Hospitalization Due to Asthma Exacerbation: A China Asthma Research Network (CARN) Retrospective Study in 29 Provinces Across Mainland China

PURPOSE: Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS: A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS: There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.

Clinical features of frequent acute exacerbations of chronic obstructive pulmonary disease in elderly patients / 中华老年医学杂志

Objective:To investigate the clinical features of frequent acute exacerbations of chronic obstructive pulmonary disease(COPD)in the elderly.Methods:A total of 93 elderly patients with stable COPD who were followed up in Bethune Hospital Affiliated to Shanxi Medical University from August 2015 to September 2016 were retrospectively analyzed.They were divided into the frequent acute exacerbation group(n=45)and the non-frequent acute exacerbation group(n=48). Data on the body mass index(BMI), lung function, the smoking index(package year), the respiratory status questionnaire and serum creatinine levels were collected.Logistic regression analysis was used to analyze the influencing factors for the frequency of acute exacerbations of COPD in elderly patients.Results:The BMI was lower [19.59(18.08-23.50)kg/m 2vs. 23.36(21.14-25.46)kg/m 2, Z=8.898, P=0.003], while scores of the modified Medical Research Council(mMRC)dyspnea scale, COPD Assessment Test(CAT)and smoking index were higher [3.00(1.00-3.00) vs. 1.00(0.00-1.00), 15.00(8.50-17.50) vs.10.00(6.00-13.75), 60.00(30.00-80.00)package years vs.37.50(3.75-60.00)package years, Z=17.671, 7.318 and 6.589, P<0.001, 0.007 and 0.010]in the frequent acute exacerbation group than in the non-frequent acute exacerbation group.The glomerular filtration rate(GFR)and percentage of predicted forced expiratory volume in the first second were lower in the frequent acute exacerbation group than in the non-frequent acute exacerbation group [105.13(89.84-114.69)ml·min -1·1.73m -2vs.121.74(93.89-142.02)ml·min -1·1.73m -2, 40.10(31.40-56.00)% vs.70.65(47.36-85.36)%, Z=6.071 and 17.814, P=0.014 and<0.001]. Logistic regression analysis showed that the odds ratios( OR)with 95% confidence interval(95% CI)of the smoking index and GFR were 1.025(1.006-1.044)and 0.957(0.927-0.995)( P=0.009 and 0.025), respectively, indicating that with the increase of smoking index and the decrease of GFR, the risk of frequent exacerbations of COPD was increased. Conclusions:There are phenotypic differences between elderly COPD patients with frequent acute exacerbations and without frequent acute exacerbations.Elderly COPD patients with frequent acute exacerbations have a lower BMI index, a higher smoking index, more clinical symptoms, worse pulmonary function, and are prone to early kidney injury.

Building and application of the nursing management system for pediatric outpatient infusion / 中华医院管理杂志

The nursing management information system for pediatric outpatient transfusion was constructed based on the refined management concept. It is designed to correct the current heavy workload, crowded conditions and low satisfaction. By comparing the indicators before and after the application and those of management concern, the system proves that it can effectively improve the quality of transfusion nursing in pediatric outpatient department, reduce the occurrence of nursing defects, and improve the satisfaction of nurses, patients and parents, hence worthy of promotion.

Seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China / 中华流行病学杂志

Objective: To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China. Methods: This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast, north, central, east, south, northwest and southwest). The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded. The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared. Results: During the study period, 6 480 patients were admitted for asthma exacerbation, accounting for 3.14% of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals. The ratio of asthmatic patients to total inpatients in the northeast area (5.61%) was highest, and the ratio in east area was lowest (1.97%). Statistical analysis showed that the difference among different areas was significant (P<0.000 1). In most areas, both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October). In the northeast area, east area and south area, the peaks in spring were more obvious, while in the north area and southwest area, the peaks in autumn were more obvious. In the northwest area the peaks occurred in winter (December-January) and summer (June-August), respectively. The differences in hospitalization due to asthma among different months were significant in the northeast, north, and southwest areas (P<0.005). Conclusion: The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China. In most areas, more asthmatic patients were admitted to hospitals in spring and autumn.

Seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China / 中华流行病学杂志

Objective To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China.Methods This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast,north,central,east,south,northwest and southwest).The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded.The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared.Results During the study period,6 480 patients were admitted for asthma exacerbation,accounting for 3.14％ of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals.The ratio of asthmatic patients to total inpatients in the northeast area (5.61％) was highest,and the ratio in east area was lowest (1.97％).Statistical analysis showed that the difference among different areas was significant (P＜0.000 1).In most areas,both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October).In the northeast area,east area and south area,the peaks in spring were more obvious,while in the north area and southwest area,the peaks in autumn were more obvious.In the northwest area the peaks occurred in winter (December-January) and summer (June-August),respectively.The differences in hospitalization due to asthma among different months were significant in the northeast,north,and southwest areas (P＜0.005).Conclusion The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China.In most areas,more asthmatic patients were admitted to hospitals in spring and autumn.

Analysis of the sperm DNA fragmentation in different degrees of varicocele infertility patients after high ligation of the spermatic vein / 中国内镜杂志

Objective To analyze the sperm DNA fragmentation in different degrees of varicocele (VC) infertility patients after high ligation of the spermatic vein. Methods There were 57 patients with different degrees of VC infertility patients. 27 patients had been diagnosed with level two VC, and 30 patients had been diagnosed with level three VC. All patients' sperm DNA fragmentation index (DFI) were detected and calculated at preoperative one month and postoperative three months. Results 57 VC infertility patients were all suffered from laparoscopic high ligation of the spermatic vein on both sides. There was no statistically difference on preoperative sperm DFI between level two and level three patients (P > 0.05). All patients' sperm DFI were decreased after laparoscopic (P < 0.05), and level two VC infertility patients had significant greater progress than level three patients (P < 0.05). Conclusion Laparoscopic high ligation of the spermatic vein can effectively improve VC infertility patients sperm DFI. It would be better for level two VC infertility patients.

Clinical study of preventive effect of traditional Chinese medicine wet compress on vein puncture sclerosis / 中国基层医药

Objective To investigate the effect of self decoction wet compress on puncture venous sclerosis.Methods 180 patients received intravenous therapy,they were randomly divided into group A,group B and group C,60 cases in each group.Group A was given with Traditional Chinese medicine decoction(rhubarb 20g,Xuan Ming powder 20g,Cortex Phellodendri 15g,20g purslane fried together) for in the direction of blood vessel along the direction of the blood vessel after operation of conventional intravenous infusion,8 layer 10cm×5cm sterile gauze soaked wet,then covered with plastic wrap plastic to the end of infusion 30 min after removal.Group B was given with Traditional Chinese medicine decoction at the end of intravenous infusion at the puncture point along the direction of the blood vessels,8 layer 10cm×5cm sterile gauze soaked wet and then with plastic wrap plastic cover 6h after removing.Group C was given with routine intravenous infusion operation without wet compress intervention.In 3d,5d,vein elasticity of each group was assessed,the normal was effective,mild,moderate and severe hardening was invalid.Results After 3d,5d treatment,the effective rates of group A were 100.0%,91.7% respectively,which in group B were 100.0%,81.7%,respectively,the effective rate at 5d had statistically significant difference between group A and group B (x2=5.17,P<0.05);after 3d,5d treatment,the effective rates of group C were 71.7%,60.0%,and the effective rate at 5 d had statistically significant difference compared with group B and group A (x2=21.07,6.82,all P<0.01).Conclusion The effect of intravenous infusion process to local decoction wet compress on the prevention of venous puncture hardening is significant,and the method is simple,has non-toxic side effects,it is worthy of clinical application.

Novel guidance system assistance percutaneous pedicle screw placement for thoracolumbar vertebral fracture without nerve injury / 局解手术学杂志

Objective The aim of this study was to compare recent clinical efficacy between a novel guidance method for percutaneous pedicle screw placement and the conventional fluoroscopic method for long segments thoracolumbar vertebral fracture without nerve injury. Methods A total of 38 patients with thoracolumbar vertebral fracture in our hospital from September 2010 to December 2012 were divided into group A and group B.Eighteen patients in group A underwent 200 percutaneous pedicle screw fixation by conventional fluoroscopic meth-od.Twenty patients in group B underwent 210 percutaneous pedicle screw fixation by a novel guidance method.All the operation for 38 cases were performed by the same surgeon.The time of insertion,radiation exposure,and accuracy of the screw placement between the two groups were compared.The accuracy of screws was evaluated and graded by two consecutive postoperative CT of operation segment for two groups. Results The mean time for a single pedicle screw placement was (13.11 ±2.32)minutes in group A and (10.35 ±1.92)minutes in group B,respectively.The average radiation exposure was (8.11 ±1.15)s in group B and (13.07 ±2.06)s in group A respectively.The differ-ences were statistically significant for both screw placement and radiation exposure times (P 0.05).Conclusion The novel guidance system can significantly reduce the insertion time and radiation expo-sure for long segments percutaneous pedicle screw placement,which provides the same accuracy for screw placement compared with the con-ventional method.

Clinical Observation of Sertraline in the Treatment of Diabetes Patients Complicated with Depression / 中国药师

Objective:To investigate the effect and safety of sertraline tablets with oral administration in the diabetes patients com-plicated with depression. Methods:Totally 74 diabetes patients complicated with depression were randomly divided into 2 groups with 37 ones in each. All the patients were orally given dimethyldiguanide 500 mg,tid,and the observation group was given sertraline tablets additionally,50-100 mg,qd. The treatment course was 8 weeks. The changes of sugar metabolism and the scores of self-rating depres-sion scale( SDS)and quality of life scale( DMQLS)in the two groups were compared. Results:After the 8-week treatment,the blood sugar,SDS scores and DMQLS scores in the two groups were significantly improved when compared with those before the treatment( P0. 05). Conclusion:Sertraline tablets can improve the depression of diabetes patients and enhance the blood sugar control and quality of life.

Misdiagnosed allergic granulomatous vasculitis as bronchial asthma: 1 case and literature review / 中华全科医师杂志

The clinical characteristics of Churg-Strauss syndrome (CSS) were summarized to improve the understanding of disease and reduce its misdiagnostic rate.Report clinical data,treatment and follow-up of one confirmed case and review the domestic reports of CSS before 2013.Among 94 reported cases,most had initial respiratory symptoms and increased eosinophil was found in peripheral blood of 95.74％ patients.