Analysis of prevalence rate and risk factors for aspiration pneumonia in elderly inpatients / 中华老年医学杂志

Objective To analyze the prevalence rate and risk factors for aspiration pneumonia in elderly inpatients,and to identify a high-risk population for aspiration pneumonia.Methods Totally 398 inpatients aged ≥ 60 years in Beijing Hospital from April 2014 to April 2015 were selected.A questionnaire survey was performed for aspiration risk factors,including gender,age,smoking and drinking history,swallowing function,basal diseases,medication history,activities of daily living(ADL),occurrence of aspiration pneumonia over the past year.The patients were divided into aspiration pneumonia group and non-aspiration pneumonia group,and the prevalence rate and risk factors for aspiration pneumonia were studied.Results 364 cases with complete data were collected,and 14.3％ (52/364)were identified definitively as aspiration pneumonia over the past year.The ADL score was (77.0± 33.9) scales in aspiration pneumonia group,and (88.0 ± 22.2) scales in non-aspiration pneumonia group,with statistically significant difference (P＜ 0.05).The incidence rate of aspiration pneumonia was increased along with the increase of the age of patients.Risk factors for aspiration pneumonia were different in different age group.The proportion of patients aged 60-69,70-79 and over 80 years were 23.1％ (12 cases),36.5％ (19 cases),40.4％ (23 cases)in the aspiration pneumonia group,respectively.Under the condition of a propensity score-matched case-control pair design on 104 subjects with versus without aspiration pneumonia,the logistic regression analysis showed that smoking history,coronary heart disease,Parkinson's disease,dementia,chronic obstructive pulmonary disease(COPD),gastro-esophageal reflux disease(GERD),long-term uses of theophylline,calcium antagonists,nitrates,diazepam,antidepressants,anti-Parkinson drugs were the risk factors for aspiration pneumonia in elderly(all P＜0.05).Conclusions Smoking history,basal diseases and medication history are associated with the incidence rate of aspiration pneumonia in elderly.Assessment of these risk factors for aspiration pneumonia should be emphasized,and preventive measures should be considered conscientiously to lower the incidence rate of aspiration pneumonia in elderly.

Investigation of distinct clinical phenotypes of airways disease in the elderly based on hierarchical cluster analysis / 中华老年医学杂志

Objective To explore the clinical phenotype of airways disease in elderly patients using hierarchical cluster analysis.Methods A total of 67 elderly patients with respiratory symptoms were enrolled in a prospective study.Demographic and clinical data,such as respiratory symptoms,cumulative tobacco cigarette consumption,acute exacerbation,atopic symptoms and peak flow diary were collected.Pulmonary function tests,blood tests (total serum IgE level and blood eosinophil level) were performed in each patient during the stable stage.Then patients with different clinical phenotype were identified by hierarchical cluster analysis.Results Four clusters were identified with the following characteristics by hierarchical cluster analysis:cluster 1,atopic patients with no smoking,normal lung function,but increased total serum IgE levels and asthma symptom;cluster 2,patients with no smoking and normal pulmonary function with wheezing but without chronic cough;cluster 3,patients with chronic obstructive pulmonary disease and smoking,severe airflow limitation and poor quality of life;cluster 4,patients with asthma-chronic obstructive pulmonary disease overlap syndrome and smoking,airflow limitation and increased total serum IgE levels.The forced expiratory volume in 1 second (FEV1) / forced vital capacity (FVC) ratio,FEV1/predicted value,rate of FEV1 change,maximal mid-expiratory flow (MMEF)/ predicted value,the diffusion lung capacity for carbon monoxide (DLCO)/alveolar volume (VA)/predicted value,residual volume (RV)/ predicted value,total serum Ig E levels,cumulative tobacco cigarette consumption,the St.George's Respiratory Questionnaire (SGRQ) score had significant differences in patients before versus after treatment (all P＜0.05 or P＜0.01).Conclusions Based on hierarchical cluster analysis,distinct clinical phenotypes of airways disease in elderly patients can be identified.Conclusions With patients having asthma or COPD alone,patients with Asthma-COPD overlap syndrome (ACOS) always experience a more rapid decline in lung function and frequent exacerbations,having poor health-related quality-of-life (HRQOL) outcomes,which deserve our high attention.

Study of the clinical phenotype of symptomatic chronic airways disease by hierarchical cluster analysis and two-step cluster analyses / 中华内科杂志

Objective To study the distinct clinical phenotype of chronic airway diseases by hierarchical cluster analysis and two-step cluster analysis.Methods A population sample of adult patients in Donghuamen community,Dongcheng district and Qinghe community,Haidian district,Beijing from April 2012 to January 2015,who had wheeze within the last 12 months,underwent detailed investigation,including a clinical questionnaire,pulmonary function tests,total serum IgE levels,blood eosinophil level and a peak flow diary.Nine variables were chosen as evaluating parameters,including pre-salbutamol forced expired volume in one second(FEV1)/forced vital capacity (FVC) ratio,pre-salbutamol FEV1,percentage of post-salbutamol change in FEV1,residual capacity,diffusing capacity of the lung for carbon monoxide/alveolar volume adjusted for haemoglobin level,peak expiratory flow (PEF) variability,serum IgE level,cumulative tobacco cigarette consumption (pack-years) and respiratory symptoms (cough and expectoration).Subjects' different clinical phenotype by hierarchical cluster analysis and two-step cluster analysis was identified.Results (1) Four clusters were identified by hierarchical cluster analysis.Cluster 1 was chronic bronchitis in smokers with normal pulmonary function.Cluster 2 was chronic bronchitis or mild chronic obstructive pulmonary disease (COPD) patients with mild airflow limitation.Cluster 3 included COPD patients with heavy smoking,poor quality of life and severe airflow limitation.Cluster 4 recognized atopic patients with mild airflow limitation,elevated serum IgE and clinical features of asthma.Significant differences were revealed regarding pre-salbutamol FEV1/FVC％,pre-salbutamol FEV1％ pred,postsalbutamol change in FEV1 ％,maximal mid-expiratory flow curve (MMEF)％ pred,carbon monoxide diffusing capacity per liter of alveolar(DLCO)/(VA)％ pred,residual volume(RV)％ pred,total serum IgE level,smoking history (pack-years),St.George' s respiratory questionnaire (SGRQ) score,acute exacerbation in the past one year,PEF variability and allergic dermatitis (P ＜ 0.05).(2) Four clusters were also identified by two-step cluster analysis as followings,cluster 1,COPD patients with moderate to severe airflow limitation;cluster 2,asthma and COPD patients with heavy smoking,airflow limitation and increased airways reversibility;cluster 3,patients having less smoking and normal pulmonary function with wheezing but no chronic cough;cluster 4,chronic bronchitis patients with normal pulmonary function and chronic cough.Significant differences were revealed regarding gender distribution,respiratory symptoms,pre-salbutamol FEV1/FVC％,pre-salbutamol FEV1 ％ pred,post-salbutamol change in FEV1 ％,MMEF％ pred,DLCO/VA％ pred,RV％ pred,PEF variability,total serum IgE level,cumulative tobacco cigarette consumption (pack-years),and SGRQ score (P ＜ 0.05).Conclusion By different cluster analyses,distinct clinical phenotypes of chronic airway diseases are identified.Thus,individualized treatments may guide doctors to provide based on different phenotypes.

Expression of microRNA-203 and P63 in human epidermal stem cells and keratinocytes / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the changes in expression of microRNA-203 and P63 in human epidermal stem cells and KCs, and to investigate their effects and significance in the epidermal proliferation and differentiation.</p><p><b>METHODS</b>(1) Five normal foreskin tissue specimens were collected from 5 patients by circumcision in Department of Urinary Surgery of the First Affiliated Hospital of Nanchang University from March to June in 2013. Then single cell suspension was obtained by separating epidermis with trypsin digestion method. The cells were divided into quick adherent cells and non-quick adherent cells by type IV collagen differential adherent method. The biological characteristics of cells were observed by inverted phase contrast microscope immediately after isolation and on post culture day (PCD) 3. The expression of CD29, keratin 19, keratin 1, and keratin 10 was identified by immunocytochemical staining. The expression of microRNA-203 and mRNA of P63 was determined by real-time fluorescent quantitative RT-PCR. The protein expression of P63 was determined by Western blotting. Data were processed with t test and Pearson correlation analysis.</p><p><b>RESULTS</b>(1) Immediately after isolation, quick adherent cells were small, round, and dispersed uniformly. On PCD 3, the cells adhered firmly, and they grew in clones. Immediately after isolation, non-quick adherent cells appeared in different shapes and sizes, and dispersed unevenly. On PCD 3, the cells adhered precariously and did not show clonal growth. Quick adherent cells showed positive expression of CD29 and keratin 19, while non-quick adherent cells showed positive expression of keratin 1 and keratin 10. Quick adherent cells were identified as epidermal stem cells, and non-quick adherent cells were identified as KCs. (2)The expression level of microRNA-203 in epidermal stem cells (0.74 ± 0.20) was lower than that in KCs (3.66 ± 0.34, t =16.582, P <0.001). The mRNA expression level of P63 in epidermal stem cells (4. 16 ± 0.28) was higher than that in KCs (2.90 ± 0.39, t =5. 850, P =0.001). The protein expression level of P63 in epidermal stem cells (1.42 ± 0.05) was higher than that in KCs (0.73 ± 0.03, t =26.460, P <0. 001). (3) The expression level of microRNA-203 was in significantly negative correlation with the expression levels of mRNA and protein of P63 (with r values respectively - 0. 94 and -0.98 , P values below 0.05).</p><p><b>CONCLUSIONS</b>The expression levels of microRNA-203 and P63 in human epidermal stem cells and KCs were significantly different, which might be related to the different characteristics of proliferation and differentiation of the cells.</p>

Advances in the research of the role of MicroRNAs in wound healing / 中华烧伤杂志

MicroRNAs are endogenous noncoding RNA molecules with 19-22 nucleotides in length. MicroRNAs can post-transcriptionally regulate gene and (or) protein expression by binding to their target messenger RNAs (mRNAs), leading to mRNA degradation or suppression of translation. As a huge family that regulates gene expression, microRNAs has recently been shown to not only participate in the normal healing processes of wounds but also closely related to pathologic wound healing, and formation of hypertrophic scars and keloids. This review focuses on the biogenesis of microRNA and its role in wound healing.

Experimental study on the differentiation of human induced pluripotent stem cells into epidermal-like stem cells / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of differentiation of human induced pluripotent stem cells (iPSCs) into epidermal-like stem cells.</p><p><b>METHODS</b>(1) Human strain of iPSCs were plated on-to trophoblast of inactivated Fb strain of mouse embryos and cultured in complete medium of embryonic stem cells, iPSCs were subcultured by collagenase IV digestion method. The morphology and growth of iPSCs were observed under inverted phase contrast microscope, and the cells were stained with alkaline phosphatase (AKP). iPSCs were cultured in incomplete medium of embryonic stem cells to observe the ability of embryoid body formation. (2) Human iPSCs were inoculated onto 6-well plate covered with human amniotic membrane to culture as induction group. Other iPSCs were cultured on 6-well plate without human amniotic membrane as control group. Morphological changes in iPSCs in two groups were observed. Expressions of integrin beta1 and CK19 of iPSCs in two groups were determined by immunocytochemical staining.</p><p><b>RESULTS</b>Human iPSCs showed a typical stem cell clone-like growth with a clear boundary, and they proliferated vigorously in complete medium of embryonic stem cells. These cells were AKP-positive. iPSCs formed embryoid body in trophoblast-free and suspension culture conditions. After 4 days of co-culture, stem cell clones were formed on the surface of amniotic membrane in induction group, and part of the cells were integrin beta1 and CK19 positive. Most of the cells died, and no integrin beta1 and CK19 positive cells were found in control group.</p><p><b>CONCLUSIONS</b>Human iPSCs can be differentiated into epidermal-like stem cells by amniotic membrane induction, and it lays an experimental basis for providing new source of seed cells of skin tissue engineering.</p>