Preventive strategies for COVID-19 in solid organ transplantation recipients / 中华器官移植杂志

Since an outbreak of coronavirus disease 2019, there have been more than 664 million confirmed cases and more than 6.7 million deaths worldwide.The Omicron variant discovered in November 2021 has become a dominant variant in China.Compared with the general population, Omicron infection mainly presents short-term upper respiratory symptoms followed by quick recovery; solid organ transplant recipients have the characteristics of a high incidence of severe disease and high mortality after infection, and the incidence of secondary infection and rebound positivity is significantly higher than that of the general population.This review focused upon preventive strategies of solid organ transplant recipients from the perspectives of the characteristics of organ transplant recipients, general preventive strategies, vaccination and long-acting neutralizing antibodies.

New progress in diagnosis and treatment of drug-resistant cytomegalovirus infection in transplant recipients / 中华器官移植杂志

This article summarizes the new progress in the diagnosis and treatment strategies on drug-resistant cytomegalovirus(CMV)infections in organ transplant recipients, including the prevention and treatment medications for CMV infection, the diagnosis and treatment strategies, and the immunological treatment regimen for drug-resistant CMV infection.The article is aimed to provide references for the prevention and treatment of drug-resistant CMV infection in organ transplant recipients.

A multicenter prospective cohort study of Xuebijing injection in the treatment of severe coronavirus disease 2019 / 中华危重病急救医学

Objective:To evaluate the effect of Xuebijing injection on the improvement of pneumonia severity index (PSI) and prognosis in patients with severe coronavirus disease 2019 (COVID-19).Methods:A multicenter prospective cohort study was designed. Adult patients with COVID-19 admitted to the intensive care unit (ICU) of 28 designated COVID-19 hospitals in 15 provinces and cities of China from January to March 2020 were enrolled. All patients were treated according to the standard treatment plan of COVID-19 issued by the National Health Commission of the People's Republic of China. They were divided into Xuebijing group and standard treatment group according to whether they received Xuebijing injection or not. In the standard treatment group, routine medical care measures such as antiviral, respiratory support, circulatory support and symptomatic treatment were taken. In the Xuebijing group, on the basis of standard treatment, Xuebijing was used within 12 hours of admission to the ICU, 100 mL each time, twice daily. The minimum duration of Xuebijing administration was 1 day. The improvement rate of PSI risk rating on the 8th day and clinical outcome on the 28th day were recorded.Results:A total of 276 COVID-19 patients were screened continuously, and the data of 144 severe patients who met PSI risk rating Ⅲ-Ⅴ were analyzed. Seventy-two cases were involved each in standard treatment group and Xuebijing group. The average age of the standard treatment group and Xuebijing group were (65.7±7.9) years old and (63.5±10.9) years old, and male accounted for 75.0% (54/72) and 70.8% (51/72), respectively. There were no significant differences in general conditions, comorbidities, PSI risk rating and score, sequential organ failure assessment (SOFA) score, oxygenation index (PaO 2/FiO 2), respiratory support mode and other baseline indicators between the two groups. Compared with the standard treatment group, the improvement rate of PSI risk rating in Xuebijing group on the 8th day after admission was significantly improved [56.9% (41/72) vs. 20.8% (15/72), between-group difference and 95% confidence interval (95% CI) was 36.1% (21.3% to 50.9%), P < 0.01], PSI score, SOFA score and PaO 2/FiO 2 were significantly improved [PSI score: 83.7±34.8 vs. 108.2±25.6, between-group difference (95% CI) was -24.5 (-34.9 to -14.1); SOFA score: 2.0 (1.0, 4.0) vs. 7.0 (4.0, 10.0), between-group difference (95% CI) was -3.5 (-5.0 to -2.0); PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa): 289.4±111.6 vs. 188.5±98.1, between-group difference (95% CI) was 100.9 (65.3 to 136.5); all P < 0.01]. The 28-day discharge rate of Xuebijing group was 44.5% higher than that of standard treatment group [66.7% (48/72) vs. 22.2% (16/72), P < 0.01], and the 28-day survival rate was 9.8% [91.7% (66/72) vs. 81.9% (59/72), P < 0.01]. There was no significant difference in the combination of antiviral drugs, antibiotics, anticoagulants and vasopressor drugs between the two groups. There was no significant difference in the incidence of adverse events between the Xuebijing group and standard treatment group [41.7% (30/72) vs. 43.1% (31/72), P > 0.05], and no serious adverse events and adverse reactions of Xuebijing were reported. Conclusion:Standard treatment combined with Xuebijing injection can significantly improve the PSI risk score and clinical prognosis of patients with severe COVID-19 without increasing drug safety risk.

Premature complex-induced chronic cough :case report and literature review / 中华全科医师杂志

The clinical presentation,chest image and electrocardiogram of 4 cases of premature complex-induced chronic cough admitted in the First Affiliated Hospital of Guangzhou Medical University from March 2008 to February 2009,were retrospectively analyzed.And other 6 cases of premature complex-induced chronic cough were retrieved for literature review.In total 10 patients,there were 3 males and 7 females aged 58(36-74) years,with a disease duration of 10.5 (3.0,264.0) months.The main clinical presentations were chronic dry cough with post-sternal thump and premature beats as shown by auscultation and 24 h-electrocardiogram examination.Cough was relieved after the premature beats were controlled with the treatment of arrhythmia drugs or radiofrequency ablation.Premature complex-induced cough is rare but it should be considered when the chief complaint of patients with premature beat is chronic cough.

Age and Sex Distribution of Chinese Chronic Cough Patients and Their Relationship With Capsaicin Cough Sensitivity

PURPOSE: An older female predominance has been reported among chronic cough patients in Western countries, which is considered to be associated with a higher cough sensitivity in females. However, the characteristics of Chinese chronic cough patients remain unclear. This study aimed to explore the age and sex distribution as well as their relationship with cough reflex sensitivity to capsaicin in Chinese chronic cough patients. METHODS: We analyzed the demographic features of 1,882 consecutive chronic cough patients who attended our cough clinic in Guangzhou, China. Cough sensitivity to capsaicin, which was defined as the lowest concentration of capsaicin causing 5 coughs or more (C5), was measured in 539 of the 1,882 patients and 68 healthy volunteers. RESULTS: The mean age of the patients was 43.0 ± 13.7 years and patients aged <50 years accounted for more than two-thirds of the study population. Around 87% of the patients were never-smokers. The proportion of females (51.5%) was almost equal to that of males (48.5%). The pattern of the age and sex distribution was consistently reflected within most common causes of chronic cough, while a female predominance was shown in patients with cough-variant asthma and patients aged ≥50 years. Female patients had higher cough sensitivity to capsaicin than male patients (log C5: 1.58 ± 0.84 vs. 2.04 ± 0.84 μmol/L, P = 0.001), and patients aged ≥50 years had higher cough sensitivity to capsaicin than patients aged <50 years. CONCLUSIONS: In China, patients with chronic cough have a roughly equal sex distribution and a middle-aged predominance, irrespective of a higher cough sensitivity to capsaicin in females and older patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02591550

Omalizumab Improves Quality of Life and Asthma Control in Chinese Patients With Moderate to Severe Asthma: A Randomized Phase III Study

PURPOSE: Omalizumab is the preferred add-on therapy for patients with moderate-to-severe persistent allergic asthma and has demonstrated efficacy and safety in various ethnicities. This study evaluated the efficacy and safety of omalizumab in Chinese patients with moderate-to-severe allergic asthma. METHODS: This randomized, double-blind, parallel-group, placebo-controlled, phase III study assessed lung function, quality of life, asthma control, and safety of omalizumab after 24-week therapy in Chinese patients (18-75 years of age). RESULTS: A total of 616 patients were randomized (1:1) to omalizumab or placebo. The primary endpoint, least squares mean treatment difference (LSM-TD) in morning peak expiratory flow (PEF) (omalizumab vs placebo), at Weeks >20-24 was 8.85 L/min (Full analysis set; P=0.062). Per-protocol analysis set showed significant improvements with LSM-TD of 11.53 L/min in mean mPEF at Weeks >20-24 (P=0.022). The FEV1 % predicted was significantly improved with omalizumab vs placebo from 8 to 24 weeks (after 24-week treatment: LSM-TD=4.12%; P=0.001). At Week 24, a higher proportion of omalizumab-treated patients achieved clinically relevant improvements in standardized AQLQ (58.2% vs 39.3%; LSM=0.51 vs 0.10; P<0.001) and ACQ (49.5% vs 35.5%; LSM=-0.51 vs -0.34; P=0.002) scores vs placebo. Total and nighttime symptom scores reduced significantly with omalizumab vs placebo (LSM-TD=-0.21, P=0.048 and -0.12, P=0.011, respectively). Although the study was not powered to study differences in exacerbation rates (P=0.097), exacerbations in winter months were less frequent in the omalizumab vs placebo group (2 vs 21). Adverse event and severe adverse event rates were comparable between omalizumab and placebo. CONCLUSIONS: Omalizumab improves lung function, quality of life, and asthma control in Chinese patients with moderate-to-severe persistent allergic asthma and has a good safety profile.

Changes in small airway function in rhinitis without asthma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Observe the changes of small airway function in patients with rhinitis but without asthma and/or lower airway symptoms.@*METHOD@#Between June 2008 and December 2012, we recruited 903 subjects, including 377 with allergic rhinitis (AR), 262 with non-allergic rhinitis (NAR) and 264 healthy subjects. All subjects underwent meticulous history taking, nasal examination, allergen skin prick test, blood routine test, serum total immunoglobin E assay, pulmonary ventilation function test and bronchial challenge test.@*RESULT@#The indices of FEV1/FVC%, MEF25pred% and MMEFpred% were lower in AR group than in the control group (P 0.05). The positive rate of airway hyperresponsiveness(AHR) in AR group and in NAR group was 12.2%, 6.1% respectively. Indices of small airway function were all lower in the AHR group than NAHR group in rhinitis.@*CONCLUSION@#Compared with healthy controls, small airway function in patients with rhinitis has apparent changes, part of rhinitis patients has AHR, and is associated with small airway function changes.

An Intratracheal Challenge Murine Model of Asthma: Can Bronchial Inflammation Affect the Nose?

PURPOSE: Extensive data support the influence of the upper airway on lower airway inflammation and pathophysiology in allergic disease. However, few studies have focused on allergic inflammation in the nose after an isolated lower airway allergen challenge, a situation that can exist clinically when human subjects breathe primarily through the mouth, as occurs when nasally congested. This study used a mouse model to investigate whether upper airway inflammation and hyperresponsiveness were induced by an isolated lower airway allergen challenge. METHODS: BALB/c mice were sensitized by systemic intraperitoneal injection of ovalbumin/saline and challenged with intratracheal ovalbumin/saline. Inflammation in the nose and lungs was assessed by cytology and histology of nasal tissues and bronchoalveolar lavage fluid (BALF), while nasal airway resistance and response were measured over 3 days post-challenge. RESULTS: Intratracheal application of an allergen in anaesthetized mice resulted in exclusive deposition in the lower airway. Compared to control animals, ovalbumin-sensitized mice after challenge showed bronchial hyperreactivity and increased IL-5 in the serum BALF, as well as eosinophil infiltration in the lungs. However, nasal histology of the ovalbumin-sensitized mice showed no increase in eosinophil infiltration. The nasal lavage fluid revealed no increase in eosinophils or IL-5, and the nasal airway resistance did not increase after challenge either. CONCLUSIONS: In a mouse allergy model, exclusive allergen challenge of the lower airway can elicit a pulmonary and systemic allergic response, but does not induce upper airway inflammatory or physiological responses.

The effect of nasal irrigation in the treatment of allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare the symptoms and lower airway inflammatory factors of patients with allergic rhinitis (AR), and to observe the effect of nasal irrigation in the treatment of allergic rhinitis.@*METHOD@#Sixty-one cases diagnosed as AR after skin prick test (SPT)were selected and randomly divided into three groups: 17 patients in group A used nasal steroid spray; 21 cases in group B used nasal irrigation; 23 patients in group C combined ir rigation with nasal steroid. Before and after 3 months treatment, nasal visual analogue scale (VAS) score, rhino conjunctivtis quality of life questionnaire (RQLQ) score, fractional exhaled nitric oxide (FENO) values were observed and compared in each group.@*RESULT@#Before treatment, there is no statistically difference between three groups (P > 0.05). After 3 months of treatment, VAS, RQLQ, FENO of all patients was significantly decreased (P 0.05), FENO value has no statistically significant difference between group A and group B (P > 0.05), but were less than that in group C (P < 0.05).@*CONCLUSION@#Nasal irrigation can ameliorate nasal symptoms, improve quality of life, decrease lower airway inflammation of allergic rhinitis patients. Nasal irrigation is an effective treatment of allergic rhinitis. Nasal irrigation combined with nasal steroid can achieve more significant efficacy.

The efficacy and safety of low-dose tiotropium bromide inhaled via Respimat(R) in patients with chronic obstructive pulmonary disease / 中华内科杂志

Objective To compare the efficacy and safety of long-term treatment (48 weeks) with tiotropium bromide (5 μg) via Respimat(R) with placebo in patients with chronic obstructive pulmonary disease (COPD).Methods A total of 338 patients were randomized in this double-blind,placebo controlled,parallel study.All patients received either tiotropium bromide or placebo.Tiotropium bromide solution 5 μg (2 × 2.5 μg/puff) or matching placebo was delivered via Respimat(R) at a dosage of once daily for 48 weeks.Co-primary endpoints were trough forced expiratory volume in one second (FEV1) and the time to first exacerbation.Results Statistically significant improvements of both trough FEV1 and trough forced vital capacity (FVC) in the tiotropium group were achieved at weeks 4,24,and 48 compared with those in the placebo group(P ＜ 0.000 1).Tiotropium treatment delayed the time to first exacerbation.The time was 157 days in the tiotropium group and 85 days in the placebo group.A statistically significant difference (P =0.002 7) in favor of tiotropium was also observed.The total numbers of exacerbation during treatment were 90 and 128 in the tiotropium and placebo groups,respectively.The Poisson regression analysis gave a mean exacerbation rate per patient year exposure of 0.67 in the tiotropium group compared to 0.98 in the placebo group with a rate ratio of 0.69 (95％ CI O.50-0.93,P =0.016 4).A much larger improvement from baseline in St.George's respiratory questionnaire (SGRQ) total score was observed for the tiotropium group than in the placebo group(P =0.036 7),SGRQ symptom and activity scores of patients in the tiotropium group were also superior to those of patients receiving placebo.The drugs-related adverse events in the tiotropium and placebo groups were 12 cases and 11 cases,respectively.Conclusions Tiotropium significantly improved lung function and quality of life,delayed the time to first exacerbation,reduced the number of exacerbation.Overall,tiotropium was well tolerated.

Establishment of eosinophilic bronchitis mice model without airway hyperresponsiveness / 中国医师杂志

Objectiev To explore the use of different nebulizer to establish mice model that have airway eosinophilic inflam -mation without airway hyperresponsiveness .Methods Female BALB/c mice were obtained and divided randomly into 3 groups:eo-sinophilic airway inflammation group ( experimental group ) , asthma group, and control group .Mice were immunized with ovalbumin ( OVA) .The experiment group and asthma group were challenged with an aerosol of 1% w/v OVA using a PARI TIA and PARI LC STAR nebulizer on day 28, 29, 30, respectively.The control mice were received saline sensitization and challenge .Airway respon-siveness was measured .Cell different counts in bronchial alveolus lavage fluid ( BALF) were performed and a pathologist performed histopathological evaluation of the trachea and lung .Results Airway responsiveness in the experimental group was not significantly different compared with the normal saline ( NS) group but was significantly different compared with the asthma group .Eosinophils in BALF were increased significantly in experimental group compared with the NS group , and significant difference was observed between experimental group and asthma group .The intensity of airway inflammation in experimental group was milder than that in the asthma model .Conclusions We established an eosinophilic bronchitis mice model without hyperresponsiveness successfully .Our model es-tablished a foundation for the further research in airway hyperresponsiveness .

Study on the epidemic plasmid carrying blaCTX-M-15 in Guangzhou / 中华微生物学和免疫学杂志

Objective To study the molecular characteristic of the epidemic plasmids carrying blaCTX-M-15 in Guangzhou. Methods A total of 38 strains of E. coli and 47 strains of K. pneumoniae both producing CTX-M-15 ESBLs were collected from nine hospitals in Guangzhou from 2007 to 2008. The clonal relationship of isolates carrying blaCTX-M-15 was determined by PFGE and MLST. Antimicrobial susceptibility was determined by microdilution test for all isolates. Conjugative plasmids carrying blaCTX-M-15 were obtained by mating and were subject to restriction analysis. PCR was used to determine phylogenetic groups of E. coli,and to study replicon type and the genetic contexts of the plasmids harboring blaCTX-M-15. Serum agglutination test was used to detect the serotype of E. coli. Results The 37 strains of E. coli were classified into 28 genotypes, while the 47 strains of K. pneumoniae were divided into 30 genotypes. ST131 was found in E. coli but not O25 serotype. Two novel-alleles of tonB and new ST were determined in K. pneumoniae. Forty out of 58 isolates represented independent genotypes have been succeeded to transfer the plasmid carrying blaCTX-M-15 to the E. coli C600(Rif) by conjugation. The sizes of plasmids carrying blaCTX-M-15 are 65 kb in 57.9% isolates of E. coli and 92 kb in 87.5% isolates of K. pneumoniae. Two epidemic plasmids were detected in E.coli and K. pneumoniae by restriction enzyme, designated p15-e and p15-k respectively. The blaCTX-M-15 and ISEcpI were identified on p15-e, and the blaCTX-M-15 ,ISEcpI,aac(6')- Ⅰ b,aac(3')-Ⅲ ,blaOXA-1 ,qnrB,qnrS,blaDHA-1 , blaTEM-1 were determined on p15-k. The p15-k also was identified to belong to the incompatible group FⅡ. Conclusion The local dissemination of blaCTX-M-15 appears to be due to the spread of epidemic plasmids harboring blaCTX-M-15. No evidence supports the dissemination of clone strains which carried blaCTX-M-15.

CT and MRI manifestations of the intrathoracic ganglioneuroma / 中华放射学杂志

ObjectiveTo evaluate CT and MRI findings of the intrathoracic ganglioneuroma and to improve its diagnosis and differential diagnosis ability.MethodsClinical,CT( n = 14),MRI (n = 6) and pathology manifestations of 20 patients with the intrathoracic ganglioneuroma were retrospectively analyzed.All 20 cases had chest CT and MRI plain scanning and multiphase enhance scanning before operation.ResultsSeventeen of 20 lesions were located in posterior mediastinum,2 in pleura side and 1 in right thorax cavity.The CT value of the plain scans ranged from 20 to 40 HU ( mean 30.5 HU),Tubercle calcification were detected in four masses,one case with fat density was showed on CT scanning.After injecting contrast media,CT value ranged from 0 to 12 HU (mean 6.2 HU) in artery phase,ranging from 10 to 20 HU ( mean 14.3 HU) in delay phase.Five of 6 cases of MRI signals were homogeneously low intensity on T1 WI,1 case with fat signal was imhomogeneously low intensity on T1WI.Six cases were imhomogeneously high intensity on T2WI.A whorled appearance was visualized in one tumor on T2WI.The post-contrast enhancement MR images was slight enhancement imhomogeneously in artery phase and gradual increasing enhancement in delay phase.ConclusionOn CT and MR imaging,no enhancement or slight enhancement in artery phase and gradual increasing enhancement in delay phase are characteristic manifestations of ganglioneuroma in the thorax.

Prolonged expiratory method and curve fitting method used in exploratory study of expiratory capnography in elderly patients with chronic obstructive pulmonary disease / 中华老年医学杂志

Objective To find noninvasive estimation of partial pressure of carbon dioxide in artery (PaCO2) by measuring the end-tidal CO2 partial pressure (PETCO2) in elderly patients with respiratory failure with chronic obstructive pulmonary disease (COPD). Methods All the 30 acutely exacerbated COPD subjects received routine clinical treatment including bronchodilators,mucolytics, glucocorticosteroid, antibiotics and oxygen therapy for 5-7 days, and part of them received noninvasive positive-pressure ventilation (NIPPV) treatment concurrently. They were both tested by eupnea method and prolonged expiratory method before and after treatment. Results Before treatment, PET CO2 (Q) (end-tidal CO2 pressure with eupnea, (50.72±8.93) mm Hg wassignificantly lower than PaCO2 (F=38.73, P＜0.01 ). Yet, PETCO2(P) (end-tidal CO2 pressure with prolong expiration) was (70.35±8.91) mm Hg and PaCO2 was (71.25±9.08) mm Hg. There was no significant difference between PETCO2 (P) and PaCO2 (P＞0.05). The similar results were found after treatment. By linear regression analysis, PetCO2(P) was remarkably positive correlated with PaCO2 before and after treatment (r=0.96 and 0.97, respectively, P＜0.01). According to TABG,PCO2(C) which was calculated by the average expiratory time of fitting curve was (71.78±9.04)mm Hg. And there was no significant difference between PCO2 (C) and PaCO2 (P＞0.05);Thesimilar results were founcl after treatment. By linear regression analysis, PCO2 (C) was remarkably positively correlated with PaCO2 (r=0.97 and 0.98, respectively, P＜0.01) before and after treatment. Conclusions In COPD patients with type Ⅱ respiratory failure, conventional PETCO2 (Q) is significantly lower than PaCO2. Yet, PETCO2 (P) could exactly estimate PaCO2 and is appropriate to its dynamic monitoring. And PCO2 (C) which is calculated by mode Boltzmann on eupnea curve also obtain similar results.

In vitro antimicrobial activity of piperacillin-sulbactam and other 7 antimicrobial agents against non-fermentative bacilli / 中华内科杂志

Objective To evaluate the in vitro antimicrobial activity of piperacillin-sulbactam against clinical isolates of non-fermentative bacilli isolated from common infections. Methods Microdilution was employed to study the antimicrobial resistance. Results A total of 770 strains were collected from 6 hospitals in Guangzhou, including Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia , Burkholderia cepacia , Flavobacterium , and Alcaligenes. Compared with other β-lactams,piperacillin-sulbactam displayed the highest activity against all the isolates of P. aeruginosa, especially for imipenem non-sensitive isolates, with the susceptibility of 71.9% and 55.8%, respectively. Piperacillinsulbactam and cefoperazone-sulbactam kept good activity against imipenem sensitive isolates of A. baumannii,with the susceptibility of 71.0% and 73. 0%, respectively. For the strains of Burkholderia cepacia, 69% strains exhibited minimal inhibitory concentration (MIC) of ≤ 16 mg/L for piperacillin-sulbactam. For the strains of Flavobacterium, and Alcaligenes, piperacillin-sulbactam also had excellent activity, with the susceptibility of 70. 2% and 94. 4%, respectively. Conclusion Piperacillin-sulbactam exhibits good activity again non-fermentative bacilli, especial for imipenem non-sensitive isolates of P. aeruginosa.

Analysis of correlation between resistance of carbapenem agents in Pseudomonas aeruginosa and mutation and altered expression of oprD2 / 中华微生物学和免疫学杂志

Objective To investigate the impact on the resistance of carbapenem with the expression of OprD2 or OprD2 mutation in Pseudomonas aeruginosa. Methods One hundred and one clinical strains of Pseudomonas aeruginosa with MIC for imipenem ≥8 μg/ml were studied. MIC were determined by the broth microdilution method, and the antibiotics tested were imipenem(IPM ), biapenem( BPM), meropenem(MEM) and panipenem(PEM). The expression of the oprD2 gene in Pseudomonas aeruginosa were analyzed by real-time reverse transcriptase PCR(RT-PCR). For the Pseudomonas aeruginosa with normal expression of OprD2 and resistance to imipenem, full-length oprD2 gene was amplified by PCR and the products were sequenced. Results According to the result of the expression of oprD2 gene, 101 strains of Pseudomonas aeruginosa were divided into two groups: group1 with diminished expression of OprD2, and group2 with normal expression of OprD2. Comparing isolates with MIC of 4 kinds of carbepenem agents ≥ 16 μg/ml in two groups. Data showed the amount of OprD2 expression were different between two groups(P ＜0.01 or P ＜ 0.05). In group1, there are 28 isolates with MIC ≥ 16 μg/ml of all the 4 kinds of carbapenems, among which 25 isolates have obviously diminished expression of OprD2 ( ＜ 0.4). Negative correlations tendency appeared between the level of OprD2 transcription and MICs of 4 kinds of carbepenem agents in Pseudomonas aeruginosa. In group2, 16 strains with OprD2 mutation divided into 4 types according to the pattern of alteration. Compared with PAO1, these strains have increased MIC with different degree to IPM,BPM, MEM and PEM. Conclusion The deletion or diminished expression of OprD2 resulted in resistance to imipenem in Pseudomonas aeruginosa. The level of OprD2 transcription and antimicrobial activities for carbapenem agents proved to be highly correlated in Pseudomonas aeruginosa. The mutation of OprD2 in Pseudomonas aeruginosa probably decreased the sensitivity of carbapenem agents against Pseudomonas aeruginosa.

Change of diaphragm electromyograms in patients with obstructive sleep apnea-hypoventilation syndrome and its significance / 中华全科医师杂志

Objective To explore change of diaphragm electromyograms in patients with obstructive sleep apnea-hypoventilation syndrome (OSAHS) before and after nocturnal sleep, as well as effective nasal continuous positive airway pressure (n-CPAP) ventilation treatment for more than two months. Methods Diaphragm electromyogram was recorded with chest surface electrodes in 22 patients with moderate and severe OSAHS and 24 normal people, and phrenic nerve conduction time (PNCT) and diaphragm compound muscle action potential (CMAP) provoked by unilateral magnetic stimulation (UMS) were measured for them before and after sleep. Measurements were repeated for five patients with severe OSAHS after effective OSAHS patients before and after nocturnal sleep than that in normal people bilaterally, (8.4±0. 6)ms and (8.4±0. 9)ms vs (7. 3±0. 8)ms and (7. 3±0. 8) ms for the left side; and (8.4±1.3) ms and (8. 9 ± 0. 8) ms vs (7.2 ± 0. 8) ms and (7.2 ± 0. 8 ) ms for the right side ( P < 0. 01 ), respectively ; and amplitude of CMAP was significantly lower in OSAHS patients, (0. 60±0. 20)mV and (0. 64±0. 29)mV vs (0. 98 ± 0. 28)mV and (0. 97±0. 27)mV for the left side; and (0. 53±0. 23)mV and (0. 56±0. 26)mV vs (0. 93 ±0. 29) mV and ( 0. 94 ± 0. 29 ) mV for the right side, respectively ( P < 0. 01 ) ; but no significant significantly shortened bilaterally in five patients with severe OSAHS after effective n-CPAP ventilation treatment for more than two months, (8.6±0. 7)ms vs (7.4±0. 5)ms for the lfet side and (7. 8±0. 6)ms vs (6.4 ± 0. 6) ms for the fight side ( P < 0. 05 ), respectively. Conclusions Both phrenic nerve conduction and diaphragm muscle function are weakened in patients with OSAHA, which may be related to hypoxia and/ or disturbance of sleep structure at night.

Effects of sepsis bundles on severe pneumonia and septic shock / 中华急诊医学杂志

Objective To investigate the effects of sepsis bundles in China.Method An observational study of 43 patients with severe pneumonia and septic shock admitted to the respiratory intertive care unit(1/11/2006-31/12/2007)was carried out.The selection criteria were in accordance with criteria set by International Conference On Sepsis in 2001.Implementation of 6 hours and 24 hours sepsis bundles was divided into 3 continu-ous phases consisting of education,trial,and application phase.A cohort of 43 patients with matched disease his-tory(1/1/2004-31/10/2006)was enrolled as control group.The percentages for categorical variables and mean±SD for continuous variables were reported.Chi-Square test.unpaired Student's t -test.paired-samples t test,univariate and multivariate logistic regression models were used.Statistical significance was defined as P＜0.05.Results There were very little significant differences in basic characteristics of patients between the two groups.Compared with control group,the differences in serrum lactate,fluid resuscitation and fluid volume infused within 6 hours and blood glucose control in shock subgroup were significant(P values were 0.024,0.009,0.045,and 0.000,respectively).Compared with control group,the differences in respiratory rate and oxygenation index of bundles group at 72 hours later were significant(P values were 0.033 and 0.041,respectively).Compared with control group,the differences in APACHE Ⅱ score and predicted mortality in shock subgroup of bundles were sig-nificant(P values were 0.017 and 0.040,respectively).Compared with control group,the reduction in absolute mortality was 23.30% in bundles group(P=0.019).Conclusions Implementation of sepsis bundles con-tributes noticeably to the significant reduction in mortality of patients with severe pneumonia and septic shock.

Current status of prevention and management of chronic obstructive pulmonary disease in rural area in China / 中华内科杂志

Objective To investigate the current status of prevalence, prevention and management of chronic obstructive pulmonary disease(COPD) in rural area in China. Methods A cross-sectional survey of COPD was conducted in Beijing city, Shanghai city, Guangdong province, Liaoning province,Tianjin city, Chongqing province and Shanxi province. A population-based cluster sample was randomly selected from each rural area. In the selected community,all residents at least 40 years old were recruited,and interviewed with a modified standardized questionnaire from the international burden of obstructive lung diseases (BOLD) study. All participants were tested with spirometry. Those with airflow limitation were performed on post-bronchedilator spirometry. The post-bronchedilator a ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) less than 70% was defined as the diagnostic criteria of COPD. Results (1) Data of 9434 participants was valid for analysis, with a valid response rate of 83. 6% ;the prevalence of COPD in rural was 8. 8% (830/9434), 12. 8% in male and 5.4% in female. (2)The percentage of smoking and the exposure to biomass smoke in rural was 43. 0% (4059/9434) and 83. 1% (7835/9434) respectively; cigarettes cessation rate was 17.5% ; only 12. 4% ( 502/4059 ) of smokers had received advice to quit smoking. (3) Among COPD patients, only 30. 0% (249/830) had ever been diagnosed as COPD, bronchitis, emphysema, or asthma, 2. 4% (20/830) had ever received spirometric tests, and 74. 5% were current smokers; only 7.9% (50/634)COPD patients in stage two or over had received regular drug treatment. Conclusion There was high prevalence and poor prevention and management for COPD in rural areas. Therefore, an enforced prevention and management for COPD are urgent.

The effects of acetylcysteine on proliferation and collagen synthesis of human lung fibroblast / 中国综合临床

Objective To study the effects of N-acetylcysteine (NAC) on the proliferation, apoptosis and collagen synthesis of human lung fibroblast (HLF). Methods HLF was primarily cultured in complete medium of DMEM/F12. Different concentrations of NAC (5,10,20,40mmol/L) were administrated. Cell proliferations were tested by methylthiazolyltetrazolium (MTT) ,apoptosis and cell cycle were detected with Flow cytometer and mRNA and 40 mmoi/L )after 24 hours,the apoptosis rates were (34.38±5.80)%, (37.72±3.10)%, (44.05± 4.52) % and (59.18±5.24) % ) respectively, significantly higher than that of the controls (3.92±1.24) % pression of type Ⅰ procollagen in HLF was decreased significantly after administration of NAC at 5, 10,20, 40 mmol/L respectively (P < 0.01 ). Conclusion Administration of NAC induces apoptosis and directly inhibites the proliferation and the collagen synthesis of HLF.