psychological stress or emotional changes during their isolation period,only 11.7%had almost no emotional changes.Arbidol(Umifenovir;an anti-influza drug;69.2%)was the drug most commonly used to target infection in mild and moderate symptoms.Conclusion:The main perceived mode of transmission was not maintaining protection when working at a close distance and having intimate contact with infected cases.Positive psychological intervention is necessary.展开更多
Objectives To investigate the effects of preoperative smoking and smoking cessation time on preoperative peripheral blood inflammatory indexes and postoperative hospitalization outcomes in male patients with lung canc...Objectives To investigate the effects of preoperative smoking and smoking cessation time on preoperative peripheral blood inflammatory indexes and postoperative hospitalization outcomes in male patients with lung cancer and surgery therapy.Methods We retrospectively enrolled 637 male patients who underwent curative-intent lung cancer resection between January 2014 and December 2016.Patients were classified as the current smokers,the never smokers,and the ex-smokers based on their smoking history,and the ex-smokers were allocated into five subgroups according to their smoking cessation times(CeT):CeT W6 weeks,6weeks<CeT W lyear,lyear<CeT<5years,5years<CeT<lOyears,CeT>10years.The preoperative peripheral blood white blood cells(WBCs),albumin,neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),intraoperative blood loss,30-day mortality,in-hospital days,hospitalization costs,intensive care un辻(ICU),admission days and placement time of closed thoracic drainage tube were compared among difTerent groups.Results There were significant differences in WBC(F=S.275,P<0.001)and albumin(F=2,470,P<0.05)among patients of current smokers,ex-smokers with different smoking cessation time,and never-smokers.The blood WBC count in current smokers(7.7 X 109/L)was significantly higher than that in ex・smokers(7.0 X 109/L)and never-smokers(5.9 X 109/L)(t=-2.145,P<0.05;t=-6.073,P<0.01,respectively).The level of peripheral blood albumin in current smokers(41.1 g/L)was lower than that in ex・smokers(42.1 g/L)and neve—smokers(43.2 g/L)(t=2.323,P<0.05;t=3.995,P<0.01,respectively).The level of peripheral blood NLR in current smokers(3.7)was higher than that in ex-smokers(3.1)and never smokers(2.8)(t—-1.836,P<0.05;t=-2.889,P<0.01,respectively).There was no significant difference in WBC,albumin and NLR among five subgroups of different smoking cessation time.No significant difference was observed in intraoperative blood loss,30-day mortality,hospitalization costs,hospital stay,ICU stay and placement time of closed thoracic drainage tube among groups either.Conclusion Smoking increases the preoperative inflammatory indexes in peripheral blood of lung cancer patients.Smoking cessation has beneficial effect on reducing levels of these inflammatory indexes,which may be not impacted by the time length of smoking cessation.Therefore,lung cancer patients should be encouraged to quit smoking at any time.展开更多
In this Commentary,we would like to comment on the article titled"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)"as a featur...In this Commentary,we would like to comment on the article titled"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)"as a featured article in Military Medical Research.In the guideline,except for"confirmed cases","suspected cases","close contact"and"suspicious exposure"were defined by clinical perspective based on epidemiological risk,clinical symptoms and auxiliary examination.Combined with our experience,we introduced a simple scoring proposal additionally based on not only CT imaging as strongly recommended by the guideline but also blood routine test,especially for primary screening of such patients in the out-patient department.展开更多
BACKGROUND: The effect of blood eosinophils(EOSs) on mortality in acute respiratory distress syndrome(ARDS) patients and whether corticosteroids affect this effect are unclear.METHODS: The Medical Information Mart for...BACKGROUND: The effect of blood eosinophils(EOSs) on mortality in acute respiratory distress syndrome(ARDS) patients and whether corticosteroids affect this effect are unclear.METHODS: The Medical Information Mart for Intensive Care III database(version 1.4) was used to extract data. Patients with ARDS were selected for inclusion. Cox regression models using the backward stepwise method and propensity score matching(PSM) were used to assess the relationship between blood EOS counts and 28-day mortality. RESULTS: A total of 2,567 patients with ARDS were included, and the 28-day mortality rate was 24.19%. The crude 28-day mortality was significantly lower in patients with EOS counts ≥2%(18.60% [85/457] vs. 25.40% [536/2,110], P=0.002) than in those with EOS counts <2%. In the Cox regression model, the EOS counts ≥2% showed a significant association with the decreased 28-day mortality(hazard ratio [HR] 0.731;95% confidence interval [95% CI] 0.581–0.921, P=0.008). In the corticosteroid non-use subgroup, EOS counts ≥2% was significantly related to decreased 28-day mortality(HR 0.697, 95% CI 0.535–0.909, P=0.008), but the result was not significant in the corticosteroid non-use subgroup model(P=0.860). A total of 457 well-matched pairs were obtained by a 1:1 matching algorithm after PSM. The 28-day mortality remained significantly lower in the EOS counts ≥2% group(18.60% [85/457] vs. 26.70% [122/457], P=0.003).CONCLUSIONS Higher EOS counts are related to lower 28-day mortality in ARDS patients, and this relationship can be counteracted by using corticosteroids.展开更多
BACKGROUND： Ventilator induced lung injury （VILI） is a serious complication in the treatment of mechanical ventilating patients, and it is also the main cause that results in exacerbation or death of patients. In t...BACKGROUND： Ventilator induced lung injury （VILI） is a serious complication in the treatment of mechanical ventilating patients, and it is also the main cause that results in exacerbation or death of patients. In this study, we produced VILI models by using glucocorticoid in rats with high tidal volume mechanical ventilation, and observed the content of macrophage inflammatory protein-1α （MIP-1α） in plasma and bronchoalveolar lavage fluid （BALF） and the expression of MIP-1α mRNA and nuclear factor-kappa B （NF-кB） p65 mRNA in the lung so as to explore the role of glucocorticoid in mechanical ventilation.METHODS： Thirty-two healthy Wistar rats were randomly divided into a control group, a ventilator induced lung injury （VILI） group, a dexamethasone （DEX） group and a budesonide （BUD） group. The content of MIP-1a in plasma and BALF was measured with ELISA and the level of MIP-1α mRNA and NF-кBp65 mRNA expressing in the lung of rats were detected by RT-PCR. The data were expressed as mean±SD and were compared between the groups.RESULTS： The content of MIP-1α in plasma and BALF and the level of MIP-1α mRNA and NF-кBp65 mRNA in the lung in the DEX and BUD groups were signifi cantly lower than those in the VILI group （P〈0.001）. Although the content of MIP-1α in plasma and BALF and the level of MIP-1α mRNA and NF-кBp65 mRNA in the lung in the BUD group were higher than those in the DEX group, there were no signifi cant differences between them （P〉0.05）.CONCLUSIONS： Glucocorticoid could down-regulate the expression of MIP-1α by inhibiting the activity of NF-кB in the lung and may exert preventive and therapeutic effects on VILI to some extent. The effect of local use of glucocorticoid against VILI is similar to that of systemic use, but there is lesser adverse reaction.展开更多
Objective To examine the correlation between the health-related quality of life measured by the St.George's Respiratory Questionnaire(SGRQ) and the commonly used physiological measures in lymphangioleiomyomatosis(...Objective To examine the correlation between the health-related quality of life measured by the St.George's Respiratory Questionnaire(SGRQ) and the commonly used physiological measures in lymphangioleiomyomatosis(LAM).Methods This study retrospectively analyzed the SGRQ scores and other measures(the Borg scale of breathlessness at rest,6-minute walking distance,blood oxygen levels,and pulmonary function) of patients diagnosed and confirmed with LAM.Altogether 38 patients between June 2007 and November 2009 were included.Results The mean values of the SGRQ three components(symptoms,activity,and impacts) and total scores in the LAM patients were 46.95±28.90,58.47±25.41,47.89±29.66,and 51.11±26.35,respectively.The SGRQ total or component scores were correlated well with the Borg scale of breathlessness,6-minute walking distance,partial pressure of oxygen in arterial blood,spirometry and diffusion capacity of lung.There were poor correlations between SGRQ score and residual volume or total lung capacity.In our preliminary observation,sirolimus improved the SGRQ total and three component scores and the Borg scale of breathlessness significantly after 101-200 days of treatment(n=6).Conclusions The SGRQ score in LAM is correlated well with physiological measures(Borg scale of breathlessness,6-minute walking distance,blood oxygen levels,and pulmonary function tests).The SGRQ could therefore be recommended in baseline and follow-up evaluation of patients with LAM.Treatment with sirolimus,an inhibitor of mammalian target of rapamycin,may improve the quality of life and patient's perception of breathlessness in LAM.展开更多
Objective: To study the therapeutic effects of panax notoginside (PN) and methylprednisolone (MP) on pulmonary fibrosis in rats. Methods: Bleomycin was introduced into the bronchial tree of 75 Wistar male rats through...Objective: To study the therapeutic effects of panax notoginside (PN) and methylprednisolone (MP) on pulmonary fibrosis in rats. Methods: Bleomycin was introduced into the bronchial tree of 75 Wistar male rats through a tracheal incision to establish a rat model of pulmonary fibrosis (PF). The rats were equally divided into 3 groups: PF group, PN treated group and MP treated group. Five rats of each group were killed 1, 3, 7, 14 and 28 d after the administration of bleomycin and the specimens of lung tissue and plasma were collected for the determination of content of collagen Ⅰ and Ⅲ with immunohistochemical method and the level of MIP-1α and MCP-1 with ELIZA. Results: The severity of PF, the content of collagen Ⅰ and Ⅲ and the level of MIP-1α and MCP-1 were significantly decreased in PN and MP treated groups than in PF group (P<0.05). Conclusion: PN and MP are effective to control the development of PF induced with bleomycin in rats.展开更多
INTRODUCTIONScrub typhus, a tropical febrile vector borne disease also known as ＂Tsutsugamushi disease＂, is caused by Orientia tsutsugamushi, a gram negative obligate intracellular slow growing bacteria. The infecti...INTRODUCTIONScrub typhus, a tropical febrile vector borne disease also known as ＂Tsutsugamushi disease＂, is caused by Orientia tsutsugamushi, a gram negative obligate intracellular slow growing bacteria. The infection is transmitted by the bite of larval stage （chiggers） mites belonging to the family Trombiculidae.展开更多
Objective： Irinotecan in combination with cisplatin for extensive-stage disease small-ceU lung cancer （ED-SCLC） patients has gained wide interest. Varying results for this treatment underpin the need for a synthesi...Objective： Irinotecan in combination with cisplatin for extensive-stage disease small-ceU lung cancer （ED-SCLC） patients has gained wide interest. Varying results for this treatment underpin the need for a synthesis of evidence. Methods： We conducted a literature-based meta-analysis to quantify the magnitude of the benefit comparing irinotecan in combination with cisplatin （IP） with etoposide in combination with cisplatin （EP） in ED-SCLC patients. The primary outcome was overall survival （OS） and progression-free survival （PFS）; secondary outcomes included overall response rate, 1- and 2-year survival rates, disease control rate and toxicity. Results： Four trials including 1,541 patients were identified in the analysis. No positive results （P〈0.05） were seen： OS （HR=0.85, CI95%=0.71-1.01; P=-0.08） with high heterogeneity （Chi2=7.76, dr=-3 [P=-0.05]; I2=61%）, PFS （HR=0.91, CI95%=0.74-1.28; P=-0.36） with high heterogeneity （Chi2=11.96, df=3 [P=-0.008]; I2=75%）, overall response rate（OR=1.16; CI95%=0.79-1.70; P=0.45）, disease control rate （OR=1.01; CI95%=0.74-1.38; P=0.95）, 1-year survival rate （OR = 1.30; CI95%=0.98-1.72; P=0.07） and 2-year survival rate （OR=1.97; CI95%=0.95-4.09; P=-0.07）. Fewer patients who received IP suffered severe hematologic toxicities （grade≥3）, such as neutropenia, thrombocytopenia and leucopenia. However, severe non-hematologic toxicities （grade≥3）, such as diarrhea, nausea, vomiting, fatigue, anorexia, and dehydration, were more common among patients who received IP. Conclusion： IP does not lengthen the overall survival or progression-free survival compared with EP in patients with ED-SCLC Fewer patients receiving IP had grade ≥ 3 hematological toxicities of nentropenia, leucopenia and thrombocytopenia, but more had grade≥3 diarrhea, nausea, vomiting, fatigue, anorexia and dehydration.展开更多
Background The coronavirus disease 2019(COVID-19)pandemic has had a profound and prolonged impact on healthcare services and healthcare workers.Aims The Australian COVID-19 Frontline Healthcare Workers Study aimed to ...Background The coronavirus disease 2019(COVID-19)pandemic has had a profound and prolonged impact on healthcare services and healthcare workers.Aims The Australian COVID-19 Frontline Healthcare Workers Study aimed to investigate the severity and prevalence of mental health issues,as well as the social,workplace and financial disruptions experienced by Australian healthcare workers during the COVID-19 pandemic.Methods A nationwide,voluntary,anonymous,single timepoint,online survey was conducted between 27 August and 23 October 2020.Individuals self-identifying as frontline healthcare workers in secondary or primary care were invited to participate.Participants were recruited through health organisations,professional associations or colleges,universities,government contacts and national media.Demographics,home and work situation,health and psychological well-being data were collected.Results A total of 9518 survey responses were received;of the 9518 participants,7846(82.4%)participants reported complete data.With regard to age,4110(52.4%)participants were younger than 40 years;6344(80.9%)participants were women.Participants were nurses(n=3088,39.4%),doctors(n=2436,31.1%),allied health staff(n=1314,16.7%)or in other roles(n=523,6.7%).In addition,1250(15.9%)participants worked in primary care.Objectively measured mental health symptoms were common:mild to severe anxiety(n=4694,59.8%),moderate to severe burnout(n=5458,70.9%)and mild to severe depression(n=4495,57.3%).Participants were highly resilient(mean(SD)=3.2(0.66)).Predictors for worse outcomes on all scales included female gender;younger age;pre-existing psychiatric condition;experiencing relationship problems;nursing,allied health or other roles;frontline area;being worried about being blamed by colleagues and working with patients with COVID-19.Conclusions The COVID-19 pandemic is associated with significant mental health symptoms in frontline healthcare workers.Crisis preparedness together with policies and practices addressing psychological well-being are needed.展开更多
The pulmonary diffusing capacity for carbon monoxide(D_LCO)was measuredin 50 normal subjects,50 patients with emphysema and 31 with asthma.The results sh-owed that the D_LCO value of the asthma group was markedly high...The pulmonary diffusing capacity for carbon monoxide(D_LCO)was measuredin 50 normal subjects,50 patients with emphysema and 31 with asthma.The results sh-owed that the D_LCO value of the asthma group was markedly higher than that of thehealthy group,while the D_LCO/pr% and KCO values of the asthma group were similarto those of the healthy group.The values of D_LCO,D_LCO/pr% and KCO in the emphy-sema group were very significantly lower than those in the asthma and healthy groups.Our study suggests that the measurement of D_LCO is onc of the useful pulmonary func-tion tests in differentiation of emphysema from asthma.The mechanism ofdiffcrcnt D_LCOvalues between emphysema and asthma is discussed.The D_LCO values in patients withmild to severe emphysema gradually decreased with the severity of emphysema.The KCOvalues between the mild emphysema and healthy groups were dramatically different.Thisis helpful in the early diagnosis of emphysma as combined with other clinical data.展开更多
The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnos...The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.展开更多
Objective:Placement of self expanding metallic stents(SEMS) is invariably associated with complications and often necessitates their removal usually by rigid bronchoscope.There have been few reports published on use o...Objective:Placement of self expanding metallic stents(SEMS) is invariably associated with complications and often necessitates their removal usually by rigid bronchoscope.There have been few reports published on use of flexible bronchoscope(FB) for the removal.This article summarizes the indications,methods and complications of SEMS removal by FB.Methods:We reviewed our experience with removal of SEMS using FB retrospectively.The clinical data on 29 patients with average age of(39.0±13.2) years was analyzed who underwent removal of SEMS using FB between April 2002 and August 2008.Results:Thirty-seven procedures were performed in 29 consecutive patients to remove 37 stents.The average duration of stent placement was(55± 94.7) d(0-472 d).Twenty-two procedures(59.4%) were performed under local anesthesia.The percentage of procedures under general anesthesia was 13%(3/24),67%(4/6) and 100%(7/7) for the short-term(≤30 d),medium-term(31-90 d) and long-term(>90 d) of stents placement,respectively.Indications for stents removal included migration in 15(40.6%),scar restenosis in 11(29.7%),airway shaping in 5(13.5%),stent fracture in 2(5.4%),stent incomplete expansion in 2(5.4%),improper size in 1(2.7%),mucus plugging with chest pain in 1(2.7%).And 85.7% of long-term stents were removed due to scar restenosis.The total success rate was 92%.There was no significant difference in success rate between the uncovered and covered group(82.3% and 100%,P>0.05).Complications were encountered in 13 patients,bleeding being the most common(53.8%).Conclusion:Operation by FB may be an alternative method to remove SEMS effectively and safely based on the proper anesthesia chosen.展开更多
文摘Objective ：To evaluate the applicable value of respiratory impedance for the stage 0 of chronic obstructive pulmonary disease （COPD）. Methods：Respiratory impedance was measured by impulse oscillometry （lOS） in 41 cases at stage 0 of COPD （NHLBI/WHO, 2001 Standard） and their conventional pulmonary function values were compared with 42 healthy subjects. Both groups had no significant deviation in age, stature and avoirdupois, etc. Master-Screen pulmonary function test system （Jaeger Co, Germany） were used to determine IOS parameters including viscous resistance of 5Hz, 20 Hz and 35Hz （R5, R20, R35）, reactance of 5Hz, 35 Hz （X3, X35）, resonant frequency （Fres） ,total respiratory impedance （Zrs） and routine pulmonary function values including forced expiratory volume in one second to predicted value （FEV1 % ）, forced expiratory volume in one second to forced vital capacity ratio（ FEV1/ FVC% ）, maximal mid expiratory flow （MMEF%）,V23% and V50%. Results：Both groups had no significant deviation in FEV1%, FEV1/FVC% and X35（P〉0.05）. It was increased significantly in viscous resistance of 5Hz, 20 Hz and 35Hz （R5, R20, R35） in COPD group than that in healthy group （P〈0.01）. So were Fres and Zrs （P〈0.01）. MMEF%,V25%,V50% and reactance of 5Hz （X5） in COPD group were marked lower than that in healthy group （P〈0.01）. The sensitivity of MMEF%, V25%,V50% was higher than others, but its specificity was lower. In parameters of IOS, Fres was the most sensitive index for diagnosis of the small airway function and its specificity was higher than that of MMEF%, V25% ,V50%. Conclusion：In the risk case at the stage 0 of COPD, MMEF%, V25% and V50% could be decreased, but Fres, R5 ,R5-20 could be increased in spite of FEV1% and FEV1/FVC% in normal range.
基金Supported by National Ministry of Education Doctor Foundation of China(20020023045)
文摘Objective To investigate the optimal dosage of pirfenidone for the treatment of pulmonary fibrosis induced by bleomycin in Wistar rats, and the alteration of expressions of transforming growth factor beta-1 （ TGF-β1 ）, tissue inhibitor of metalloproteinase-1 （ TIMP-1 ）, and matrix metalloproteinase-13 （ MMP-13 ） in lung tissue. Methods Male Wistar rats were endotracheally instilled with bleomycin or normal saline. Pirfenidone （25-800 mg · kg^-l · d^-1 ）, dexamethasone （3 mg/kg）, or 1% carboxymethylcellulose sodium were given daily by feed 2 days before instillation of bleomycin. Groups T7 and T14 were fed pirfenidone 50 mg · kg^-1 · d^-1 at 7 days or 14 daYs after bleomycin instillation. Lungs were harvested at 28 days after bleomycin instillation. Patholological changes in luffg tissues were evaluated with HE staining. Lung collagen was stained by sirius red and measured by content of hydroxypro- line. Expression of proteins of TGF-β1 TIMP-1, and MMP-13 were detected by Western blotting. Results At doses of 25, 50, and 100 mg· kg^- 1 · d ^- 1, pirfenidone had significant anti-fibrotic effects for bleomy- cin-induced rat pulmonary fibrosis, and these effects were most significantly attenuated at the dosage of 50 mg · kg^-1 ·d^ -1（ HE： P 〈 0. 01, P 〈 0.01, and P = 0.064; sirius red： P 〈0.05, P 〈 0.01, and P 〈 0.05 ; hydroxyproline： P = 0.595, P 〈 0.01, and P = 0.976）. Pirfenidone at a dosage of 50 mg · kg^- l · d^-1 inhibited protein expression of TGF-131 and TIMP-1 in lung tissue in the early phase （0.79 and 0.75 times of control group）, but had no effect on ex- nr^eelnn nf MMP-13. Conclusion Low dose pirfenidone, especially at dosage of 50 mg · kg^-1 · d^-1, has significant anti-fibrotic effects on bleomycin-induced rat pulmonary fibrosis. Pirfenidone partially inhibits the enhancement of the expression of TGF-131 and TIMP-β1 in lung tissue.
文摘Objective To investigate the antagonistic effects of different doses of Lianhua Qingwen on pulmonary injury induced by fine particulates PM2.5 in rats. Methods Fine particulates suspended in the environment were collected. Forty-eight healthy adult wistar rats were randomly divided into 6 groups with 8 rats in each group. Four groups of rats were exposed to PM2.5 by intratracheally dripping suspensions of fine particulates PM2.5(7.5 mg/kg) as dust-exposed model rats. Among them 24 rats in three groups received Lianhua Qingwen treatment(crude drug) at a dose of 2 g/kg, 4 g/kg, 8 g/kg per day for 3 days before dust exposure and were defined as low-dose, middle-dose and high-dose Lianhua Qingwen treatment groups respectively. The other dust-exposed model rats without treatment were assigned as PM2.5 control group. The un-exposed rats were set as saline control group(1.5 ml/kg saline) and blank control group. All rats were killed after 24 hours of the exposure. Lung tissue, serum and bronchoalveolar lavage fluid(BALF) were collected. The levels of malonaldehyde(MDA), lactate dehydrogenase(LDH), and glutathione peroxidase(GSH-PX) in blood serum and BALF, and superoxide dismutase(SOD) in blood surum were measured using fluorescent quantitation PCR; Expression of NF-E2-related factor 2(NRF-2), heme oxygenase 1(HO-1) and quinone oxidoreductase 1(NQO1) in lung tissues were measured using Western blot. Pathological changes of lung tissues in each group were also examined. Results Pathology revealed thickened alveolar septum, congestion of capillary, interstitial edema and infiltration of lymphocyte and neutrophil surrounding bronchiole in the PM2.5 control group, which weresignificantly relieved in the Lianhua Qingwen treatment groups. Compared to the blank and saline control groups, the PM2.5 control group had significantly higher levels of LDH and MDA(p<0.01) and lower level of GSH-PS(p<0.01) in BALF, significantly higher levels of LDH and MDA(p<0.05) and lower level of GSH-PS(p<0.05) in rat serum. The levels of MDA in blood serum and BALF were significantly lower in each treatment group than that in PM2.5 control group(all P<0.05). In both middle-dose and high-dose treatment group the measurements of LDH in serum and BALF as well as GSH-PX in serum were significant difference from those of PM2.5 control group(all P<0.05). Expressions of NRF-2, HO-1 and NQO1 in lung tissues were significantly different among middle-dose and high-dose treatment group compared with those in PM2.5 control group(all P<0.05). Conclusion Fine particulates PM2.5 in environment may induce pulmonary oxidative lesions in rats. Middle-dose and high-dose Lianhua Qingwen has antagonist effece on the injuries induced by fine particulates.
基金Supported by National Natural Science Foundation of China(81372063)
文摘Objective To explore the effects of dermabrasion combined with ReCell on large superficial facial scars caused by burn, trauma and acnes. Methods Nineteen patients with large superficial facial scars were treated by the same surgeon with dermabrasion combined with ReCell？. According to the etiology, patients were classified into post-burning group （n=5）, post-traumatic group （n=7） and post-acne group （n=7）. Fifteen patients completed the follow-ups, 5 patients in each group. Healing time, complication rate, the preoperative and 18-month-post-operative assessments using Patient Satisfaction Score （PSS）, Vancouver Scar Scale （VSS）, and Patient and Observer Scar Assessment Scale （POSAS） of each group were analyzed to compare the effect of the combined therapy on outcomes.Results The healing time of post-burning group （19.6±4.0 days）, post-traumatic group （15.8±2.6 days）, and post-acne group （11.4±3.1 days） varied remarkably （F=7.701, P=0.007）. The complication rates were 60%, 20%, and 0 respectively. The post-operative POSAS improved significantly in all groups （P〈0.05）, where the most significant improvement was shown in the post-acne group （P〈0.05）. The post-operative PSS and VSS improved only in the post-traumatic group and post-acne group （all P〈0.05）, where the more significant improvement was also shown in the post-acne group （P〈0.05）. Conclusions The combined treatment of dermabrasion and ReCell has remarkable effect on acne scars, moderate effect on traumatic scars and is not suggested for burn scars. POSAS should be applied to assess the therapeutic effects of treatments for large irregular scars.
基金funded by the National Natural Science Foundation of China(Grant No.81370172 and 81570078)China Postdoctoral Science Foundation(2016 T1015)
文摘Trauma is a major factor that contributes to the risk for acute respiratory distress syndrome(ARDS).Biomarkers that predict the risk,diagnosis,treatment response and prognosis of ARDS after trauma have been widely investigated.In addition to their applications in clinical diagnosis and treatment,these biomarkers provide important insights into our understanding of the pathogenesis of ARDS.This review begins with a brief introduction regarding the incidence and pathogenesis of trauma-associated ARDS.Then,we focus on reviewing the clinical trials that have been designed to investigate the value of biomarkers in ARDS after trauma.Biomarkers with a confirmed value in ARDS have been organized on the basis of key pathogenic processes that are central to ARDS and are described in detail.Among these,angiopoietin 2(Ang-2),L-selectin,Clara cell protein 16(CC16),soluable receptor for advanced glycation end products(s RAGE),Surfactant protein D(SP-D),histones,mt DNAs and some biomarker panels had a certain association with the diagnosis and prognosis of trauma-related ARDS.Further investigations are needed regarding the design of trials,the best sampling approaches and the optimal combinations of the biomarker panels.
文摘Objectives To investigate the overall prevalence of cardiovascular disease （CVD） in subjects hospitalized for chronic obstructive pulmonary disease （COPD）,and explore the prevalence of the major CVD complications and trends in patients with COPD over a 10-year period.Methods Medical records in the PLA General Hospital,Beijing Union Medical College Hospital,and Beijing Hospital from 2000/01/01 to 2010/03/03 were retrospectively reviewed.A total of 4960 patients with COPD were reviewed in the study （3570 males,mean age,72.2 ± 10.5 years; 1390 females,mean age,72.0 ± 10.4 years）.Results The prevalence of CVD in COPD patients was 51.7％.The three most prevalent CVDs were ischemic heart disease （28.9％）,heart failure （19.6％）,and arrhythmia （12.6％）.During the 10-year study period,the prevalence of various CVDs in COPD patients showed a gradual increasing trend with increasing age.There was higher morbidity due to ischemic heart disease （P ＜ 0.01） in male COPD patients than in the female counterparts.However,heart failure （P ＜ 0.01）and hypertension （P ＜ 0.01） occurred less frequently in male COPD patients than in female COPD patients.Furthermore,the prevalence of ischemic heart disease decreased year by year.In addition to heart failure,various types of CVD complications in COPD patients tended to occur in younger subjects.The prevalence of all major types of CVD in women tended to increase year by year.Conclusions The prevalence of CVD in patients hospitalized for COPD in Beijing was high.Age,sex and CVD trends,as well as life style changes,should be considered when prevention and control strategies are formulated.
基金supported(in part)by the Entrusted Project of National Center for Medical Service Administration,National Health and Family Planning Commission China(No.[2019]099)the First Level Funding of the Second Medical Leading Talent Project in Hubei Provincethe Special Project for Emergency of the Ministry of Science and Technology(2020YFC0841300)。
文摘In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
基金supported by the Emergency Science and Technology Project in Hubei Province(2020FCA008)
文摘Background:Many healthcare workers were infected by coronavirus disease 2019(COVID-19)early in the epidemic posing a big challenge for epidemic control.Hence,this study aims to explore perceived infection routes,influencing factors,psychosocial changes,and management procedures for COVID-19 infected healthcare workers.Methods:This is a cross-sectional,single hospital-based study.We recruited all 105 confirmed COVID-19 healthcare workers in the Zhongnan Hospital of Wuhan University from February 15 to 29,2020.All participants completed a validated questionnaire.Electronic consent was obtained from all participants.Perceived causes of infection,infection prevention,control knowledge and behaviour,psychological changes,symptoms and treatment were measured.Results:Finally,103 professional staff with COVID-19 finished the questionnaire and was included(response rate:98.1%).Of them,87 cases(84.5%)thought they were infected in working environment in hospital,one(1.0%)thought their infection was due to the laboratory environment,and 5(4.9%)thought they were infected in daily life or community environment.Swab of throat collection and physical examination were the procedures perceived as most likely causing their infection by nurses and doctors respectively.Forty-three(41.8%)thought their infection was related to protective equipment,utilization of common equipment(masks and gloves).The top three first symptoms displayed before diagnosis were fever(41.8%),lethargy(33.0%)and muscle aches(30.1%).After diagnosis,88.3%staff experienced psychological stress or emotional changes during their isolation period,only 11.7%had almost no emotional changes.Arbidol(Umifenovir;an anti-influza drug;69.2%)was the drug most commonly used to target infection in mild and moderate symptoms.Conclusion:The main perceived mode of transmission was not maintaining protection when working at a close distance and having intimate contact with infected cases.Positive psychological intervention is necessary.
基金Fund supported by the National Key R&D Program of China(No.2018YFC2001800)~~。
文摘Objectives To investigate the effects of preoperative smoking and smoking cessation time on preoperative peripheral blood inflammatory indexes and postoperative hospitalization outcomes in male patients with lung cancer and surgery therapy.Methods We retrospectively enrolled 637 male patients who underwent curative-intent lung cancer resection between January 2014 and December 2016.Patients were classified as the current smokers,the never smokers,and the ex-smokers based on their smoking history,and the ex-smokers were allocated into five subgroups according to their smoking cessation times(CeT):CeT W6 weeks,6weeks<CeT W lyear,lyear<CeT<5years,5years<CeT<lOyears,CeT>10years.The preoperative peripheral blood white blood cells(WBCs),albumin,neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),intraoperative blood loss,30-day mortality,in-hospital days,hospitalization costs,intensive care un辻(ICU),admission days and placement time of closed thoracic drainage tube were compared among difTerent groups.Results There were significant differences in WBC(F=S.275,P<0.001)and albumin(F=2,470,P<0.05)among patients of current smokers,ex-smokers with different smoking cessation time,and never-smokers.The blood WBC count in current smokers(7.7 X 109/L)was significantly higher than that in ex・smokers(7.0 X 109/L)and never-smokers(5.9 X 109/L)(t=-2.145,P<0.05;t=-6.073,P<0.01,respectively).The level of peripheral blood albumin in current smokers(41.1 g/L)was lower than that in ex・smokers(42.1 g/L)and neve—smokers(43.2 g/L)(t=2.323,P<0.05;t=3.995,P<0.01,respectively).The level of peripheral blood NLR in current smokers(3.7)was higher than that in ex-smokers(3.1)and never smokers(2.8)(t—-1.836,P<0.05;t=-2.889,P<0.01,respectively).There was no significant difference in WBC,albumin and NLR among five subgroups of different smoking cessation time.No significant difference was observed in intraoperative blood loss,30-day mortality,hospitalization costs,hospital stay,ICU stay and placement time of closed thoracic drainage tube among groups either.Conclusion Smoking increases the preoperative inflammatory indexes in peripheral blood of lung cancer patients.Smoking cessation has beneficial effect on reducing levels of these inflammatory indexes,which may be not impacted by the time length of smoking cessation.Therefore,lung cancer patients should be encouraged to quit smoking at any time.
文摘In this Commentary,we would like to comment on the article titled"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)"as a featured article in Military Medical Research.In the guideline,except for"confirmed cases","suspected cases","close contact"and"suspicious exposure"were defined by clinical perspective based on epidemiological risk,clinical symptoms and auxiliary examination.Combined with our experience,we introduced a simple scoring proposal additionally based on not only CT imaging as strongly recommended by the guideline but also blood routine test,especially for primary screening of such patients in the out-patient department.
文摘BACKGROUND: The effect of blood eosinophils(EOSs) on mortality in acute respiratory distress syndrome(ARDS) patients and whether corticosteroids affect this effect are unclear.METHODS: The Medical Information Mart for Intensive Care III database(version 1.4) was used to extract data. Patients with ARDS were selected for inclusion. Cox regression models using the backward stepwise method and propensity score matching(PSM) were used to assess the relationship between blood EOS counts and 28-day mortality. RESULTS: A total of 2,567 patients with ARDS were included, and the 28-day mortality rate was 24.19%. The crude 28-day mortality was significantly lower in patients with EOS counts ≥2%(18.60% [85/457] vs. 25.40% [536/2,110], P=0.002) than in those with EOS counts <2%. In the Cox regression model, the EOS counts ≥2% showed a significant association with the decreased 28-day mortality(hazard ratio [HR] 0.731;95% confidence interval [95% CI] 0.581–0.921, P=0.008). In the corticosteroid non-use subgroup, EOS counts ≥2% was significantly related to decreased 28-day mortality(HR 0.697, 95% CI 0.535–0.909, P=0.008), but the result was not significant in the corticosteroid non-use subgroup model(P=0.860). A total of 457 well-matched pairs were obtained by a 1:1 matching algorithm after PSM. The 28-day mortality remained significantly lower in the EOS counts ≥2% group(18.60% [85/457] vs. 26.70% [122/457], P=0.003).CONCLUSIONS Higher EOS counts are related to lower 28-day mortality in ARDS patients, and this relationship can be counteracted by using corticosteroids.
文摘BACKGROUND： Ventilator induced lung injury （VILI） is a serious complication in the treatment of mechanical ventilating patients, and it is also the main cause that results in exacerbation or death of patients. In this study, we produced VILI models by using glucocorticoid in rats with high tidal volume mechanical ventilation, and observed the content of macrophage inflammatory protein-1α （MIP-1α） in plasma and bronchoalveolar lavage fluid （BALF） and the expression of MIP-1α mRNA and nuclear factor-kappa B （NF-кB） p65 mRNA in the lung so as to explore the role of glucocorticoid in mechanical ventilation.METHODS： Thirty-two healthy Wistar rats were randomly divided into a control group, a ventilator induced lung injury （VILI） group, a dexamethasone （DEX） group and a budesonide （BUD） group. The content of MIP-1a in plasma and BALF was measured with ELISA and the level of MIP-1α mRNA and NF-кBp65 mRNA expressing in the lung of rats were detected by RT-PCR. The data were expressed as mean±SD and were compared between the groups.RESULTS： The content of MIP-1α in plasma and BALF and the level of MIP-1α mRNA and NF-кBp65 mRNA in the lung in the DEX and BUD groups were signifi cantly lower than those in the VILI group （P〈0.001）. Although the content of MIP-1α in plasma and BALF and the level of MIP-1α mRNA and NF-кBp65 mRNA in the lung in the BUD group were higher than those in the DEX group, there were no signifi cant differences between them （P〉0.05）.CONCLUSIONS： Glucocorticoid could down-regulate the expression of MIP-1α by inhibiting the activity of NF-кB in the lung and may exert preventive and therapeutic effects on VILI to some extent. The effect of local use of glucocorticoid against VILI is similar to that of systemic use, but there is lesser adverse reaction.
基金Supported by National Basic Research Program of China (973 Program) (2009CB522106)
文摘Objective To examine the correlation between the health-related quality of life measured by the St.George's Respiratory Questionnaire(SGRQ) and the commonly used physiological measures in lymphangioleiomyomatosis(LAM).Methods This study retrospectively analyzed the SGRQ scores and other measures(the Borg scale of breathlessness at rest,6-minute walking distance,blood oxygen levels,and pulmonary function) of patients diagnosed and confirmed with LAM.Altogether 38 patients between June 2007 and November 2009 were included.Results The mean values of the SGRQ three components(symptoms,activity,and impacts) and total scores in the LAM patients were 46.95±28.90,58.47±25.41,47.89±29.66,and 51.11±26.35,respectively.The SGRQ total or component scores were correlated well with the Borg scale of breathlessness,6-minute walking distance,partial pressure of oxygen in arterial blood,spirometry and diffusion capacity of lung.There were poor correlations between SGRQ score and residual volume or total lung capacity.In our preliminary observation,sirolimus improved the SGRQ total and three component scores and the Borg scale of breathlessness significantly after 101-200 days of treatment(n=6).Conclusions The SGRQ score in LAM is correlated well with physiological measures(Borg scale of breathlessness,6-minute walking distance,blood oxygen levels,and pulmonary function tests).The SGRQ could therefore be recommended in baseline and follow-up evaluation of patients with LAM.Treatment with sirolimus,an inhibitor of mammalian target of rapamycin,may improve the quality of life and patient's perception of breathlessness in LAM.
文摘Objective: To study the therapeutic effects of panax notoginside (PN) and methylprednisolone (MP) on pulmonary fibrosis in rats. Methods: Bleomycin was introduced into the bronchial tree of 75 Wistar male rats through a tracheal incision to establish a rat model of pulmonary fibrosis (PF). The rats were equally divided into 3 groups: PF group, PN treated group and MP treated group. Five rats of each group were killed 1, 3, 7, 14 and 28 d after the administration of bleomycin and the specimens of lung tissue and plasma were collected for the determination of content of collagen Ⅰ and Ⅲ with immunohistochemical method and the level of MIP-1α and MCP-1 with ELIZA. Results: The severity of PF, the content of collagen Ⅰ and Ⅲ and the level of MIP-1α and MCP-1 were significantly decreased in PN and MP treated groups than in PF group (P<0.05). Conclusion: PN and MP are effective to control the development of PF induced with bleomycin in rats.
文摘INTRODUCTIONScrub typhus, a tropical febrile vector borne disease also known as ＂Tsutsugamushi disease＂, is caused by Orientia tsutsugamushi, a gram negative obligate intracellular slow growing bacteria. The infection is transmitted by the bite of larval stage （chiggers） mites belonging to the family Trombiculidae.
文摘Objective： Irinotecan in combination with cisplatin for extensive-stage disease small-ceU lung cancer （ED-SCLC） patients has gained wide interest. Varying results for this treatment underpin the need for a synthesis of evidence. Methods： We conducted a literature-based meta-analysis to quantify the magnitude of the benefit comparing irinotecan in combination with cisplatin （IP） with etoposide in combination with cisplatin （EP） in ED-SCLC patients. The primary outcome was overall survival （OS） and progression-free survival （PFS）; secondary outcomes included overall response rate, 1- and 2-year survival rates, disease control rate and toxicity. Results： Four trials including 1,541 patients were identified in the analysis. No positive results （P〈0.05） were seen： OS （HR=0.85, CI95%=0.71-1.01; P=-0.08） with high heterogeneity （Chi2=7.76, dr=-3 [P=-0.05]; I2=61%）, PFS （HR=0.91, CI95%=0.74-1.28; P=-0.36） with high heterogeneity （Chi2=11.96, df=3 [P=-0.008]; I2=75%）, overall response rate（OR=1.16; CI95%=0.79-1.70; P=0.45）, disease control rate （OR=1.01; CI95%=0.74-1.38; P=0.95）, 1-year survival rate （OR = 1.30; CI95%=0.98-1.72; P=0.07） and 2-year survival rate （OR=1.97; CI95%=0.95-4.09; P=-0.07）. Fewer patients who received IP suffered severe hematologic toxicities （grade≥3）, such as neutropenia, thrombocytopenia and leucopenia. However, severe non-hematologic toxicities （grade≥3）, such as diarrhea, nausea, vomiting, fatigue, anorexia, and dehydration, were more common among patients who received IP. Conclusion： IP does not lengthen the overall survival or progression-free survival compared with EP in patients with ED-SCLC Fewer patients receiving IP had grade ≥ 3 hematological toxicities of nentropenia, leucopenia and thrombocytopenia, but more had grade≥3 diarrhea, nausea, vomiting, fatigue, anorexia and dehydration.
基金The Royal Melbourne Hospital Foundation and the Lord Mayor’s Charitable Foundation kindly provided financial support for this study.
文摘Background The coronavirus disease 2019(COVID-19)pandemic has had a profound and prolonged impact on healthcare services and healthcare workers.Aims The Australian COVID-19 Frontline Healthcare Workers Study aimed to investigate the severity and prevalence of mental health issues,as well as the social,workplace and financial disruptions experienced by Australian healthcare workers during the COVID-19 pandemic.Methods A nationwide,voluntary,anonymous,single timepoint,online survey was conducted between 27 August and 23 October 2020.Individuals self-identifying as frontline healthcare workers in secondary or primary care were invited to participate.Participants were recruited through health organisations,professional associations or colleges,universities,government contacts and national media.Demographics,home and work situation,health and psychological well-being data were collected.Results A total of 9518 survey responses were received;of the 9518 participants,7846(82.4%)participants reported complete data.With regard to age,4110(52.4%)participants were younger than 40 years;6344(80.9%)participants were women.Participants were nurses(n=3088,39.4%),doctors(n=2436,31.1%),allied health staff(n=1314,16.7%)or in other roles(n=523,6.7%).In addition,1250(15.9%)participants worked in primary care.Objectively measured mental health symptoms were common:mild to severe anxiety(n=4694,59.8%),moderate to severe burnout(n=5458,70.9%)and mild to severe depression(n=4495,57.3%).Participants were highly resilient(mean(SD)=3.2(0.66)).Predictors for worse outcomes on all scales included female gender;younger age;pre-existing psychiatric condition;experiencing relationship problems;nursing,allied health or other roles;frontline area;being worried about being blamed by colleagues and working with patients with COVID-19.Conclusions The COVID-19 pandemic is associated with significant mental health symptoms in frontline healthcare workers.Crisis preparedness together with policies and practices addressing psychological well-being are needed.
文摘The pulmonary diffusing capacity for carbon monoxide(D_LCO)was measuredin 50 normal subjects,50 patients with emphysema and 31 with asthma.The results sh-owed that the D_LCO value of the asthma group was markedly higher than that of thehealthy group,while the D_LCO/pr% and KCO values of the asthma group were similarto those of the healthy group.The values of D_LCO,D_LCO/pr% and KCO in the emphy-sema group were very significantly lower than those in the asthma and healthy groups.Our study suggests that the measurement of D_LCO is onc of the useful pulmonary func-tion tests in differentiation of emphysema from asthma.The mechanism ofdiffcrcnt D_LCOvalues between emphysema and asthma is discussed.The D_LCO values in patients withmild to severe emphysema gradually decreased with the severity of emphysema.The KCOvalues between the mild emphysema and healthy groups were dramatically different.Thisis helpful in the early diagnosis of emphysma as combined with other clinical data.
基金supported(in part)by the National Key Research and Development Program of China(2020YFC0845500)the Special Project for Emergency of Hubei Province(2020FCA008)the First Level Funding of the Second Medical Leading Talent Project in Hubei Province。
文摘The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.
文摘Objective:Placement of self expanding metallic stents(SEMS) is invariably associated with complications and often necessitates their removal usually by rigid bronchoscope.There have been few reports published on use of flexible bronchoscope(FB) for the removal.This article summarizes the indications,methods and complications of SEMS removal by FB.Methods:We reviewed our experience with removal of SEMS using FB retrospectively.The clinical data on 29 patients with average age of(39.0±13.2) years was analyzed who underwent removal of SEMS using FB between April 2002 and August 2008.Results:Thirty-seven procedures were performed in 29 consecutive patients to remove 37 stents.The average duration of stent placement was(55± 94.7) d(0-472 d).Twenty-two procedures(59.4%) were performed under local anesthesia.The percentage of procedures under general anesthesia was 13%(3/24),67%(4/6) and 100%(7/7) for the short-term(≤30 d),medium-term(31-90 d) and long-term(>90 d) of stents placement,respectively.Indications for stents removal included migration in 15(40.6%),scar restenosis in 11(29.7%),airway shaping in 5(13.5%),stent fracture in 2(5.4%),stent incomplete expansion in 2(5.4%),improper size in 1(2.7%),mucus plugging with chest pain in 1(2.7%).And 85.7% of long-term stents were removed due to scar restenosis.The total success rate was 92%.There was no significant difference in success rate between the uncovered and covered group(82.3% and 100%,P>0.05).Complications were encountered in 13 patients,bleeding being the most common(53.8%).Conclusion:Operation by FB may be an alternative method to remove SEMS effectively and safely based on the proper anesthesia chosen.
