Analysis of predictive factors for pulmonary hypertension in patients with chronic obstructive pulmonary disease / 中国医师进修杂志

Objective:To explore the predictive factors of secondary pulmonary hypertension (PH) in patients with chronic obstructive pulmonary disease (COPD).Methods:The patients who were hospitalized and diagnosed with COPD in Huai′an Hospital Affiliated to Xuzhou Medical University from September 2017 to December 2019 were enrolled, and the pulmonary systolic pressure were estimated by echocardiography. The patients were divided into simple COPD group and COPD combined with PH group. The general clinical data, hematology indexes, and pulmonary function indexes of each group were collected and analyzed to explore the predictive value of the above factors on the occurrence of PH in COPD.Results:The levels of average blood platelet volume (MPV), red blood cell distribution width (RDW), and logarithmic functionof amino-terminal brain natriuretic precursor (lgNT-proBNP) in the in the COPD combined with PH group were higher than those in the simple COPD group: (11.91 ± 2.60) fl vs. (10.39 ± 1.44) fl, (14.25 ± 2.49)% vs. (12.56 ± 1.12)%, (2.82 ± 0.54) ng/L vs. (2.22 ± 0.38) ng/L; the ratio of forced expiratory volume in the first second (FEV 1) and force vital capacity (FVC) and the percentage of FEV 1 to the predicted value (FEV 1%) were lower than those in the simple COPD group: (51.43 ± 8.07)% vs. (59.99 ± 8.33)%, (37.00 ± 12.62)% vs. (48.28 ± 15.10)%, the differences were statistically significant ( P<0.05). Logistic regression analysis showed that the changes of MPV( OR = 1.401, P = 0.015), RDW ( OR = 1.769, P = 0.013), lgNT-proBNP ( OR = 6.959, P<0.001), FEV 1/FVC( OR = 0.905, P<0.001) were closely related to the occurrence of PH in COPD. The receiver operating characteristic (ROC) curve analysis showed that the area under the curve of MPV, RDW, NT-proBNP combined detection in diagnosis of PH was the largest (0.873). Conclusions:The changes in NT-proBNP, RDW, MPV, FEV 1/FVC have a certain predictive value for COPD patients with PH. The combined detection of three hematological indicators can better predict the presence of PH in COPD patients than single detection or combined detection.

Structurally defined tandem-responsive nanoassemblies composed of dipeptide-based photosensitive derivatives and hypoxia-activated camptothecin prodrugs against primary and metastatic breast tumors

Substantial progress in the use of chemo-photodynamic nano-drug delivery systems (nano-DDS) for the treatment of the malignant breast cancer has been achieved. The inability to customize precise nanostructures, however, has limited the therapeutic efficacy of the prepared nano-DDS to date. Here, we report a structurally defined tandem-responsive chemo-photosensitive co-nanoassembly to eliminate primary breast tumor and prevent lung metastasis. This both-in-one co-nanoassembly is prepared by assembling a biocompatible photosensitive derivative (pheophorbide-diphenylalanine peptide, PPA-DA) with a hypoxia-activated camptothecin (CPT) prodrug [(4-nitrophenyl) formate camptothecin, N-CPT]. According to computational simulations, the co-assembly nanostructure is not the classical core-shell type, but consists of many small microphase regions. Upon exposure to a 660 nm laser, PPA-DA induce high levels of ROS production to effectively achieve the apoptosis of normoxic cancer cells. Subsequently, the hypoxia-activated N-CPT and CPT spatially penetrate deep into the hypoxic region of the tumor and suppress hypoxia-induced tumor metastasis. Benefiting from the rational design of the chemo-photodynamic both-in-one nano-DDS, these nanomedicines exhibit a promising potential in the inhibition of difficult-to-treat breast tumor metastasis in patients with breast cancer.

Epidemiological study of positive children with respiratory syncytial virus in Jiangsu / 公共卫生与预防医学

Objective To investigate the epidemiological characteristics of respiratory syncytial virus (RSV) positive children in Jiangsu, and to provide reference for the prevention and treatment of RSV infection. Methods A total of 11 574 children with respiratory tract infection from June 2018 to June 2020 were selected. RSV antigen was detected by direct immunofluorescence assay in all children. Other 6 kinds of respiratory viruses were detected in RSV positive specimens to understand the mixed infection. Results The positive rate of RSV in 11 574 samples was 12.34%(1 428/11 574), and the male to female ratio of RSV positive children was 1.92:1 (915/476). The detection rate of male children (12.79%) was significantly higher than that of female children (10.77%)(χ2=10.951, P2=27.48, P0.05). The positive rate of RSV from November to March was significantly higher than that from other months (χ2=9.451, P<0.05). The highest positive rate was 2 months (16.99%). Of the 1428 RSV-positive cases, 148 were co-infected with at least one other respiratory virus, accounting for 10.36%(148/1 428) of the RSV-positive cases. Among them, 117 cases were double infection and 31 cases were triple infection. RSV combined with PIV3 infection was the most common in 39 cases (26.35%). Conclusion RSV positive children are mainly concentrated in infants under 12 months of age in Jiangsu province, and the incidence is high from November to March. The protection of infants under 12 months of age should be strengthened, especially in hospitalized cases and male cases, which are often mixed with infection..

Pulmonary rehabilitation for patients with moderate or severe obstructive pulmonary disease / 中华物理医学与康复杂志

Objective To observe any curative effect of applying comprehensive pulmonary rehabilitation in moderate and severe cases of chronic obstructive pulmonary disease (COPD).Methods A total of 135 persons hospitalized with moderate or severe COPD were randomly divided into a rehabilitation group of 75 and acontrol group of 60.Both groups were given routine treatment,while the rehabilitation group was additionally provided with a comprehensive pulmonary rehabilitation regimen,including health education,exercise training,respiratory function training,respiratory muscle training,psychological support and nutritional intervention for six months.Before and after the treatment,both groups were evaluated using their walking distance within 6 minutes (6MWD),an anhelation index,a COPD assessment test (CAT),the Beck anxiety and depression scale,a nutritional assessment and indexes of pulmonary function and blood gases.Results After the intervention the average 6 MWD,anhelation index,CAT score,Beck anxiety and depression scores,forced expiratory volume,forced vital capacity and PaO2 of the rehabilitation group were all significantly better than before the treatment and better than those of the control group.Conclusion For moderate and severe COPD patients,comprehensive pulmonary rehabilitation effectively strengthens their moving ability,pulmonary function and arterial partial pressure of oxygen,while relieving anhelation,anxiety and depression.

Study on the Inhibitory Effect of Artesunate on Wnt / β-catenin Signaling Pathway and Improve Asthma rat Model of Airway Inflammation and Airway Remodeling / 医学研究杂志

Objective To investigate the role of Wnt/β-catenin signaling pathway in airway inflammation and airway remodeling in asthmatic rats,and to explore the possible molecular mechanism of artesunate (ART) in the treatment of asthma.Methods Forty-eight SD rats were randomly divided into normal group,asthmatic group,dexamethasone group,low-dose artesunate group,middle-dose artesunate group and high-dose artesunate group.Asthmatic models were established by ovalbumin (OVA) challenge and aerosol inhalation,and were treated with drugs.The morphological changes of lung tissue,the white blood cell count and the white blood cell count of bronchoalveolar lavage fluid (BALF) were observed in each group.The bronchial wall thickness and smooth muscle thickness were measured by Image-Pro plus image analysis software.The expressions of β-catenin and WISP-1 in lung tissue were detected by immunohistochemistry and RT-PCR respectively.The expression of IL-6 in serum and BALF was detected by ELISA.Results The artesunate group rats,airway inflammatory cells infiltration,the smooth muscle thickness,bronchial wall thickness were significantly lower than those in asthma group,and the difference was statistically significant (P ＜ 0.01).The expression of artesunate group β-catenin,WISP-1 protein and WISP-1 mRNA were significantly lower than those in asthma group,and the difference was statistically significant (P ＜0.01).The level of IL-6 in serum and BALF of artesunate group was significantly lower than that of asthmatic group (P ＜ 0.01).Conclusion The possible mechanism of artesunate to improve airway inflammation and airway remodeling in asthmatic rats related to the inhibition of Wnt/ beta-catenin signaling pathway activity and down-regulation of IL-6 levels.

Study on the Inhibitory Effect of Artesunate on Wnt / β-catenin Signaling Pathway and Improve Asthma rat Model of Airway Inflammation and Airway Remodeling / 医学研究杂志

Objective To investigate the role of Wnt/β-catenin signaling pathway in airway inflammation and airway remodeling in asthmatic rats,and to explore the possible molecular mechanism of artesunate (ART) in the treatment of asthma.Methods Forty-eight SD rats were randomly divided into normal group,asthmatic group,dexamethasone group,low-dose artesunate group,middle-dose artesunate group and high-dose artesunate group.Asthmatic models were established by ovalbumin (OVA) challenge and aerosol inhalation,and were treated with drugs.The morphological changes of lung tissue,the white blood cell count and the white blood cell count of bronchoalveolar lavage fluid (BALF) were observed in each group.The bronchial wall thickness and smooth muscle thickness were measured by Image-Pro plus image analysis software.The expressions of β-catenin and WISP-1 in lung tissue were detected by immunohistochemistry and RT-PCR respectively.The expression of IL-6 in serum and BALF was detected by ELISA.Results The artesunate group rats,airway inflammatory cells infiltration,the smooth muscle thickness,bronchial wall thickness were significantly lower than those in asthma group,and the difference was statistically significant (P ＜ 0.01).The expression of artesunate group β-catenin,WISP-1 protein and WISP-1 mRNA were significantly lower than those in asthma group,and the difference was statistically significant (P ＜0.01).The level of IL-6 in serum and BALF of artesunate group was significantly lower than that of asthmatic group (P ＜ 0.01).Conclusion The possible mechanism of artesunate to improve airway inflammation and airway remodeling in asthmatic rats related to the inhibition of Wnt/ beta-catenin signaling pathway activity and down-regulation of IL-6 levels.

Relationship between type of obesity and lung function, systemic/airway inflammation, and disease control in asthmatic patients / 中华临床营养杂志

Objective To explore the role of body fat distribution in the pathogenesis of obesity-related asthma.Methods Totally 125 patients with stable asthma were recruited and were divided into non-obese group (n =51),peripheral obesity group (n =34) and central obesity group (n =40) according to body mass index and waist circumference.The FEV1％,FVC,FEV1/FVC ratio,IL-6,and hs-CRP levels in peripheral blood,eosinophil and neutrophil percentage in induced sputum,as well as exhaled NO levels were determined,and asthma control test (ACT) scores were calculated.Both one-way analysis of variance and analysis of covariance were used for statistical analysis.Results The values of FVC in the central obesity group and the non-obese group were [3.98 (3.99) ±0.99] L and [4.51 (4.51) ±1.00] L,while the levels of IL-6 and hs-CRP in peripheral circulation and the percentage of neutrophils in induced sputum were [33.63 (33.28) ± 14.04] ng/L and [21.22 (21.33)±11.23] ng/L,[2.12 (2.15) ±0.73] mg/L and [0.92 (0.91) ±0.61] mg/L,52.58 (52.81) ± 14.14 and 45.41 (45.34) ± 12.84,respectively (all P ＜ 0.05).After adjusting for inhaled corticosteroids (ICS) doses,the ACT scores were also significantly higher in central obesity group (22.10 ± 1.68 vs.23.01 ± 1.62) (P ＜ 0.05).Only the hs-CRP level was found significantly higher in peripheral obesity group than in non-obese group [(1.54±0.68) mg/Lvs.(0.91 ±0.61) mg/L] (P＜0.05).Conclusion Central obesity may play the leading role in the pathogenesis of obesity-related asthma.

Influences of depression on exercise capacity of patients with chronic obstructive pulmonary disease in 6-minute walk test / 中华全科医师杂志

Objective To investigate the influences of depression on exercise capacity of patients with chronic obstructive pulmonary disease (COPD) in 6-minute walk test (6MWT).Methods One hundred and twenty COPD patients,whose acute exacerbation was controlled,were enrolled in the study from September 2009 to April 2011.According to Hamilton depression scale (HAMD) scores,48 patients with HAMD scores ＜ 7 were classified as non-depression group (control),60 patients with HAMD scores ≥17 were classified as depression group,patients with 7 ≤ HAMD scores ＜ 17 were classified as uncertain depression and not included in the experiment.Six-minute walk testing was performed in patients.Blood pressure,heart rates,respiratory rates,Borg scores were measured before and after 6MWT; body mass index and lung function were also measured in all patients.Results The distances of walk in the depression group and control group were (259 ±91) and (312 ±71) meters,respectively (P ＜0.05).Heart rates,svstolic blood pressure,respiratory rates and Borg index in depression group after testing were (108± 11)/min,(148.7 ± 15.4) mm Hg(1 mm Hg =0.133 kPa),(23.3 ±3.9) /min and (4.65 ± 1.67),respectively;those for control group were (95 ±9) /min,(141.8±8.9) mm Hg,(20.2 ±3.7) /min and (2.59±1.52),respectively.There were significant differences between two groups (all P ＜ 0.05).Conclusions Depression may affect the exercise capacity of COPD patients,the psychological status of the patients should be under consideration when conventional treatment is taken.

Correlation of depression and cognitive function in patients with chronic obstructive pulmonary disease / 中华全科医师杂志

Based upon the measure of depression as defined by Hamilton depression scale (HAMD)scores ＞ 17,120 patients with chronic obstructive pulmonary disease (COPD) were classified into 2 groups:COPD patients with or without depression.According to the mini-mental state examination (MMSE),the cognitive functions of all patients were evaluated.Meanwhile,oxygen saturation and pulmonary function were measured by blood gas analyzer and spirometer respectively.Fifty-four COPD patients were complicated with depression.HAMD scores were significantly negatively correlated with oxygen saturation and pulmonary function (P ＜0.05).Multiple regression analysis revealed that gender,oxygen saturation and MMSE scores were risk factors of depression (P ＜ 0.05).MMSE scores decreased more obviously in the COPD patients with depression and were positively correlated with oxygen saturation (P ＜ 0.01).A negative correlation existed between MMSE scores and HAMD scores (r =-0.549,P ＜ 0.05).

Quality of life and its related factors in patients of stable chronic obstructive pulmonary disease / 中华全科医师杂志

A total of 185 hospitalized patients with chronic obstructive pulmonary disease (COPD) were recruited.And the questionnaire of COPD Assessment Test (CAT) was used to evaluate the CAT scores and Hamihon Depression Scale to evaluate HAMD scores.Lung function,body mass index,smoking and medication were measured and recorded in details.According to the HAMD scores,65 cases had depression and 120 cases no depression.Comparing with the no-depression group,the results show that HAMD and CAT scores were higher significantly in the depression group and there was a lower proportion of long-term domiciliary oxygen therapy.According to the logistic regression analysis,the CAT scores were associated with global initiative for chronic obstructive lung disease (GOLD) stages Ⅳ and HAMD scores.These results suggest that poor lung function and depression affect greatly the quality of life for stable COPD patients.

Treatment of chronic obstructive pulmonary disease with salmeterol/fluticasone propionate and community intervention / 中华全科医师杂志

Objective To investigate the effects of salmeterol/fluticasone (seretide) combined with community intervention on lung function and quality of life of chronic obstruetive pulmonary disease (COPD) patients in the stable period.Methods 96 cases with COPD in the stable period were divided into two groups randomly:Group A was treated only by seretide for six months,group B was treated by seretide combined with community intervention (health education,psychological intervention,exercise training,and nutritional guidance).6 months later,the lung function was determined and the quality of life was assessed by SGRQ.Results The lung function and the score of the quality of life in two groups after treatment [Group A:(1.78 ±0.16)L,(65 ±9)％ and 40 ± 18,36 ± 16,125 ±40;group B:(2.05 ±0.28)L,(73 ±9)％ and 21 ± 10,20 ± 11,58 ± 28,respectively] were improved than those before treatment [Group A:(1.59 ±0.15),(58 ±7) and 63 ±22,50 ±24,167 ±68;group B:(1.61 ±0.14)L,(58 ± 8)％ and 62 ±22,48 ± 22,163 ± 67,respectively] (P ＜ 0.05 );The lung function and the score of the quality of life in B group were improved than those in A group after treatment ( P ＜ 0.05 ).Conclusions Using community intervention combined with seretide in treatment of COPD patients has better effect than the single use of seretide therapy,it improves lung function and quality of life.It is a safe treatment method and worthy to spread widely.

Clinical pathologic analysis of urologic primary primitive neuroectodermal tumor / 中华泌尿外科杂志

Objective To explore the clinico-pathological features, immunophenotype, treatment and prognosis of urologic primary primitive neuroectodermal tumor (PNET). Methods The clinical data of 3 patients with urologic PNET were analyzed retrospectively. All patients were male, aged 29, 32 and 75 years respectively. Two of the lesions were located in the kidney, and the third was located in the bladder. The sizes of renal tumors were 7.7 cm×6.2 cm and 12.6 cm×9.4 cm respectively. Imaging examinations revealed a well-defined mass with inhomogeneous echo inside. The size of bladder tumor was 10.0 cm×10.0 cm. CT scan demonstrated irregular thickening of the bladder wall, and the density of the wall was inhomogeneous. In the 2 cases of renal PNET radical surgery was performed, while an emergency palliative surgery to remove a blood clot and biopsy were performed in the bladder PNET case. Results In light microscope, the tumors were characterized by uniform small round or oval cells and nest-like or dense sheet structures surrounded by sparse fibrovascular stroma. Homer-Wright rosettes or pseudorosettes were observed, as well as mitoses. Immunohistochemical study revealed that all cases showed positive staining for CD99, synaptophysin and vimentin. One of the renal tumor cells showed positive for CD56, and the other renal tumor and urocystic tumor cells were focally positive for chromogranin A. Additionally, in 1 of the cases of renal tumor there was a high positive rate of 80% for Ki67 staining while the other case showed less than 5%. All 3 cases were eventually diagnosed as PNET. The first renal tumor case was not treated with radiotherapy and chemotherapy postoperatively, and the patient died of recurrence 14 months after surgery. Both the second renal tumor case and the bladder tumor case underwent chemotherapy postoperatively, and they died 4 and 6 months after surgery respectively. Conclusions The urologic primary PNET is a very rare, highly malignant soft tissue tumor, and the diagnosis must be based on pathologic findings and immunohistochemical phenotypes. The multimodal treatment for urologic primary PNET consists of surgery, chemotherapy and radiotherapy.

Posterior mediastinal thymus: case report and literature review

The incidence of aberrant thymus in the posterior mediastinum is very uncommon. It is difficult to exclude malignancy before surgical procedure. In a six-month-old male coughing for two weeks prior to admission a posterior mediastinal mass was found incidentally by chest roentgenogram. Thoracotomy was performed. Histologic study revealed normal thymic tissue. When a mass located in the posterior mediastinum, ectopic thymus should be included in differential diagnosis. Imaging techniques may spare thoracotomy. Ectopic thymus has a benign clinical course, and surgical resection is not recommended

Influence of continuous positive airway pressure treatment on cardiovascular risk factors in patients with obstructive sleep apnea-hypopnea syndrome / 中国综合临床

Objective To investigate the influence of nasal continuous positive airway pressure (nCPAP) treatment on cardiovascular risk factors in patients with obstructive sleep apnea-hypopnea Syndrome (OSAHS). Methods Thirty-one patients with newly diagnosed OSAHS were divided into 3 groups based on the status of nC-PAP treatment: group 1,10 patients with nCPAP > 4 hrs/night;group 2:9 patients with nCPAP < 4 hrs/night;group 3:12 patients without nCPAP treatment. Serum cardiovascular risk factors (i. e. ,C-reactive protein(CRP), total cholesterol, triglycerides, highdensity lipaprntein cholesterol (HDL-C), low-density lipoprotein cholesterol, apo-lipoprotein A-I (ApoA-1), and apolipoprotein B (ApoB) ) were measured at baseline and 6 months after nCPAP treatment. Results ① There was no significant difference on age,body mass index,blcod pressure,Epworth sleepi-ness scale (ESS) and saturation of blood oxygen (SPO_2) between the 3 groups (P>0.05). ②In group 1, ESS, SPO_2 minimum SPO_2 were significantly improved (3.20±2.80,93.80±2.01 and 84.10±6.17, respectively) compared to baseline (13.30±5.20,88.60±4.14 and 69.60±11.80, respectively) (P<0.01). Moreover, in group 2, there were significant improvement on ESS, SPO_2 and minimum SPO2 (4.95±2.67,94.20±1.46 and 85.20±4.97, respectively) compared to baseline (12.80±5.50,89.10±5.11 and 73.70±12.50, respectively) (P<0.01). ③In group 1 ,significant decreases in the levels of CRP,total cholesterol was observed (P=0.021 and 0.038). ④In group 2, group 3 there were slightly decrease of CRP after treatment, but the difference did not reach statistieal significance. Conclusions Good compliance to nCPAP treatment decreases the serum levels of cardiovas-cular risk factors, indicating a beneficial effect on the overall cardiovascular disease prevention and control.

Comparison of clinical histopathology of chronic necrotizing pulmonary aspergillosis and aspergilloma / 中华传染病杂志

Objective To evaluate the role of clinical features,radiography and histopathology in differential diagnosis between chronic necrotizing pulmonary aspergillosis(CNPA)and aspergilloma.Methods Thirty-four patients including 8 cases of CNPA and 26 of aspergilloma comfirmed by operation and histopathology in First Affiliated Hospital,Zhejiang University were investigated retrospectively.The clinical manifestations,radiological and pathological findings of all the patients were analyzed and related references were reviewed. Results The age of onset was not significantly different between CNPA and aspergilloma.Obsolete pulmonary tuberculosis and lung abscess were predisposing factors of them.Productive cough was presented in all 8 cases of CNPA,haemoptvsis in 7,and 5 were presented with constitutional symptoms.The most common symptom of aspergilloma was haemoptysis, which was presented in 25 cases.The less common symptoms were cough and sputum,which was presented in 17 cases.Only two cases were presented with constitutional symptoms."Air crescent"sign at radiography was typical and suggestive of diagnosis in both CNPA and aspergilloma,but the wall of cavity in CNPA was thicker and irregular,infiltrates were often to be seen around the cavity.Histologically,CNPA and aspergilloma both showed septate fungal hyphae branching at an acute angle.CNPA was characterized with the presence of tissue invasion by aspergillus,tissue necrosis and granulomatous inflammation. Fungal hyphae ware only found in a preexistent cavity or ectatic bronchus without tissue invasion in aspergilloma.Conclusions Histopathology is gold standard of differential diagnosis of CNPA and aspergilloma. Meanwhile, clinical features and radiological findings appear to be valuable for the diagnosis.

Lower Respiratory Tract Nosocomial Infection by Candida albicans in Geriatric Inpatients / 中华医院感染学杂志

OBJECTIVE To investigate the factors that result in lower respiratory tract infection by Candida albicans and the situation of drug resistance in geriatric inpatients.METHODS Clinical samples were collected from the geriatric inpatients with lower respiratory tract infection in our hospital from Jan 2004 to Dec 2006,and among them,146 patients were found containing C.albicans in their sputum.Meanwhile retrospective analysis was made.RESULTS There were many factors resulting in lower respiratory tract nosocomial infection by C.albicans in geriatric inpatients,and the detection rates of C.albicans increased year by year in the past three years were 25.2%,36.9% and 39.9%,respectively.The drug resistance of C.albicans raised obviously at the same time was 20.6%,41.8% and 34.2%,respectively.CONCLUSIONS It is necessary for reducing lower respiratory tract infection rates to efficiently control the C.albicans infection factors and to properly use antibiotics.

PRIMARY TUMORS OF THE DUODENUMA REPORT OF EIGHTEEN CASES / 中国普通外科杂志

Eighteen cases of primary tumors of the duodenum were reported. There were four cases of benign tumors, and fourteen cases of malignancy. The tumor was located in the bulb of the duodenum in seven cases, the descending part in nine cases and the transversepart in two cases. Five cases were complicated with intestinal perforation. Four cases with hemorrhage, four cases with obstruction and five cases with choledochal obstruction. The pathology, diagnosis and treatment of primary duodenum tumors are discussed.