Clinical features and risk factors associated with severe COVID-19 patients in China / 中华医学杂志(英文版)

BACKGROUND@#Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the world. In this study, we aimed to identify the risk factors for severe COVID-19 to improve treatment guidelines.@*METHODS@#A multicenter, cross-sectional study was conducted on 313 patients hospitalized with COVID-19. Patients were classified into two groups based on disease severity (nonsevere and severe) according to initial clinical presentation. Laboratory test results and epidemiological and clinical characteristics were analyzed using descriptive statistics. Univariate and multivariate logistic regression models were used to detect potential risk factors associated with severe COVID-19.@*RESULTS@#A total of 289 patients (197 nonsevere and 92 severe cases) with a median age of 45.0 (33.0, 61.0) years were included in this study, and 53.3% (154/289) were male. Fever (192/286, 67.1%) and cough (170/289, 58.8%) were commonly observed, followed by sore throat (49/289, 17.0%). Multivariate logistic regression analysis suggested that patients who were aged ≥ 65 years (OR: 2.725, 95% confidence interval [CI]: 1.317-5.636; P = 0.007), were male (OR: 1.878, 95% CI: 1.002-3.520, P = 0.049), had comorbid diabetes (OR: 3.314, 95% CI: 1.126-9.758, P = 0.030), cough (OR: 3.427, 95% CI: 1.752-6.706, P < 0.001), and/or diarrhea (OR: 2.629, 95% CI: 1.109-6.231, P = 0.028) on admission had a higher risk of severe disease. Moreover, stratification analysis indicated that male patients with diabetes were more likely to have severe COVID-19 (71.4% vs. 28.6%, χ2 = 8.183, P = 0.004).@*CONCLUSIONS@#The clinical characteristics of those with severe and nonsevere COVID-19 were significantly different. The elderly, male patients with COVID-19, diabetes, and presenting with cough and/or diarrhea on admission may require close monitoring to prevent deterioration.

Sampling survey on the prevalence of skeletal fluorosis in the coal-burning-borne fluorosis affected areas of Chongqing / 中华地方病学杂志

Objective:To master the epidemic status and characteristics of skeletal fluorosis in the coal-burning-borne fluorosis affected areas of Chongqing, and to provide a scientific basis for formulating accurate prevention and control strategy for elimination of coal-burning-borne fluorosis.Methods:Stratified sampling method was used to select the villages with mild, moderate and severe coal-burning-borne fluorosis in Wushan and Pengshui, respectively in January-November 2018. The number of villages surveyed in each area was determined by the proportion of 5% to 10% of the actual number of the diseased villages. To investigate the resident population, all the adults over 25 years old in the village were examined for skeletal fluorosis through clinical and X-ray examination, and were diagnosed according to the "Diagnostic Criteria of Endemic Skeletal Fluorosis" (WS 192-2008). The prevalence of skeletal fluorosis in different disease areas, different sexes, different ages (25 -, 35 -, 45 -, 55 -, ≥65 years old) were compared and analyzed. The number of cases of skeletal fluorosis in Chongqing was calculated according to the 2015 population survey data.Results:A total of 7 768 adults over 25 years old were investigated in 15 villages of 10 townships in 2 counties, and 478 people were diagnosed clinically as skeletal fluorosis, and the clinical detection rate was 6.15%. There were differences in the clinical diagnosis of skeletal fluorosis among different disease areas (χ 2 = 183.23, P < 0.01). There were significant differences among different age groups (χ 2 = 406.73, P < 0.01). But no difference was found among different sex groups (χ 2 = 0.32, P > 0.05). A total of 690 people were diagnosed as skeletal fluorisis by X-ray, the X-ray detection rate was 8.88%, and moderate and severe skeletal fluorosis detection rate was 4.20% (326/7 768). The X-ray diagnosis rates of skeletal fluorosis were different among different disease areas (χ 2 = 46.25, P < 0.01) and different age groups (χ 2 = 384.60, P < 0.01). There was no difference between different sexes groups(χ 2 = 1.77, P > 0.05). According to the different disense in Chongqing, there were about 48 770 cases of skeletal fluorosis diagnosed clinically and 72 630 cases diagnosed by X-ray. Conclusions:The more serious the disease area is, and the older the people's age is, the higher the prevalence of skeletal fluorosis will be. In the future, it is of great important to investigate the prevalence of skeletal fluorosis in coal-burning-borne fluorosis areas in Chongqing.

The application of Whole-Mount immuno fluorescence staining technique in the study of lymphatic morphology in mice / 中华整形外科杂志

Objective@#To elaborate the characteristics and advantages of Whole-Mount immune fluorescence staining by observing the lymphatic vessels of mice.@*Methods@#The ear skin tissue, the hindlimb lymphatic vessels and the mesenteric lymphatic vessels were harvested from normal C57 mice. The tissue samples were subjected to whole-tissue immunofluorescence staining.These tissue samples were fixed by paraformaldehyde, blocked by bovine serum and incubated in primary and secondary antibodies. Then, the lymphatic vessels were observed and analyzed in these samples with a confocal laser-scanning microscope.@*Results@#The capillary lymphatic vessels and lymphatic endothelial cells can be clearly showed in the ear skin. The valves and smooth muscles can be clearly showed in the hindlimb and mesenteric lymphatic vessels by Whole-Mount immunofluorescence staining.@*Conclusions@#The whole-tissue immunofluorescence staining technique can observe the external morphology of lymphatic vessels clearly and stereoscopically, and can deeply observe the internal structure of lymphatic vessels. This technique can provide more accurate study on physiology and pathology of lymphatic vessels.

Preliminary study on polyetheretherketone implant applied to cranioplasty of skull defect / 天津医药

Objective To study on the procedure, safety and effectiveness of polyetheretherketone (PEEK) implant applied to cranioplasty of skull defect. Methods A total of 11 cases (10 male, 1 female) of unilateral skull defect, more than 6 months post operation, were included in this study. PEEK implant was custom-made by three-dimensional numerically controlled processing depended on the data obtained from 1 mm-slice CT scan before cranioplasty individually. Autoclaved implants were applied to cranioplastic surgeries under general anesthesia. Findings of imaging examination and vital signs were compared before and after operation. Vital sign changes and circumstances during procedure were noted, and following-up reviews were performed on 2-week, 3-month and 1 year after operation respectively. Results Wounds healing were uneventful in 11 cases, no postoperative paresthesia presented. Surgical complications including temporary subcutaneous exudates were cleared up by puncture and aspiration in 5 cases, subcutaneous hematoma duo to drainage removal in 1 case, of which an emergency evacuation was performed and the implant was still with instant incision closure and then smooth recovery eventually. No significant abnormal fluctuation of laboratory examination was reported, moreover no artifact interference was found on postoperative CT scan or MR image. The subjective feelings and external sensory effects are satisfactory in patients. No emerging dysfunction of central nervous system or other organs was found, and no long-term complication was appeared. Conclusion It is feasible and safe to apply PEEK implant to cranioplasty without additional operative difficulty. This kind of material is an ideal alternative for repairing skull defect to patients with good financial condition and specific demands for postoperative status especially.

pharmacodynamic simulation to evaluate tigecycline in treatment of nosocomial pneumonia caused by multidrug-resistant Acinetobacter baumannii

The shortage of effective antibiotics against multidrug-resistant Acinetobacter baumannii [MDR-Ab] has posed great threat to the public health. But the advent of tigecycline gives us new hope. The goal of our research was to assess the clinical efficacy of tigecycline at different doses by using a pharmacokinetic/pharmacodynamic [PK/PD] model which can incorporate pharmacokinetic data of tigecycline from patients with pneumonia and MICs of MDR-Ab from a tertiary hospital. A 10000-patient Monte-Carlo Simulation based on the PK/PD model was conducted to calculate the probability of target attainment [PTA] and the cumulative fraction of response [CFR] of tigecycline. 97% isolates displayed susceptibility and 3% were tigecycline-intermediate strains and the values of MIC ranged from 0.125 to 4microg/ml. A CFR of 61.62% was predicted for tigecycline at current dosage [50 mg q12h]. When the dosage was increased, the predicted CFRs for 75 mg q12h, 100 mg q12h, 125 mg q12h, 150 mg q12h were 81.00%, 89.86%, and 94.57%, 96.77%, respectively. Despite presented higher susceptibility, the CFR obtained was not optimal at current dosage. A higher CFR indicating a better clinical efficacy can be gained by the increased dosage.

The Expression of CTGF in Condyle Cartilage under Asymmetric Masticatory Force / 昆明医科大学学报

Objective To investigate the effect of the asymmetric of masticatory force on the remodeling of bilateral mandibular condylar cartilage of SD rats. Methods The animal models were established respectively by excising the unilateral temporalis, and injecting botulinum toxin A into the unilateral masseter. Dividing three batch processing 3 weeks, 6 weeks, and 9 weeks after the animal modeling, six rats were killed in each group. The expression of CTGF in condylar cartilage was observed by immunohistochemical staining. Results CTGF expressed in proliferative layer,chondroblast layer and hypertrophic layer of the condylar cartilage. The expression of CTGF in the experimental groups was increased than control groups (0.05), the expression of CTGF after 6 weeks of operation was stronger than the group after 3 weeks of operation, the expression of CTGF after 9 weeks of operation was the strongest than all of other groups ( <0.05) . Conclusions The asymmetric of masticatory force can up-regulate the expression of CTGF mRNA in rat mandibular condylar chondrocytes. CTGF induces the effect of stress-mediated on the mandibular condylar cartilage remodeling.

Regulative effect of substance P on proliferation of human skin fibroblast and expression of its monocyte chemoattractant protein-1 under high glucose condition / 中华创伤杂志

Objective To investigate effects of exogenous substance P (SP) on proliferation of humau skin fibroblast (HSF) and expression of its monocyte chemoattractant protein-1 (MCP-1) under high glucose condition.Methods HSF cultured in high glucose DMEM medium were treated with SP of various concentrations at different time points.Levels of MCP-1 in the supernatants were determined by ELISA and time-effect relationship of SP regulating expression of MCP-1 was analyzed.Expression of MCP-1 mRNA in HSF was detected by semi-quantitative RT-PCR and Real Time-PCR,Conclusion,while cxpression of MCP-1 by Western blot.Proliferation of HSF treated with SP of different concentrations was detected by cell counting Kit-8 (CCK-8).Results MCP-1 had a strong expression at 8 hours after SP disposal (P ＜0.05) and reached the peak at 24 hours (P ＜ 0.01).Meanwhile,MCP-1 expressed the most at 10 nmol/L and 100 nmol/L SP (P ＜0.01).SP significantly enhanced the expression of MCP-1 mRNA and its synthesis under high glucose condition,especially at the concentration of 10 nmol/L (P ＜0.01).Also,SP induced obvious proliferation of HSF at concentrations of 10 nmol/L and 1 000 nmol/L(P ＜ 0.05).Conclusion SP promotes proliferation of HSF and expression of MCP-1 in high glucose DMEM medium,which may be of significance in promoting diabetic wound healing.

Effect of granulocyte/macrophage colony-stimulating factor on expression of vascular endotllelial growth factor in human dermal fibroblasts / 中华医学美学美容杂志

Objective To study the effects of granulocyte-macrophage colony stimulating factor (GM-CSF) on the expression of vascular endotllelial growth factor (VEGF) in human dermal fibroblast. Methods In vitro human dermal fibroblasts in good status were incubated with GM-CSF (GM-CSF group) or non-GM-CSF (control group) culture medium for different periods of time. The mRNA, protein expression of VEGF in derma fibroblast were determined by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting, respectively, and the secretion of VEGF in supernatant was measured by enzyme linked immunosorbant assay (ELISA). Results The expression of VEGF mRNA from dermal fibroblasts was increased significantly after l or more hours of incubation with GM-CSF comparing with the control (P＜0.05). 6 hours of stimulation by GM-CSF caused maximal expression of VEGF mRNA. The expression of VEGF protein in dermal fibroblasts was increased from 12 hours and was peaked at 24 hour after stimulation by GM-CSF. VEGF protein from the supernatant of the dermal fibroblasts was also raised persistently from 12 hour after stimulation by GM-CSF and was improved remarkably compared with the control. Conclusions GM-CSF can up-regulate directly the expression of VEGF in human derma fibroblast, which may be one of the mechanisms that GM-CSF accelerates neovascularization in wound healing.

Asymptomatic patients of chronic obstructive pulmonary disease in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Chronic obstructive pulmonary disease (COPD) has a variable natural history and not all individuals follow the same course. This study aimed to identify the prevalence and characteristics of asymptomatic COPD patients from a population-based survey in China.</p><p><b>METHODS</b>A multistage cluster sampling strategy was used in a population from seven different provinces/cities. All residents (over 40 years old) were interviewed with a standardized questionnaire and spirometry. Post-bronchodilator forced expiratory volume in 1 second (FEV(1))/forced vital capacity (FVC) of less than 70% was defined as the diagnostic criterion of COPD. All COPD patients screened were divided into symptomatic group and asymptomatic group according to the presence or absence of chronic respiratory symptoms. Socio-demographic, personal and exposure variables were collected and analyzed.</p><p><b>RESULTS</b>Among the 1668 patients who were diagnosed with COPD from the 25 627 sampling subjects, 589 (35.3%) were asymptomatic. The age, sex, body mass index (BMI), rural and urban distributions, smoking habit and education levels were similar in the two groups. A total of 64.7% of the asymptomatic patients had no comorbidities. Cardiovascular diseases and lung cancer were more common among symptomatic COPD patients than asymptomatic group. Asymptomatic COPD group were less likely to present with poor ventilation in the kitchen, a family history of respiratory disease and recurrent childhood cough. Asymptomatic COPD patients had significantly higher FEV(1) (73.1% vs. 61.0%), FVC (91.9% vs. 82.0%), and a higher ratio of FEV(1)/FVC (62.9% vs. 58.7%) (all P < 0.001) than symptomatic group. More asymptomatic patients were underdiagnosed (91.9% vs. 54.3%, P < 0.001) than symptomatic patients.</p><p><b>CONCLUSIONS</b>This large population-based survey confirmed a high prevalence of asymptomatic COPD patients in China. More use of spirometry screening test may be important to the early detection of COPD.</p>

Expression of neuropeptide substance P during wound healing of deep partial thickness scalding in diabetic rats / 上海第二医科大学学报

Objective To study the expression and change of neuropeptide substance P (SP) during the wound healing of deep partial thickness scalding in diabetic rats. Methods Eighty-four Wistar rats were randomly divided into diabetes mellitus group (n=42) and control group (n=42). Diabetic rat models were established by intraperitoneal injection of streptozotocin (STZ) in diabetes mellitus group, and those in control group were intraperitoneally injected with aseptic citrate buffer solution. Deep partial thickness scalding with diameter of 2 cm on the back were prepared in all the rats. The pre-scalding and post-scalding wound specimens of different time points were obtained, and the percentages of wound closure were calculated. The wound specimens were also obtained for immunohistological staining to compare the areas with positive staining of SP, and ELISA was employed to detect the expression of SP in the wound tissues. Results The percentage of wound closure was significantly lower in diabetes mellitus group than that in control group from 7 days post-scalding (P< 0.01). The areas with positive staining of SP in diabetes mellitus group were much smaller than those in control group at different time points, which was most significant on the seventh day post-scalding[(1 350.93±99.28) μm2 vs(1 715.86± 103.41) μm2](P < 0.01). The expression of SP in the wound tissues was significantly lower in diabetes mellitus group than that in control group at different time points, which was most significant on the seventh day post-scalding[(114.04±9.96) vs(143.39±8.94)](P<0.01). Conclusion The significantly lower expression of SP in wound site may be one of the causes of delayed wound healing in diabetic rats.

Effects of external substance P on scalding wound healing and neovascularization in diabetic rats / 上海交通大学学报（医学版）

Objective To evaluate the effects of external substance P (SP) on scalding wound healing and neovascularization.Methods Eighty-four Wistar rats were induced into diabetic models by intraperitoneal injection of streptozotocin (STZ), and deep partial thickness scalding wound on the back with diameter of 2 cm was prepared. Rats were randomly divided into experiment group (n=42, local injection of SP) and control group (n=42, local injection of PBS). The process of wound healing was observed, and the percentages of wound closure were calculated on D0, D1, D3, D7, D10, D14, D21 post scald. The expression of CD31, surface marker of neovascular endothelial cells, was detected within the wound sites by immunohistochemical staining, and the microvessel density was calculated. Results The percentage of wound closure in experiment group was significantly higher than that in control group on D7 post scald [(42.69±3.26) % vs (30.24±1.17)%, P<0.01]. Immunohistochemical detection revealed that the expression of CD31 and the microvessel density in experiment group were significantly higher than those in control group from D7 post scald (P<0.01). ConclusionExternal SP may promote scalding wound healing in diabetic rats, the mechanism of which may be associated with upregulation of expression of CD31 and acceleration of neovascularization.

Effect of high glucose on expression of MIP-2 and MCP-1 in macrophages cultured in vitro / 上海第二医科大学学报

0.05).The protein and mRNA expression of MIP-2 in high glucose group significantly increased after culture for 4 h,and guadually decreased then.The protein and mRNA expression of MCP-1 began to increase significantly after culture for 8 h,reached peak at 12 h,and slightly decreased after culture for 24 and 48 h. Conclusion High glucose promotes the protein and mRNA expression of MIP-2 and MCP-1 from mouse peritoneal macrophages cultured in vitro,which indicates that high glucose may delay the wound healing by increasing the expression of chemokines in diabetic mice.

Cost analysis of Shenqi Fuzheng injection on reducing adverse effects during chemotherapy / 中华流行病学杂志

<p><b>OBJECTIVE</b>The goals of this work was to analyse the cost of Shenqi Fuzheng injection-an extraction of a Chinese traditional herbs on reducing adverse effects in lung cancer patients during chemotherapy.</p><p><b>METHODS</b>In a randomized cross-over trial, each patient completed two identical cisplatin-based chemotherapy cycles, one with Shenqi Fuzheng injection, another without Shenqi Fuzheng injection. Adverse effects and change scores of quality of life (QOL) during chemotherapy were compared in tow cycles. The direct cost dealing with adverse effect and cost-effectiveness analysis were taken.</p><p><b>RESULTS</b>One hundred and thirty were enrolled with 123 of whom were evaluable. The patient characteristics were well balanced between the two groups. The chemotherapy cycles with Shenqi Fuzheng injection spent 220.5 more Chinese yuan, but the adverse effect of leukopenia, thrombocytopenia and vomiting were slight different and the change of score of several QOL domains showed significant better as compared to those in another cycle.</p><p><b>CONCLUSION</b>Shenqi Fuzheng injection could reduce the severity of toxicity related to chemotherapy and improve the QOL of patients and had some benefits in terms of cost-effectiveness.</p>