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Gallbladder carcinoma is a common malignant tumor of the biliary system characterized by poor specificity of early symptoms， a high degree of malignancy， and rapid progression， and it is difficult to make an early diagnosis. Gallstones and gallbladder polyps are considered the most common risk factors for gallbladder carcinoma. Ultrasound is the preferred examination， while CT， MRI， and PET also have their own advantages. There is a lack of radical treatment methods for gallbladder carcinoma， and surgical operation remains the preferred treatment method for gallbladder carcinoma； however， due to the rapid progression of this disease， most patients have lost the opportunity for surgery at the time of diagnosis. A combination of various treatment modalities， such as radiochemotherapy， targeted therapy， and immunotherapy， has improved the prognosis of patients to a certain extent， but with an unsatisfactory long-term therapeutic effect. Therefore， it is of particular importance to give priority to prevention rather than treatment and emphasize early identification and treatment.
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BACKGROUND@#Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE).@*METHODS@#This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE.@*RESULTS@#This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively.@*CONCLUSIONS@#Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.
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Two new trichilin-type limonoids were isolated from the fruits of Trichilia connaroides along with two known limonoids, 3α-deacetylamoorastatin (3) and mesendanins K (4). Their planar structure and relative configuration were elucidated by comprehensive analyses of HR-ESI-MS, 1H NMR, 13C NMR, HSQC, HMBC and ROESY data. An antitumor activity assay showed that compounds 1, 2 and known compound 4 had weak cytotoxicity against a human cervical cancer cell line (HeLa).
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Thrombocytopenia is the main clinical manifestation or common complication of multiple diseases, but there is still a lack of systematic understanding of pathogenesis, underlying diseases and treatment strategies of thrombocytopenia. Based on evidence-based medicine, this consensus summarizes seven aspects related to thrombocytopenia, including definition, epidemiology, pathogenesis, clinical manifestations, laboratory examination, diagnosis and treatment. This consensus provides an important reference for the diagnosis and treatment of thrombocytopenia.
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Six new trichilin-type limonoids (1-6) with C-19/29 lactol or acetal bridge and a new ring intact limonoid (7) were isolated from the desiccative ripe fruits of Trichilia sinensis. Their structures were determined by extensive spectroscopic methods including H NMR, C NMR, HSQC, HMBC, ROESY experiments as well as HRESI-MS data. All isolated compounds were evaluated for toxicities against human pulmonary carcinoma A549 and Hela cell lines by sulforhodamine B (SRB) method. Compound 7 showed weak inhibitory activity in Hela cell line at 40 μmol·L.
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Chemical constituents were isolated from the fruiting bodies of Ganoderma australe by various column chromatographic techniques and HPLC method, and their chemical structures were identified through the combined analysis of physicochemical properties and spectral data. Meanwhile, their α-glucosidase inhibitory activity and anti-oxidative ability were evaluated. Seven compounds were isolated from G. australe and were identified as 6-methoxyl-cyclo-(Phe-Ile)(1), applanoxidic acid A methyl ester(2), ergosta-7,22 E-dien-3β-ol(3), cinnamic acid(4), 5α,8α-epidioxy-(20S,22E,24R)-ergosta-6,22-diene-3β-ol(5), 1-(3, 4-dihydroxyphenyl) ethanone(6), salicylic acid(7) and benzoic acid(8). Among the compounds, compound 1 was a new cyclic dipeptide. Compound 2 was a new lanosta natural product, and compounds 4, 6, 7 and 8 were obtained from G. australe for the first time. Moreover, compounds 4 and 8 exhibited α-glucosidase inhibitory activity with inhibition rates of 36.8% and 34.7%, and compounds 4, 7 and 8 had a certain activity in DPPH free radical scavenging activity with IC_(50) values of 0.168, 0.458 and 0.170 g·L~(-1), respectively. The DPPH radical scavenging rate of compound 1 was 41.1%.
Subject(s)
Free Radical Scavengers , Fruiting Bodies, Fungal , Chemistry , Ganoderma , Chemistry , Glycoside Hydrolase Inhibitors , Molecular StructureABSTRACT
Objective: To study the secondary metabolites from the fermentation broth of marine-derived fungus Aspergillus sp. SCS-KFD66. Methods: The constituents were isolated and purified by silica gel, Sephadex LH-20 column chromatography and HPLC methods. The structures of the compounds were identified by spectral data analysis. The DPPH radical scavenging, acetylcholinesterase and α-glucosidase inhibitory activities of compounds were evaluated by DPPH method, Ellman colorimetric method and PNPG method, respectively. The inhibitory effect and the minimal inhibitory concentration (MIC) of compounds on Escherichia coli, Staphylococcus aureus, Bacillus subtilis, and Listeria monocytogenes were tested using 96-well microtiter plates method. Results: A total of 13 compounds were isolated from the fermentation broth of marine-derived fungus Aspergillus sp. SCS-KFD66 and identified as 3-epi-trans-4-hydroxylinalool 3,6-oxide (1), trans-4-hydroxylinalool 3,6-oxide (2), aloe emodin (3), emodin (4), citreorosein (5), protocatechualdehyde (6), 2,5-dihydroxybenzaldehyde (7), methyl 4-hydroxyphenylacetate (8), 4-hydroxybenzoic acid (9), 4-hydroxyphenylacetic acid (10), 2-(4-hydroxyphenyl) ethanol (11), (E)-p-hydroxycinnamic acid (12) and (E)-ferulic acid (13), respectively. Compounds 1, 6, 7 and 9-13 showed DPPH radical scavenging activities; Compounds 4 and 6 showed acetylcholinesterase inhibitory activity; Compounds 6 and 7 exhibited inhibitory activity against α-glucosidase. Compound 4 has inhibitory activity against S. aureus and B. subtilis with the MIC values of 16 μg/mL and 64 μg/mL, respectively. Compound 6 showed inhibitory activity against E. coli, B. subtilis and L. monocytogenes, with MIC values of 64, 128 and 128 μg/mL, respectively. Conclusion: Twelve known compounds and one new compound were isolated. Compound 1 is a new compound named as aspergfuranol.
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@#【Objective】To investigate a new method for assessing the intrauterine adhesion（IUA）by three- dimensional（3D） endometrial area imaging. 【Methods】 A total of 121 women with suspected IUA or tubal factor infertility undergoing hysteroscopy were enrolled in this retrospective study. The patients were divided into two groups ：those with IUA and those without IUA. The endometrial area cutoff point was calculated to classify the patients with IUA into mild ， moderate ，and severe subgroups according to their AFS classification. 【Results】 When IUA were diagnosed based on the endometrial area，the area under the receiver operating characteristic（ROC）curve was 0.839，the cutoff point was 4.23 cm2，the sensitivity was 0.86，and the specificity was 0.74，the diagnostic efficiency is 76.03%. We further classified IUA into mild，moderate，and severe groups based on the endometrium area as follows：mild IUA（4.02，4.23］cm2，moderate IUA（3.23 ，4.02］cm2 ，and severe IUA≤3.23 cm2. The incidence rate of IUA increased by 30.6% for each one-unit decrease in abortive gestational age and increased by 18.9% for each one-unit decrease in endometrial area.【Conclusion】3D endometrial area imaging is a simple and fast tool for IUA diagnosis and severity assessment，providing a new diagnosis method for gynaecologists to assess IUA.
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OBJECTIVE: To evaluate the effect of Kuntai capsule on the gonadotrophin releasing hormone agonist(GnRH-a)-induced perimenopaus symptoms and the sex hormone levels.METHODS: A total of 99 patients with uterine fibroids,adenomyosis or moderate to severe endometriosis who needed the treatment of GnRH-a at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from June 2015 to March 2016 were collected and randomly divided into research group(Kuntai capsule)and control group(Tibolone). GnRH-a was injected once every 28 days and first injection of GnRH-a was administered on the 2 nd to 4 th day of menstrual period or retraction bleeding after surgery.Kuntai capsule or Tibolone was orally taken beginning from the first GnRH-a injection,and the co-administration of Caltrate D-600 and alfacalcidol was given in both groups.The Kupperman scores,sex hormone levels including folliclestimulating hormone(FSH)and estrogen(E_2),and adverse events were recorded.RESULTS: Kuntai capsule kept the perimenopause symptoms at mild level with the slow increase of Kupperman scores,whose effect was significantly superior to Tibolone(P<0.05)after 8 weeks of treatment,especially in paresthesia,nervousness,and formication.The FSH and E_2 levels in both Kuntai and Tibolone groups were obviously decreased when compared with the pre-treatment(P<0.05),and these hormone levels in Kuntai group were comparable to those in Tibolone group.No adverse events occurred in either group. CONCLUSION: In the short-term treatment of GnRH-a,Kuntai capsule exhibits significant alleviating effects on perimenopause symptoms caused by GnRH-a with high safety and few adverse reactions.
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BACKGROUND@#Lung cancer is the leading cause of cancer-related death in China. The results from a randomized controlled trial using annual low-dose computed tomography (LDCT) in specific high-risk groups demonstrated a 20% reduction in lung cancer mortality. The aim of tihs study is to establish the China National lung cancer screening guidelines for clinical practice.@*METHODS@#The China lung cancer early detection and treatment expert group (CLCEDTEG) established the China National Lung Cancer Screening Guideline with multidisciplinary representation including 4 thoracic surgeons, 4 thoracic radiologists, 2 medical oncologists, 2 pulmonologists, 2 pathologist, and 2 epidemiologist. Members have engaged in interdisciplinary collaborations regarding lung cancer screening and clinical care of patients with at risk for lung cancer. The expert group reviewed the literature, including screening trials in the United States and Europe and China, and discussed local best clinical practices in the China. A consensus-based guidelines, China National Lung Cancer Screening Guideline (CNLCSG), was recommended by CLCEDTEG appointed by the National Health and Family Planning Commission, based on results of the National Lung Screening Trial, systematic review of evidence related to LDCT screening, and protocol of lung cancer screening program conducted in rural China.@*RESULTS@#Annual lung cancer screening with LDCT is recommended for high risk individuals aged 50-74 years who have at least a 20 pack-year smoking history and who currently smoke or have quit within the past five years. Individualized decision making should be conducted before LDCT screening. LDCT screening also represents an opportunity to educate patients as to the health risks of smoking; thus, education should be integrated into the screening process in order to assist smoking cessation.@*CONCLUSIONS@#A lung cancer screening guideline is recommended for the high-risk population in China. Additional research , including LDCT combined with biomarkers, is needed to optimize the approach to low-dose CT screening in the future.
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Aged , Female , Humans , Male , Middle Aged , China , Epidemiology , Early Detection of Cancer , Lung Neoplasms , Diagnostic Imaging , Epidemiology , Mass Screening , Patient Selection , Practice Guidelines as Topic , Radiation Dosage , Risk , Rural Population , Tomography, Spiral ComputedABSTRACT
Objective To investigate the methylation status of RASSF2A gene promoter in colorectal cancer tissues and its correlation with the occurrence of colorectal.Methods From February 2007 to March 2013,a total of 111 cases of sporadic colorectal cancer patients were selected.The methylation status of RASSF2A gene in tumor tissue and normal mucosa were detected by using combined bisulfite restriction endonuclease method (COBRA).The correlations between the methylation of RASSF2A gene and the clinicopathologic features of colorectal cancer were analyzed.Results Methylation of RASSF2A gene was found in 83.78％ (93/111) and 7.21％ (8/111) of colorectal cancer tissues and normal tissues,with statistically significant difference (x2=131.245,P ＜ 0.001).The methylation of RASFF2A gene was not correlated with histology type (x2 =3.554,P =0.314),Duke staging (x2 =3.217,P =0.359) and location of tumor (x2 =1.060,P =0.303).Conclusion The presence of RASSF2A hypermethylation in colorectal cancer may be associated with the occurrence of colorectal cancer.
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Objective To investigate the distribution and drug resistance of pathogens in elderly patients with gastric cancer complicated with diabetes mellitus.Methods 367 elderly patients with gastric cancer and diabetes mellitus were selected from the hospital from March 2010 to March 2017.The samples were isolated and cultured.The Gram positive bacteria were tested by GN201,the Gram negative bacteria susceptibility test was carried out by GP,and the drug susceptibility test was carried out by disk diffusion method.Results There were 68 cases of postoperative infection in gastric cancer patients with diabetes mellitus,and 79 strains were isolated and cultured.Among the gram negative bacteria,Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa were the main pathogens.Among the Gram positive bacteria,Staphylococcus aureus and Staphylococcus epidermidis were the main pathogens.The main Gram negative bacteria,Escherichia coli to ceftazidime with levofloxacin resistance rates were 93.33% and 80.00%;Klebsiella pneumoniae had a higher drug resistance rate for cefoperazone and ciprofloxacin,76.92% and 69.23% respectively;a relatively high rate of Pseudomonas aeruginosa resistant to levofloxacin was 80.00%.Among the gram positive bacteria,the re-sistance rates of Staphylococcus aureus to penicillin and erythromycin were relatively high,respectively 91. 67% and 83.33%.Staphylococcus epidermidis had relatively high resistance rates to penicillin and erythromy-cin,100.00% and 77.78% respectively.Conclusion Gastric cancer complicated by diabetes mellitus elderly patients with postoperative infection of pathogenic bacteria distribution is given priority to with Gram-negative bacteria was the most common in,Pseudomonas aeruginosa,the main pathogenic bacteria of Escherichia coli to ceftazidime with levofloxacin resistant rate of Klebsiella pneumoniae was higher on cefoperazone and ciproflox-acin resistant Pseudomonas aeruginosa,the resistance rate of Pseudomonas aeruginosa to levofloxacin is high, and it is important to apply antibiotics rationally according to drug sensitivity test.
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PURPOSE: This study investigated whether the metabolic avidity of primary tumors and/or metastatic lymph nodes (LNs) measured by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) was related to survival after surgery in patients with advanced gastric cancer (AGC). MATERIALS AND METHODS: One hundred sixty-eight patients with AGC who underwent preoperative 18F-FDG PET/CT and curative resection were included. The 18F-FDG avidity of the primary gastric tumor and LNs was determined quantitatively and qualitatively. The diagnostic performance of 18F-FDG PET/CT was calculated, and the prognostic significance of 18F-FDG avidity for recurrence-free survival (RFS) and overall survival (OS) was assessed. RESULTS: In all, 51 (30.4%) patients experienced recurrence, and 32 (19.0%) died during follow-up (median follow-up duration, 35 months; range, 3–81 months); 119 (70.8%) and 33 (19.6%) patients showed 18F-FDG-avid primary tumors and LNs, respectively. 18F-FDG PET/CT showed high sensitivity (73.8%) for the detection of advanced pathologic T (pT ≥3) stage and high specificity (92.2%) for the detection of advanced pN (≥2) stage. 18F-FDG avidity of LNs was significantly associated with RFS (P=0.012), whereas that of primary tumors did not show significance (P=0.532). Univariate and multivariate analyses revealed that 18F-FDG avidity of LNs was an independent prognostic factor for RFS (hazard ratio=2.068; P=0.029). CONCLUSIONS: 18F-FDG avidity of LNs is an independent prognostic factor for predicting RFS. Preoperative 18F-FDG PET/CT can be used to determine the risk and prognosis of patients with AGC after curative resection.
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Humans , Electrons , Fluorodeoxyglucose F18 , Follow-Up Studies , Lymph Nodes , Multivariate Analysis , Positron Emission Tomography Computed Tomography , Prognosis , Recurrence , Sensitivity and Specificity , Stomach NeoplasmsABSTRACT
Objective To investigate the influence of synangio-excision-restruction in pancreatic cancer radical operation on the complications,living quality and survival status in the patients with pancreatic cancer.Methods A total of 255 patients with pancreatic cancer in our hospitals from January 2010 to October 2015 were selected and divided into 3 groups according to different operation modes:41 cases in the Synangio-excision-restruction group(A),113 cases in the non-synangio-excision-restruction group (B) and 101 cases in the palliative by-pass operation group(C).The clinical data in 3 groups were analyzed.The influence of Synangio-excision-restruction on operative complications,living quality and survival status was investigated.Results The incidence rate of complications in the group A was 56.10％,which was obviously higer than 34.51％ in the group 1β and 20.79％ in the group C,and the difference was statistically significant(P＜0.05).In the group A,the incidence rates of belly ache and body weight gain were 36.59％ and 51.22％ respectively,which comparing with 91.09％ and 9.09％ in the group C showed statistically significant difference(P＜0.05).The median survival time(MST) in the group A was 11.83 months,which in the group B and C were 15.43 months and 7.50 months,the difference between the group A and C was statistically significant(x2 =4.27,P＜0.05);while the difference between the group A and B was not statistically significant(x2=3.67,P＞0.05).Conclusion For the pancreatic cancer patients with affected portal vein and inferior mesenteric vein,the synangio-excision-restruction radical operation can obviously prolong the patients' survival time and improves their living quality.
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Precise medicine is an emerging clinical therapeutic concept based on genomic and genetic information of patients. Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) is an important component of precise therapy for lung cancer patients. EGFR mutations occur mainly in exon 18 to 21, in which exon 19 deletion and exon 21 L858R point mutation that are known as sensitive mutations account for nearly 45% and 40%, respectively. Except for the above two mutations and T790M point mutation, the rest are rare mutations, including Ins19, Ins20, E709, G719, S768, L861 and some compound mutations. Some previous retrospective studies of small sample size and case reports showed that most of EGFR exon19 (Ins), exon 21 (L861), exon 18 (G719X) and exon20 (S768I) mutations were sensitive to TKIs. And although the exon 20 insertion mutation is usually predicted to the first and second generations of EGFR-TKIs resistance, some specific types are sensitive to the third generation of EGFR-TKIs. Currently, targeted drugs for Ins20 -Ap32788 mutation has entered into clinical trials. Patients with complex mutations have similar efficacy on EGFR-TKIs in comparison with those with single sensitivity mutations. In conclusion, when patients with rare sensitive mutations received EGFR-TKIs therapy, the efficacy and progression-free survival time is similar to or slightly lower than those with classical sensitive mutations, whereas it is higher than those with wild-type EGFR. Compared with the first generation of EGFR-TKIs, second generation EGFR-TKIs may be more suitable for the treatment of lung cancer patients harboring rare sensitive EGFR mutations.
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ABSTRACT DNA vaccines have been shown to be an effective approach to induce antigen-specific cellular and humoral immunity. However, the inability of DNA vaccines to elicit strong immune responses in clinical trials limits the application of DNA vaccines. Here, we developed a new DNA vaccine based on MUC1, which has been suggested as a potential target for lung cancer therapy, and we enhanced the potency of the DNA vaccine by including granulocyte-macrophage colony-stimulating factor (GM-CSF) as an adjuvant. A series of DNA plasmids encoding MUC1, human GM-CSF and their conjugates were constructed and injected into female mice intramuscularly (i.m.). This action was followed by an electric pulse. The humoral and cellular immune responses after immunization were examined by ELISA and ELISPOT, respectively. To evaluate the therapeutic efficacy of the plasmids, a mouse model with a MUC1-expressing tumor was designed. Mice vaccinated with the MUC1-GM-CSF plasmid generated the strongest MUC1-specific humoral and cellular immune responses. Furthermore, these vaccinations inhibited the growth of MUC1-expressing tumors and prolonged mouse survival. These observations emphasize the potential of GM-CSF as an adjuvant for DNA vaccines and of vaccines based on MUC1 and GM-CSF as a promising treatment for lung cancer.
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<p><b>OBJECTIVE</b>To investigate the changes in the proportion and function of peripheral CD4(+)LAP(+)regulatory T cells (CD4(+)LAP(+)Treg cells) in children with asthma, as well as the role of CD4(+)LAP(+)Treg cells in the pathogenesis of asthma.</p><p><b>METHODS</b>A total of 75 children who were diagnosed with asthma from March 2014 to September 2015 were enrolled as study subjects, and according to their conditions, they were divided into acute-stage asthma group (40 children) and remission-stage asthma group (35 patients). Another 30 children who underwent physical examination were enrolled as the healthy control group. Flow cytometry was used to determine the percentage of peripheral CD4(+)LAP(+)Treg cells, and [(3)H]-thymidine incorporation assay was performed to analyze the immunosuppression of CD4(+)LAP(+)Treg cells in each group.</p><p><b>RESULTS</b>The acute-stage asthma group showed significant reductions in the proportion of CD4(+)LAP(+)Treg cells compared with the remission-stage asthma group and the healthy control group (2.0%±1.0% vs 4.1%±2.4%/4.6%±3.0%; P<0.05). The acute-stage asthma group also showed a significant reduction in the immunosuppression rate of CD4(+)LAP(+)Treg cells compared with the remission-stage asthma group and the healthy control group (21%±4% vs 55%±9%/62%±11%; P<0.05).</p><p><b>CONCLUSIONS</b>In children with asthma, the reduction in the number and inhibitory function of peripheral CD4(+)LAP(+)Treg cells may be involved in the pathogenesis of asthma.</p>
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Child , Child, Preschool , Female , Humans , Male , Asthma , Allergy and Immunology , T-Lymphocytes, Regulatory , Allergy and ImmunologyABSTRACT
<p><b>OBJECTIVE</b>To study the interactions between hemoglobin (Hb) and other proteins within human erythrocytes by using the electrophoresis release test (ERT) and co-immunoprecipitation.</p><p><b>METHODS</b>First, the fresh normal adult anti-coagulated whole blood was washed to prepare packed RBCs, which were further prepared to erythrocyte suspension and hemolysate.The erythrocyte suspension and hemolysate were analyzed by the electrophoresis release test (ERT) at the same time, and then the band of HbA of erythrocyte sample (RA) and the corresponding band of hemolysate sample (HA) were cut out from the gel and were enriched by freeze-thaw method. Then, the samples were bound with hemoglobin β antibody (37-8) AC, the complexes were separated through 5%-12% SDS-PAGE followed by Q-TOF.</p><p><b>RESULTS</b>Five bands were found in the gel, each of which was treated by hemoglobin β antibody (37-8) AC, the protein bands of 16,20,22,28 and 50 kD were emerged in RA, HA and RBC lysis.The bands were identified by MS, and the results showed that these bands were hemoglobin, band 3, peroxiredoxin2 (Prx2), band 3 and β-actin, band 3 respectively.</p><p><b>CONCLUSION</b>HbA may interact with Prx2, Band 3 and β-actin, and then the complexes are formed with each other within erythrocytes.</p>
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Humans , Electrophoresis, Polyacrylamide Gel , Erythrocytes , Hemoglobins , Immunoprecipitation , ProteinsABSTRACT
<p><b>BACKGROUND</b>Healthcare-associated pneumonia (HCAP) is associated with drug-resistant pathogens and high mortality, and there is no clear evidence that this is due to inappropriate antibiotic therapy. This study was to elucidate the clinical features, pathogens, therapy, and outcomes of HCAP, and to clarify the risk factors for drug-resistant pathogens and prognosis.</p><p><b>METHODS</b>Retrospective observational study among hospitalized patients with HCAP over 10 years. The primary outcome was 30-day all-cause hospital mortality after admission. Demographics (age, gender, clinical features, and comorbidities), dates of admission, discharge and/or death, hospitalization costs, microbiological results, chest imaging studies, and CURB-65 were analyzed. Antibiotics, admission to Intensive Care Unit (ICU), mechanical ventilation, and pneumonia prognosis were recorded. Patients were dichotomized based on CURB-65 (low- vs. high-risk).</p><p><b>RESULTS</b>Among 612 patients (mean age of 70.7 years), 88.4% had at least one comorbidity. Commonly detected pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa, and coagulase-negative staphylococci. Initial monotherapy with β-lactam antibiotics was the most common initial therapy (50%). Mean age, length of stay, hospitalization expenses, ICU admission, mechanical ventilation use, malignancies, and detection rate for P. aeruginosa, and Staphylococcus aureus were higher in the high-risk group compared with the low-risk group. CURB-65 ≥3, malignancies, and mechanical ventilation were associated with an increased mortality. Logistic regression analysis showed that cerebrovascular diseases and being bedridden were independent risk factors for HCAP.</p><p><b>CONCLUSION</b>Initial treatment of HCAP with broad-spectrum antibiotics could be an appropriate approach. CURB-65 ≥3, malignancies, and mechanical ventilation may result in an increased mortality.</p>
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Aged , Female , Humans , Male , Middle Aged , Acinetobacter baumannii , Virulence , Anti-Bacterial Agents , Therapeutic Uses , Community-Acquired Infections , Drug Therapy , Microbiology , Pathology , Hospital Mortality , Hospitalization , Pneumonia , Drug Therapy , Microbiology , Pathology , Pseudomonas aeruginosa , Virulence , Retrospective Studies , Staphylococcus aureus , VirulenceABSTRACT
Objective To investigate the distribution and clinical significance of EGFR mutations in phase Ⅰ non-smallcell lung cancer(NSCLC).Methods We examined 272 consecutive phase Ⅰ NSCLC patients' tumor samples for EGFR mutations in exons 18,19,20 and 21 using the Amplification Refractory Mutation System(ARMS).Results 154 patients (56.62％)were identified with mutations in the series of 272.Of all the mutations identified,2 (1.3％) were aminoacidic substitutions (G719 S) in exon 18,53 (34.4 ％) were in frame deletions (19-del) in exon 19,6 (3.9 ％) were insertional mutations (20-ins) in exon 19 and 97 (63.9 ％) were aminoacidic substitutions (L858 R) in exon 21.There were 11 patients with coexisting mutations in other exons.The probability of the coexisting resistance mutations (20-ins) in exon 21 was significantly higher than that in exon 19 (P ＜ 0.05).Mutations in adenocarcinoma samples (148/223,66.4％) were more frequent than that in squamous carcinoma(2/40,5％),while mutations in adeno-squamous carcinoma were highest in all histologic types (P ＜ 0.05).Conclusion EGFR mutations in phase Ⅰ NSCLC in Shanghai and surrounding areas were 56.62％.Mutations were more frequent in particular histologic types,e.g.adenocarcinoma and adeno-squamous carcinoma.Exon 19 deletion mutations and the substitution mutation L858R in exon 21 are the most frequent in NSCLC.And the probability of coexisting 20-ins mutations in exon 21 was significantly higher than which in exon 19.