Risk Factors and Countermeasures of Occupational Exposure of Medical Personnel under COVID-19 Epidemic / 中国医学伦理学

The COVID-19 is a severe respiratory pathogen infection, showing a distinct "hospital cluster" transmission characteristics. This paper illustrated the concept of occupational exposure and COVID-19. Combined with the actual situation of COVID-19, the infection status of medical personnel in this outbreak was analyzed from three aspects: the transmission risk and infection rate of medical personnel, the clinical characteristics and the undiscovered super-spreader. Through the analysis of the present situation, this paper summarized the possible occupational exposure risk factors of medical personnel in COVID-19 from five aspects: biological occupational risk factors, chemical occupational risk factors, physical occupational risk factors, violence factors and psychological factors. From isolating the source of infection and cutting off the transmission route, the "safety supervisor" mechanism is established to avoid the risks of biological, chemical and physical occupational exposure, from providing professional psychological counseling for medical personnel to reduce their psychological stress, and from improving the relevant legal level to reduce the risk of medical personnel’s violent occupational exposure.

Clinical Observation of Immunotherapy Efficacy and Adverse Effects in Chinese Patients with Lung Squamous Cell Carcinoma / 中国肺癌杂志

BACKGROUND@#Immune checkpoint inhibitors (ICIs) improved survival of partial patients with lung squamous cell carcinoma (LUSC). However, it was still insufficient of data in older patients. This study aimed to investigate the efficacy and toxicity of immunotherapy in patients with LUSC in Chinese population of real world.@*METHODS@#A total of 185 LUSC patients underwent pathological diagnosis were involved from January 2018 to January 2022. Patients were divided into elderly group (age ≥70 years) and younger group (age <70 years). The efficacy of mono-immunotherapy or combined with chemotherapy to chemotherapy in first-line treatment was compared. The expression of programmed cell death ligand 1 (PD-L1) and tumor mutational burden (TMB) were evaluated. Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 was used to evaluate the efficacy, and Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 was used to evaluate immune-related adverse. Kaplan-Meier and Log-rank test was performed. Cox regression was used in prognostic analysis.@*RESULTS@#Combined therapy acquired significantly higher overall response rate (ORR) compared with chemotherapy alone in elderly group (P<0.05), and also in younger group, despite the difference was not significant (P>0.05). The median progression-free survival (mPFS) and median overall survival (mOS) in elderly group were similar with younger group (P>0.05). Both combined group and immunology alone demonstrated prolonged mPFS in first-line compared with chemotherapy in elderly group. And combined group demonstrated significantly prolonged mPFS compared with chemotherapy in younger group (P<0.01). There was no difference of mOS between different regimes in two groups. Elderly LUSC patients had higher PD-L1 positive rate (≥1%) and similar TMB compared with younger group. There was no relationship between mPFS and mOS with the expression of PD-L1 and TMB. Immunology combined with chemotherapy demonstrated better mPFS compared to chemotherapy in first-line therapy with TMB-High (P<0.05), and inferior mPFS with TMB-Low despite the difference was not significant (P>0.05). Cox regression model demonstrated that clinical stage was an independent predictor and prognostic factor. The incidence of immune-related adverse was 58.0% (51/88) and grade 3 or above 25.0% (22/88). The most common grade 3 adverse events were rash, immune-associated pneumonia, and fatigue.@*CONCLUSIONS@#Immunology combined with chemotherapy increased ORR, mPFS and mOS of Chinese patients with LUSC in first-line therapy compared with chemotherapy. There was no difference of efficacy and adverse effects rate between elderly group and younger group. The adverse effects of immunology in elderly patients with LUSC were controllable.

Clinical observation of immunotherapy efficacy and adverse effects in elderly patients with lung squamous cell carcinoma / 中华老年医学杂志

Objective:To investigate the efficacy and adverse reactions of immunotherapy in elderly patients(≥65 years old)with lung squamous cell carcinoma(LUSC)in Chinese population of real world.Methods:A total of 113 elderly LUSC patients(age ≥65 years old)underwent pathological diagnosis were involved from January 2018 to January 2022.To compare the efficacy of mono-immunotherapy or combined with chemotherapy to chemotherapy in first-line and second-line treatment.44 patients received surgical or minimally invasive treatment, and 69 patients received first-line medical treatment, including 27 patients in chemotherapy group, 24 patients in combined chemotherapy group, and 11 patients in single drug immunization group.7 cases in targeted therapy group.Twenty-eight patients received second-line medical treatment, including 8 patients in chemotherapy group, 11 patients in combined immunochemotherapy(combined group), 4 patients in single drug immunotherapy group, and 5 patients in targeted therapy group.The therapeutic effects and adverse reactions were compared between the first-line and second-line treatments.The expression of programmed death-ligand 1(PD-L1)and tumor mutational burden(TMB)were evaluated.Response evaluation criteria in solid tumors(RECIST)version 1.1 was used to evaluate the efficacy, and common terminology criteria for adverse events(CTCAE)version 4.03 was used to evaluate immune-related adverse.Kaplan-meier and log-rank test was performed.Cox regression was used in prognostic analysis.Results:The total effective rate in the first-line combination group was 73.7%(14/19), higher than that in the chemotherapy group(24.0%, 6/25), and the difference was statistically significant( χ2=10.748, P<0.01). Median progression-free survival(mPFS)was longer in the first-line combination group, the immunization group, and the chemotherapy group, and the median overall survival(mOS)was longer in the combination group, but the differences were not statistically significant(all P<0.05); mOS in the second-line combined group were longer than those in the chemotherapy group, both P<0.01). Elderly patients with lung squamous cell carcinoma had high PD-L1 positive rate(≥1%)and high TMB expression rate(≥9 mut/Mb), 81.6%(31/38)and 57.4%(31/54), respectively.mPFS in the PD-L1 positive group(≥1%)was better than that in the PD-L1 negative group(5.10 months vs.0.93 months, P<0.05). Among PD-L1 positive patients, mPFS in the second-line combination group was better than that in the chemotherapy group(7.33 months vs.2.77 months, P<0.05). mPFS and mOS time were not related to TMB expression.The overall incidence of immune-related adverse reactions was 62.0%(31/50), and 26.0%(13/50)with grade 3 or above.The most common grade 3 adverse events were rash, immune-associated pneumonia, and fatigue. Conclusions:Immunology combined with chemotherapy increased objective response rate, mPFS and mOS of elderly patients with LUSC group in first-line therapy compared with chemotherapy.In second-line treatment, the mOS was significantly prolonged in both combination therapy and mono-immunotherapy, and the combination therapy exhibited no benefit in OS compared with monotherapy.The adverse effects of immunology in elderly patients with LUSC were controllable.

Incidence and risk factors of retinopathy of prematurity in extremely preterm infants / 中华眼底病杂志

Objective:To investigate the incidence and risk factors of retinopathy of prematurity (ROP) in extremely preterm infants (EPI) before 28 weeks of gestation during 8-years period.Methods:A retrospective study. From January 1, 2011 to December 31, 2018, 300 EPI infants with a gestational age of less than 28 weeks admitted to the neonatal intensive care unit (NICU) of Tianjin Central Hospital of Gynecology Obstetrics were included in the study. EPI birth gestational week (GA), birth weight (BW), gender and other basic information, as well as neonatal respiratory distress syndrome, oxygen (≥10 d), bronchopulmonary dysplasia (BPD) and other hospitalizations and complications were recorded. According to ROP international classification standards, ROP was staged. Severe ROP was defined as ROP that requires treatment. The screening start time, screening interval, and intervention time of all children tested were carried out in accordance with the requirements of the "Guidelines for Screening Retinopathy of Prematurity" until the end of follow-up. The most severe ROP during the follow-up of each examined child was recorded as the final screening result of the examined child, and those with asymmetric eyes with the screening results of the severe side of the diseas was recorded. A retrospective analysis of the overall incidence of EPI ROP showed the incidence of severe ROP, and the first and second stages of EPI ROP during the 8 years (from January 1 , 2011 to December 31, 2014, and January 1, 2015 to December 31, 2018), changes in the rate of severe illness. Logistic regression analysis was used to screen independent risk factors for severe ROP.Results:Among 300 EPI infants, the average GA was (26.7±1.8) weeks; the average BW was (993.3±178.7) g. Two hundred and five infants (68.3%) were diagnosed with ROP, 116 (56.6%), 57 (27.8%), and 32 (15.6%) infants of stage Ⅰ, Ⅱ, and Ⅲ disease, respectively. There were no infants of stage IV and V. There were 30 infants (14.6%) with additional lesions and 59 infants (19.7%) with severe ROP requiring treatment. With the increase of GA ( χ2=52.391, 44.521; P=0.000, 0.000) and BW ( χ2=43.772, 26.138; P=0.000, 0.000), the incidence of EPI ROP and the incidence of severe ROP decreased significantly. From 2011 to 2018, the number of people surviving EPI obviously increased, especially those with small GA (26 weeks) and low BW (750 g). The average GA of the second stage EPI was lower than that of the first stage, the difference was statistically significant ( t=2.243, P=0.026); the average BW of the second stage EPI was lower than the first stage, the difference was not statistically significant ( t=1.428, P=0.154). The incidence of ROP in the second stage EPI was slightly higher than that in the first stage, and the incidence of severe ROP was lower than that in the first stage, the difference was not statistically significant ( χ2=1.069, 1.723; P=0.301, 0.189). Multivariate logistic regression analysis showed that GA<27 weeks ( β=-2.584, P=0.032), maternal chorioamnionitis (CA) ( β=-0.935, P=0.038) and BPD ( β=-1.432, P=0.001) was an independent risk factor for severe ROP. Conclusions:The incidence of EPI ROP and severe ROP are 68.3% and 19.7%, respectively. From 2011 to 2018, the number of survivors of EPI obviously increase, and those with small GA and low BW increase significantly; however, the incidence of ROP and severe ROP remaine stable. GA, CA and BPD are independent risk factors for severe ROP.

Mortality of extremely preterm infants born at 22 +0-25 +6 gestational weeks in a single center and comparison with data from other countries / 中华围产医学杂志

Objective:To analyze the mortality of extremely preterm infants(EPIs) born at 22 +0-25 +6 weeks of gestation in Tianjin Central Hospital of Obstetrics and Gynecology and then compare it with data from other countries to provide evidence for better healthcare for this population. Methods:Clinical data of EPIs born at 22 +0-25 +6 gestational weeks in our center from January 2011 to December 2017 were retrospectively collected. The enrolled patients were grouped based on their gestational age, birth weight, and admission time in order to analyze the mortality in different groups. According to the inclusion and exclusion criteria, five sets of data regarding the mortality of EPIs born at 22 +0-25 +6 gestational weeks during the same period were retrieved from a multicenter survey involving 15 centers in China, the National Institute of Child Health and Human Development Neonatal Research Network (NICHD-NRN) in the United States, Canadian Neonatal Network TM, Australian and New Zealand Neonatal Network (ANZNN) and Korean Neonatal Network (KNN). The mortality rate among data from different sources was compared using Chi-square test on the condition that the definition of death was the same. Besides, the causes of neonatal death were analyzed. Results:A total of 64 EPIs were enrolled in our center. The total mortality rate was 42.2% (27/64), and were 1/1, 8/10, 50.0%(10/20) and 24.2%(8/33) in EPIs of gestational age of 22 +0-22 +6, 23 +0-23 +6, 24 +0-24 +6 and 25 +0-25 +6 weeks, 5/6, 50.0%(16/32), 25.0%(6/24) and 0/2 in those with birth weight of ≤600 g, >600-≤800 g, >800-≤1 000 g and >1 000 g, respectively. In the 27 death cases in our center, the causes of death were as follows: neonatal respiratory distress syndrome (16 cases, 59.3%), sepsis (two cases, 7.4%), necrotizing enterocolitis (three cases, 11.1%), severe intraventricular hemorrhage (three cases, 11.1%) and others (three cases, 11.1%). The mortality rate was 57.1%(12/21) before 2016(2011-2015), 45.0%(9/20) in 2016 and 26.1%(6/23) in 2017. The total mortality of EPIs in our center was higher than that in Canada [42.2% vs 26.6%(165/621), χ2=7.015, P=0.008], as well as in Australia and New Zealand [42.2% vs 28.2%(140/497), χ2=5.330, P=0.021], while there was no statistically significant difference when compared with that in South Korea [42.2% vs 42.1%(218/518), χ2<0.001, P=0.988]. Conclusions:The mortality of EPIs born at 22 +0-25 +6 gestational weeks is higher in our center when compared with that in some developed countries such as Canada and Australia. Therefore, we should pay more efforts to reduce the mortality of EPIs through quality improvement.

Association between circular RNAs expression in serum and gastric cancer / 中华流行病学杂志

Objective@#To analyze the association between circular RNAs expression in serum and gastric cancer and evaluate the potential of the related markers in early diagnosis of gastric cancer.@*Methods@#Forty eight gastric cancer cases in Linqu County People’s Hospital were selected as case group, and 48 controls matched by age and sex were randomly selected in the gastric cancer screening cohort during the same period. The expression levels of hsa_circ_002059, hsa_circ_0000096 and hsa_circ_0001895 were detected by quantitative real-time PCR. The results were compared between case group and control group.@*Results@#The positive expression rates of hsa_circ_002059, hsa_circ_0000096 and hsa_circ_0001895 were 70.8%, 47.9%, 75.0% in case group, slightly higher than those in control group (58.3%, 31.3%, 60.4%), although P values were all more than 0.05. The expression level medians of the 3 candidate circRNAs expression levels were 1.60% (0-5.64%), 0 (0-0.61%), 0.91% (0.06%-1.88%) in case group, while 0.05% (0-6.07%), 0 (0-0.34%), 0.42% (0-1.39%) in control group, respectively. Conditional logistic regression analysis showed that the association strength of high expressions of 3 candidate circRNAs with gastric cancer showed an increase trend, but the differences had no significance after adjusted by Helicobacter pylori infection, smoking and drinking status (all P>0.05). Further analysis by combining the 3 candidate circRNAs showed the increased strength of association between circRNAs and gastric cancer with the elevated number of positive circRNAs in serum (trend test P=0.040) compared with circRNAs negative persons.@*Conclusion@#Our study preliminarily suggested that the expression of hsa_circ_002059, hsa_circ_0000096 and hsa_circ_0001895 in serum might be correlated with gastric cancer.

Research progress of less invasive surfactant application in premature infants with respiratory distress syndrome / 中华实用儿科临床杂志

Intratracheal surfactant administration is the only specific treatment for respiratory distress syndrome and usually requires endotracheal intubation, positive pressure and/or mechanical ventilation which are harmful to the immature lung.One of these alternative methods is less invasive surfactant application (LISA) via a thin endotracheal catheter during spontaneous breathing with continuous positive airway pressure.Use of LISA allows administration of surfactant while avoiding intubation and positive pressure.Observational studies have fostered expectations of a positive effect of LISA on serious complications of preterm infants and the need for mechanical ventilation.However, there is still a controversy about indications, premedication and serious complications of preterm infants while using LISA.This article reviews the controversies of LISA technology in preterm infants with respiratory distress syndrome.

Influence of gestational age and delivery mode on neonatal pulse oxygen saturation shortly after birth / 中华围产医学杂志

Objective To explore the trend of preductal pulse oxygen saturation (SpO2) during 10 min after birth in newborns born at different gestational age and through different delivery mode.Methods From May 2014 to August 2014,319 neonates,born in Tianjin Central Hospital of Obstetrics and Gynecology and whose Apgar score at 1 min after birth ≥ 8,were included into the study.Term infants were grouped into vaginal delivery group (n=102) and caesarean group (n=117) according to the delivery mode.Infants born through caesarean section were divided into three groups,including 30-33+6 weeks (n=50),34-36+6 weeks (n=50) and 37-41+6 weeks (n=117) group according to the gestational age at birth.Immediately after the umbilical cord clamped,preductal SpO2 was recorded at each minute from one to ten minutes using the pulse oximetry.Oneway analysis of variance and two independent sample t test were applied for statistical analysis.Results At each time point within ten minutes after birth,the preductal SpO2 for preterm infants of 30-33+6 weeks gestation in the caesarean group were (54± 3)％,(59± 3)％,(65 ±4)％,(70±4)％,(75 ±4)％,(80±4)％,(84± 3)％,(89± 3)％,(91 ± 3)％ and (93 ± 2)％,respectively,which were significant lower than those of the 34-36+6 weeks group [(57 ± 5)％,(66 ± 4)％,(72 ± 6)％,(78 ± 6)％,(83 ± 6)％,(87 ± 6)％,(90± 5)％,(92 ± 4)％,(94± 4)％ and (95 ± 4)％,respectively] and of the term infants [(58 ± 3)％,(67 ± 4)％,(73 ± 5)％,(78 ± 6)％,(83 ± 6)％,(87 ± 6)％,(90± 5)％,(92± 5)％,(94± 3)％ and (95± 3)％,respectively] (all P ≤ 0.05).While the corresponding preductal SpO2 for term infants in the vaginal delivery group were (61 ± 6)％,(69± 7)％,(75 ± 6)％,(81 ± 7)％,(86± 6)％,(90 ± 6)％,(93 ± 5)％,(94± 4)％,(95 ± 4)％ and (96 ± 3)％,respectively,which were all higher than those of term infants in the caesarean group (all P ≤ 0.05).Conclusions The preductal SpO2 for preterm infants of 30-33+6 weeks of gestation is lower than that of preterm and term infants of ≥ 34 weeks of gestation at all time points within ten minutes after birth.The preductal SpO2 for term infants born through vaginal delivery is higher and rising faster than that of term infants born through caesarean section at all times.

Resuscitation and risk factors of tracheal intubation of neonates born from high risk mothers / 中华围产医学杂志

Objective To understand the whole situation of neonatal resuscitation in high risk deliveries.Methods Totally,3 420 neonates born from high risk pregnant mothers in Tianjin Central Obstetrics and Gynecology Hospital from September 2013 to November 2014 were recruited and divided into four groups according the needs of resuscitation,including no resuscitation group (Group A),initial resuscitation group (Group B),initial resuscitation plus bag-and-mask or T-piece ventilation (positive pressure ventilation group,Group C),tracheal intubation and/or external chest compression and/or epinephrine administation (tracheal intubation group,Group D).Variance analysis,Chi-square test and Logistic regression analysis were applied to compare the differences of clinical conditions among these groups and to analyze risk factors of tracheal intubation requirement for extensive resuscitation.Results Among the 3 420 newborns,2 360(69.0％) were assigned to Group A,565 (16.5％) to Group B,408 (11.9％) to Group C and 87 (2.5％) to Group D.Statistical differences were shown in the gestational age [(35.5 ± 4.1),(33.0 ± 4.3) and (32.1 ± 4.8) weeks],birth weight [(2 593.8 ± 663.6),(2 063.3 ± 973.9) and (1 839.0 ± 977.9) g],and the incidence of multiple births [66(11.7％),65(15.9％) and 23(26.4％)],abruptio placentae [15(2.7％),35(8.6％) and 9(10.3％)],umbilical cord prolapse [0(0.0％),2(0.5％),and 10(11.5％)],abnormal fetal heart rate in labor [28(5.0％),45(11.0％) and 46(52.9％)],prolonged labor [36(6.4％),35(8.6％),and 20(23.0％)],meconium stained liquor [32(5.7％),0(0.0％),and 8(9.2％)],and congenital anomaly [8(1.4％),12(2.9％) and 7(8.0％)] among Group B,C and D (F or x2=233.188,105.050,14.535,19.934,91.434,149.366,26.525,28.602 and 13.765,all P ≤ 0.05).Multiple regression analysis revealed that gestational age ≤ 28 weeks (OR=1.290,95％ CI:1.167-1.425),abnormal fetal heart rate in labor (OR=1.350,95％CI:1.184-6.862) and meconium stained liquor (OR=1.397,95％CI:1.051-6.825) were independent risk factors for endotracheal intubation requirement (all P ≤ 0.05).Conclusions More newborns born from high risk mothers may need resuscitation,especially for those in small gestational age,with abnormal fetal heart rate during labor and meconium-stained liquor,thus close monitoring and management are necessary.

Progress in non-invasive ventilation for the treatment of neonatal respiratory disease / 临床儿科杂志

Mechanicalventilation in newborns can be divided into invasive mechanical ventilation and non-invasive me-chanical ventilation. In order to reduce invasive ventilation-induced lung injury, more and more non-invasive ventilation patterns have been used clinically. Early application of nasal intermittent positive pressure ventilation (NIPPV) has become the main mode of non-invasive ventilation in many neonatal intensive care units (NICU). At the same time, the combination with selective pulmonary surfactant can reduce the incidence of chronic lung disease. This article reviews the use and prospect of non-invasive respiratory support modes which include continuous positive airway pressure (CPAP) and bi-level CPAP mode (BiPAP) such as SiPAP and NIPPV. Some modes which are in the research stage were also reviewed including synchronized nasal intermittent positive pressure ventilation, neurally adjusted ventilatory assist and non-invasive high-frequency oscillatory ventilation.

Risk factor analysis for osteoporosis in aged people in Beicai Town of Shanghai / 中华老年医学杂志

Objective To investigate the risk factors for osteoporosis (OP) in aged people at Beicai Town in Shanghai, to provide proofs for preventing OP. Methods Questionnaire survey was carried out on bone density in 608 aged people (aged from 60 to 79 years) who were randomly chosen from 4 resident committees of Beicai Town in Shanghai. Everyone underwent bone mineral density (BMD) assay of lumbar spine and total hip by DEXA machine. Results The rate of OP was 23 % in male group, and 61% in female group. It was 40% in 60-64 years old group, 44% in 65-69 years old group, 53% in 70-74 years old group and 66% in 75-79 years old group. The rate of OP was 52% in manual work group, and 42 % in non-manual work group. In males, it was 54 % in current weight less than 60 kg group, 19% in 60-70 kg group, 15% in 70-80 kg group and 23% in over 80 kg group. In females, it was 76% in current weight less than 50 kg group, 67% in 50-60 kg group, 63% in 60-70kg group, 30% in over 70 kg group. It was 56% in low body weight group, 41% in normal weight group and 58% in over weight group in their 25-year-old. It was 61% in normal body weight group, 43% in overweight group. It was 41% in non-fracture history group, 67% in once fracture group,74% in fracture history more than twice group. It was 60% in mother humpback history group, and 47% in no history of mother humpback group. Logistic regression analysis showed that gender, age,history of fracture, mother's humpbacked history, disease of internal secretion and metabolism system were the risk factors for OP. Conclusions The occurrence of OP is related with many factors in aged people at Beicai Town in Shanghai, especially for the aged women, who suffer from diseases of internal secretion and metabolism, and has the history of fracture and mother's humpbacked, the attention should be payed to the prevention and treatment of OP.

Relationship between RUNX3 expression and precancerous gastric lesions in high-risk population / 北京大学学报(医学版)

Objective:To evaluate the association between RUNX3 expression and Helicobacter pylori(H.pylori)-associated precancerous gastric lesions.Methods: A population-based study was conducted in Linqu County,Shandong Province,a high-risk area of gastric cancer in China.RUNX3 expression was determined by immunohistochemistry analysis in 1 026 H.pylori infected subjects with different gastric lesions.Results: Among 1 026 subjects,359(35.0%,359/1 026) was positive.The prevalence rates of RUNX3 expression decreased steadily with severity of gastric lesions,65.6%(40/61) among those with superficial gastritis /normal(SG/N),and 22.4%(60/268) among those with dysplasia(DYS)(P