[Clinical and molecular biological characterization of patients with accelerated chronic lymphocytic leukemia].

Objective: To investigate the clinical and molecular biological characteristics of patients with accelerated chronic lymphocytic leukemia (aCLL) . Methods: From January 2020 to October 2022, the data of 13 patients diagnosed with aCLL at The First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed to explore the clinical and molecular biological characteristics of aCLL. Results: The median age of the patients was 54 (35-72) years. Prior to aCLL, five patients received no treatment for CLL/small lymphocytic lymphoma (SLL), while the other patients received treatment, predominantly with BTK inhibitors. The patients were diagnosed with aCLL through pathological confirmation upon disease progression. Six patients exhibited bulky disease (lesions with a maximum diameter ≥5 cm). Positron emission tomography (PET) -computed tomography (CT) images revealed metabolic heterogeneity, both between and within lesions, and the median maximum standardized uptake value (SUVmax) of the lesion with the most elevated metabolic activity was 6.96 (2.51-11.90). Patients with unmutated IGHV CLL accounted for 76.9% (10/13), and the most frequent genetic and molecular aberrations included +12 [3/7 (42.9% ) ], ATM mutation [6/12 (50% ) ], and NOTCH1 mutation [6/12 (50% ) ]. Twelve patients received subsequent treatment. The overall response rate was 91.7%, and the complete response rate was 58.3%. Five patients experienced disease progression, among which two patients developed Richter transformation. Patients with aCLL with KRAS mutation had worse progression-free survival (7.0 month vs 26.3 months, P=0.015) . Conclusion: Patients with aCLL exhibited a clinically aggressive course, often accompanied by unfavorable prognostic factors, including unmutated IGHV, +12, ATM mutation, and NOTCH1 mutation. Patients with CLL/SLL with clinical suspicion of disease progression, especially those with bulky disease and PET-CT SUVmax ≥5, should undergo biopsy at the site of highest metabolic uptake to establish a definitive pathological diagnosis.

[Study on the relationship between EPHX1 gene polymorphism and antioxidant capacity in patients with chronic obstructive pulmonary disease].

Objective: To explore the difference of mRNA, protein expression levels and the indexes of peripheral blood antioxidant capacity in peripheral blood lymphocytes of different EPHX1 genotypes in chronic obstructive pulmonary disease(COPD). Methods: A case-control study was conducted to collect peripheral blood samples of 220 stable chronic COPD patients with smoking history and 230 healthy smokers (control group) from October 2016 to February 2018 in the First Affiliated Hospital of Kunming Medical University, and the genetic testing was carried out according to the operation instructions of BigDye Terminator v1.1 DNA Sequencing Kit. Based on their EPHX1 exon 3 and exon 4 polymorphism status, the EPHX1 was classified into 4 groups, i. e., normal activity, slow activity, extremely slow activity and fast activity. Then COPD patients were allocated to either a slow activity group (slow and very slow activity) or a fast activity group (normal and fast activity) according to EPHX1 genotype and gene activity. The expression of EPHX1 mRNA and protein in peripheral blood lymphocytes were detected by qRT-PCR and Western blot, and indexes of serum antioxidant capacity was detected by corresponding kits. Results: (1)The 2(-ΔΔCt) of the control group was 1.000, and the 2(-ΔΔCt) of the COPD group was 1.052±0.023. There was no significant difference in the level of EPHX1 mRNA expression between the two groups (t=1.992 P=0.865). The level of EPHX1 mRNA expression in the slow activity group was not different significantly compared to that in the fast-active group (1.053±0.023 vs 1.048±0.021, t=1.133, P=0.260). (2)The level of EPHX1 protein expression by Western blot analysis showed that the EHPX1/GAPDH gray ratio was not different significantly between the COPD group and the control group (0.613±0.089 vs 0.602±0.075, t=0.805, P=0.422). The level of EPHX1 protein expression in the slow activity group was not significantly different compared to that in the fast activity group (0.606±0.088 vs 0.622±0.092, t=-0.786 P=0.434). (3)There were significant differences in indexes of antioxidant capacity between the control group and the COPD group (P<0.05). There were significant differences in indexes of antioxidant capacity between the slow activity group and the fast activity group of COPD patients (P<0.05). Conclusions: The different antioxidant capacity of COPD patients with different EPHX1 genotypes may be related to the polymorphism of EPHX1 gene affecting the activity of microsomal epoxidase, but not to the level of EPHX1 mRNA and protein expression.

[Comparative analysis of clinical characteristics and prognosis between bacterial necrotizing pneumonia and Mycoplasma pneumoniae necrotizing pneumonia in children].

Objective: To compare the characteristics of Mycoplasma pneumoniae necrotizing pneumonia (MPNP) and bacterial necrotizing pneumonia (BNP), and explore the biomarkers for differentiation of MPNP from BNP. Methods: A retrospective, observational study of 52 necrotizing pneumonia (NP) cases who were hospitalized in our hospital from January 2008 to December 2017 was conducted. According to the pathogen causing NP, patients were divided into two groups, BNP and MPNP, and the clinical manifestations, laboratory data, imaging findings, hospital course and prognosis between these groups were analyzed. Results: This study enrolled 19 boys and 33 girls, and the median ages of patients were 4.4 (0.1-13.8) years old. Of the totally of 52 NP patients, 19 were in the BNP group (9 boys and 10 girls), 33 were in the MPNP group (10 boys and 23 girls). The mean age of MPNP patients was much older than that of BNP patients (5.2 (2.3-13.2) years vs. 1.8 (0.1-13.8) years, Z=-0.128, P<0.01). The number of patients with tachypnea and pleural effusion septation were significantly higher in BNP patients than those in MPNP patients (15 cases vs. 4 cases, χ(2)=23.222, P<0.01; 14 cases vs. 1 case, χ(2)=29.326, P<0.01), which more needed to oxygentherapy (18 cases vs. 12 cases, χ(2)=16.833, P<0.01) and undergo chest drainage (9 cases vs. 4 cases, χ(2)=5.829, P=0.022); while the number of patients required bronchoalveolar lavage was higher in MPNP patients than that in BNP patients (5 cases vs. 32 cases, χ(2)=29.326, P<0.01). The values of white blood cell (WBC) (23.2 (5.2-67.1)×10(9)/L vs. 9.7 (6.3-18.7)×10(9)/L, Z=-4.855, P<0.01), procalcitonin (PCT) (3.69 (0.23-90.15) mg/L vs. 0.28 (0.02-1.44) mg/L, Z=-3.207, P=0.001), C reactive protein (CRP) (160 (94-220) mg/L vs. 90 (5-134) mg/L, Z=-4.337, P<0.01), interleukin (IL)-10 (11.7 (4.2-401.5) ng/L vs. 4.8 (2.0-23.4) ng/L, Z=-2.278, P=0.023), pleural fluid cell count (5 200 (120-50 000)×10(6)/L vs. 790 (68-6 920)×10(6)/L, Z=-3.125, P=0.002), pleural fluid lactic dehydrogenase (LDH) (3 990 (589-29 382) U/L vs. 2 211 (673-3 993) U/L, Z=-2.488, P=0.013) in BNP group were significantly higher than those in MPNP group; while the values of pleural fluid glucose(0.43 (0.03-18.00) mmol/L vs. 5.95 (4.27-7.87) mmol/L, Z=-2.795, P=0.005), serum tumor necrosis factor (TNF)-α (2.3 (1.0-2.8) ng/L vs. 2.6 (1.3-109.2) ng/L, Z=-2.113, P=0.035) and interferon (IFN)-γ (4.8 (2.6-7.7) ng/L vs. 11.9 (2.9-154.6) ng/L, Z=-2.455, P=0.014) were lower in BNP group than those in MPNP group. Meanwhile, the mean time from the onset of symptoms to the discovery of necrotic lesions was longer in MPNP group than that in BNP group ((20.6±6.4) days vs. (14.6±6.2) days, t=3.029, P=0.004). After treatments, all patients were discharged without death, WBC and PCT recovered more quickly in MPNP group than those in BNP group (12 (0-24) days vs. 0 (0-23) days, Z=-4.484, P<0.01; 10 (5-15) days vs. 0 (0-23) days, Z=-3.244, P=0.001). As to prognosis, 34 cases were followed up, and the results showed that patients recovered without surgical intervention, and chest lesions were resolved within 3.0 (1.0-8.0) months, and the time to necrosis disappearance was similar in the BNP group and MPNP greup (3.0 (1.0-8.0) months vs. 3.0 (1.0-8.0) months, Z=-0.128, P=0.001). In receiver operator characteristic curve analysis, the cut-off values for the age, WBC, CRP, PCT, pleural fluid cell count and pleural fluid glucose were set at 2.4 years of age, 17.2×10(9)/L, 157 mg/L, 1.505 mg/L, 2 630×10(6)/L and 3.73 mmol/L, respectively. Conclusions: NP is found to be severe and prolonged, yet, reversible through proper therapy, such as rational antibiotics application. The age, WBC, CRP, PCT, pleural fluid cell count and pleural fluid glucose could be used as biomarkers to differentiate MPNP from BNP in children.

[Seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China].

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.

[A retrospective study of the mortality and death-related risk factors of patients hospitalized for asthma exacerbation in Chinese urban areas].

Objective: To study the mortality and death-related risk factors of patients hospitalized for asthma exacerbation in Chinese urban areas. Methods: A retrospective study was carried out in 29 hospitals of 29 provinces throughout mainland China. Patients hospitalized for asthma exacerbation during 2013-2014 in each hospital were included. For each patient, information about demography, admission time, comorbidities, severity of diseases, intense care unit (ICU) admission, use of mechanical ventilation and the outcome was obtained. The mortality of patients hospitalized for asthma exacerbation was calculated, and the basic information and causes of death of the patients who died were summarized. The death-related risk factors and numbers of comorbidities were compared between the patients who survived and those who died during hospitalization. Results: A total of 3 240 patients (median age 57.0) were included and among them 8 patients (median age 68.5) died. The mortality of patients hospitalized for asthma exacerbation was 0.25%. All the patients who died were admitted during the winter and spring. One patient died of acute myocardial infarction, one of cardiac shock, one of tension pneumothorax, one of sudden death, one of respiratory failure and three of unknown causes. The average number of comorbidities of patients who died was 1.10, larger than that of patients who survived (0.83) (P>0.05). More patients had diabetes, coronary artery diseases and hypertension as comorbidities in the patients who died (2/8) than those who survived[7.6% (246/3 232), 7.6% (246/3 232), 22.6% (731/3 232), respectively](all P>0.05). Conclusions: The in-hospital mortality of patients hospitalized for asthma exacerbation of China in this study is low. The patients who died are much older, and with more comorbidities, and a higher percentage of comorbidities such as diabetes, coronary artery diseases, and hypertension.

[A retrospective study of the treatment of patients hospitalized for asthma exacerbation in China].

Objective: To study the treatment of patients hospitalized for asthma exacerbation in China. Methods: This was a retrospective study and involved patients hospitalized for asthma exacerbation in 29 hospitals throughout China during Jan 2013 to Dec 2014. Information of the demographic features, the severity of the exacerbation, the medicine prescribed during the hospitalization and the use of mechanical ventilation were collected and analyzed. Results: During the study period, there were 3 240 patients hospitalized for asthma exacerbation, and 1 369(42.3%) of them were males 1 871(57.7%)were females. Patients of mild, moderate, severe, and life-threatening exacerbation counted for 41.7%, 37.8%, 19.2% and 1.0%, respectively of the total patients. Of all the patients, 72.6% used bronchodilators by nebulizer, 70.8% used inhaled corticosteroids by nebulizer, 60.5% used intravenous corticosteroids, 17.3% used oral corticosteroids, and 80.5% used antibiotics. The percentages of patients using systemic corticosteroids and antibiotics were higher in patients with more severe exacerbation. In patients with mild exacerbation, there were 74.9% and 52.2% who used antibiotics and systemic corticosteroids, respectively. A total of 73 patients (2.3%) used mechanical ventilation, and 62 of them used noninvasive ventilation, 16 used invasive ventilation, and 5 used both. Conclusions: Nebulizer therapy has been accepted as the main administration route of medicine in the treatment of asthma exacerbation. A large amount of patients used antibiotics and systemic corticosteroids during hospitalization, indicating there may be some overuse of these medicines.

[Trends of asthma control, disease management and perception in China].

Objective: To evaluate the changes of asthma control, disease management and perception in recent years in China. Methods: We conducted 2 multi-center, cross-sectional surveys. Outpatient asthmatic patients from 10 cities in mainland China (2007-2008) and 30 central cities from 30 provinces in China (except Tibet)(2015-2016) were recruited respectively. Data of asthma control, disease management and perception from the 2 surveys were compared for 10 cities which took part in both of the 2 surveys. Chi-square test was used for comparison between groups. Results: The asthma control level improved from 28.7%(839/2 928) in 2007-2008 to 39.2%(533/1 361) in 2015-2016(P<0.01). The rate of emergency visits was 18.2%(248/1 362) in 2015-2016, which was lower than that in 2007-2008(33.9%, 1 032/3 044)(P<0.01). The rate of peak flow meter (PFM) usage was 17.9%(244/1 360) in 2015-2016, which was slightly lower than the PFM usage rate in 2007-2008(21.8%, 660/3 030)(P=0.004). 56.0%(763/1 362) of the patients used inhaled corticosteroid (ICS) + formoterol to control asthma when asthma symptoms deteriorated in 2015-2016, which was higher than the result of 2007-2008(31.8%, 803/2 524)(P<0.01). 71.1%(968/1 361) of the patients in 2015-2016 had a right perception on disease nature, while the result in 2007-2008 was 63.3%(1 889/2 986)(P<0.01). 61.6%(839/1 362) of the patients in 2015-2016 had a right perception on medication choice on daily-use first-line medication for chronic asthma, while the result in 2007-2008 was 51.0%(1 500/2 942)(P<0.01). Conclusion: The current level of asthma control and disease perception in China improved significantly in recent years, while the rate of PFM usage showed no significant improvement. Asthma action plan including PFM monitoring and asthma self-management should be further promoted nationwide.

[Evaluation of asthma disease perception from China national asthma control survey].

Objective: In order to evaluate disease perception of asthma patients in urban China and provide evidence for further specific patient education. Methods: A multi-center, cross-sectional, questionnaire-based survey was carried out in 30 general hospitals dispersed in 30 provinces of mainland China (except for Tibet) during Oct 2015 to May 2016. Information of disease perception [Question 1: the disease nature of asthma; Question 2: medication choice of first-line in chronic asthma; Question 3: the occasion of using short-acting aerosols of receptor agonists; Question 4: perception of asthma treatment goal; Question 5: reason for not using peak flow meter (PFM)] were collected from asthma patients of outpatient department. These results were compared with the same type of survey results from 2007-2008. Results: Altogether 3 875 asthmatic outpatients were recruited. 69.0% (2 660/3 857) of the patients had right perception on the disease nature of asthma, 60.2% (2 321/3 857) of the patients considered inhaled corticosteroids (ICS)/inhaled corticosteroids plus long-acting beta2-agonists (ICS+ LABA) as daily-used first-line medication for chronic asthma. 85.7% (3 277/3 823) of the patients had right perception on the condition of using short-acting beta2-agonists (SABA). 75.4% (2 761/3 661) of the patients had right perception on asthma treatment goal. Only 10.1% (388/3 837) of the patients used PFM. Of the reasons for not using PFM, 65.2% (2 518/3 860) of the patients chose doctors never introduced. Among the 10 cities, which were also involved in the asthma control survey in 2007-2008, 71.1% (968/1 361) of the patients had right perception on the disease nature of asthma, 61.6% (839/1 362) of the patients considered ICS/ICS+ LABA as daily-used first-line medication for chronic asthma. 88.7% (1 207/1 361) of the patients had right perception on the condition of using SABA. 74.5% (1 013/1 360) of the patients had right perception on asthma treatment goal. 17.9% (244/1 360) of the patients used PFM. Of the reasons for not using PFM, 76.2% (931/1 221) of the patients chose doctors never introduced. Compared to the survey conducted in 2007-2008, the perception on disease nature and medication choice as daily-used first-line medication for chronic asthma significantly improved, the perception on occasion of using SABA and asthma treatment goal was comparable, while the rate of PFM usage showed no significant improvement. In reasons of not using PFM, doctors never introduced ranked the first. Conclusions: Compared to the similar survey conducted in 2007-2008, the overall status of disease perception of asthma patients has been improved in urban China, while the rate of PFM usage showed no significant improvement. Asthma education on asthma and asthma self-management should be further pushed forward.

[Evaluation of asthma management from the surveys in 30 provinces of China in 2015-2016].

Objective: To evaluate the general level of asthma management in urban areas of China and further promote the national asthma management plan. Methods: A multi-center, cross-sectional survey was carried out in 30 provinces of China (except for Tibet) during Oct 2015 to May 2016. It's a questionnaire-based face-to-face survey which included asthma management using peak flow meter (PFM) and pulmonary function test, medication choice of maintenance therapy and asthma education. Results: A total of 3 875 asthmatic outpatients were recruited including 2 347(60.6%) females and 1 528(39.4%) males. The mean age was (50.7±16.7) years ranging from 14 to 99. Only 10.1%(388/3 837) patients used PFM as monitoring, whereas 62.1%(2 405/3 874) patients underwent pulmonary function test during the past year. There were 57.4%(2 226/3 875) patients treated with inhaled cortical steroid plus long-acting ß(2)-agonist combinations (ICS+LABA) as daily medication. 43.3%(1 661/3 836) patients were followed up by physicians. Among this population, 1 362 asthmatic outpatients were recruited, who also took part in the asthma control survey in 2007-2008 in 10 cities. In this subgroup, 17.9%(244/1 360) were tested by PFM and 66.6%(907/1 362) by pulmonary function test during last year. As to the medication, 63.1%(860/1 362) selected ICS+LABA for daily control. There were 50.4%(685/1 359) patients in the follow-up cohort by physicians. Compared to the similar survey conducted in 2007-2008, the proportion of patients with ICS+LABA regimen and follow-up by physicians were markedly higher, while the rate of PFM use did not have significant improvement. Conclusion: Although the present level of asthma management in China is still far from ideal, asthma management has improved compared to 8 years ago. Yet the use of PFM does not significantly improve. Asthma action plan and application of PFM should be further promoted to improve the level of asthma management.

[A retrospective study of the inducing factors and clinical characteristics of patients hospitalized for asthma exacerbation in China in 2013-2014].

Objective: To study the inducing factors and clinical characteristics of patients hospitalized for asthma exacerbation in China. Methods: Patients hospitalized for asthma exacerbation at 29 hospitals in China were retrospectively recruited during 2013-2014. Results: Clinical data of 3 240 asthmatic patients were collected and analyzed including 1 369(42.3%) males and 1 871(57.7%) females. The patients hospitalized for asthma exacerbation counted for 2.95% (6 375/215 955) of all patients hospitalized during the same period. The leading six inducing factors, in sequence, were acute upper respiratory tract infection [42.3%(1 370/3 240)], changes of weather [22.8%(738/3 240)], noxious gas [(4.3%(140/3 240), allergy challenges [3.5%(115/3 240)], strenuous exercise [1.8%(57/3 240)], and air pollution [1.5%(49/3 240)]. In older patients, more exacerbations were induced by weather changes, yet less sensitive to allergy challenges. As to middle-aged patients, they were less sensitive to upper respiratory tract infections, however the difference was not statistically significant (P>0.05). In winter more asthma patients were induced by upper respiratory tract infections, while in autumn more patients were induced by weather changes, strenuous exercise and air pollution. In spring and summer more patients were induced by allergy challenges, but the differences failed to achieve statistical significance (P>0.05). In northern cities more patients were induced by upper respiratory infections, whereas in southern cities more by noxious gases. Allergy challenges and air pollution tended to affect more patients in northern cities, but the difference was of no significance (P>0.05). The differences of inducing factors among patients of different gender, with or without a smoking history, and with different exacerbation severity didn't show any statistical significance. The patients with severe and life-threatening exacerbations counted for 20.1% (652/3 240). The percentage of patients older than 60 years was higher in patients with severe or life-threatening exacerbations than in whose with mild or moderate exacerbations, so did the percentage of male patients, of patients with disease duration longer than 10 years, with smoking history, and with a history of hospitalization or emergency department visits due to asthma exacerbation during the last year. Conclusion: The acute upper respiratory tract infection ranks top among all the inducing factors. Senility, male gender, long duration of disease, smoking history, and a history of frequent hospital visits might be the risk factors for severe or life-threatening asthma exacerbations.

[Seasonal characteristics of patients hospitalized for asthma exacerbation in China].

Objective: To study the seasonal characteristics of patients hospitalized for asthma exacerbation in China. Methods: This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout mainland China during 2013-2014. The number of patients hospitalized for asthma exacerbation in each hospital was calculated, as well as the ratio of asthmatic patients to all the hospitalized patients. The analysis by month was conducted. The number and ratio of asthmatic patients in the northern and southern cities were calculated respectively. Results: During the study period, there were 6 480 patients hospitalized for asthma exacerbation, accounting for 3.14% (6 480/206 135) of all the hospitalized patients of the respiratory department in 29 hospitals. The analysis by month showed that the ratio of patients hospitalized for asthma exacerbation was highest in March (3.49%), then declined from April to June, then rose again from July, reaching a second peak at September (3.28%), and then declined again from October to December. The ratio of asthmatic patients in every month was higher in northern cities than in southern cities. Conclusions: The ratio of patients hospitalized for asthma exacerbation in China fluctuates with the changes of seasons, and March and September are the two peak months. Northern cities have a higher ratio of asthmatic patients than southern cities.

[Warning symptoms of asthma attack and asthma self-management: a national asthma control survey from China].

Objective: To investigate warning symptoms of asthma attack and evaluate asthma self-management status of asthma patients in urban China. Methods: A multi-center, cross-sectional, questionnaire-based survey was carried out from 30 general hospitals dispersed in 30 provinces of mainland China (except for Tibet) during Oct 2015 to May 2016. Information of frequency and warning symptoms of asthma attack, the time from warning symptoms to asthma attack, the impact of asthma attack and asthma self-management were collected from asthma patients of outpatient department. Results: Altogether 3 875 asthmatic outpatients were recruited. 78.1% (3 026/3 875) of the patients reported restriction of exercise and daily activities during asthma exacerbation. 82.5% (3 160/3 829) of the patients had warning symptoms before asthma attack, the most common warning symptoms were cough, chest tightness and shortness of breath. The median time from warning symptoms to asthma attack was 2 h, the mean time was 90 h. Only 4.4% (167/3 829) of the patients had definite confidence to control asthma when symptoms deteriorated. 76.7% (2 937/3 828) of the patients used medications to control asthma when asthma symptoms deteriorated. Medication choice: inhaled corticosteroid (ICS) + formoterol 45.8% (1 776/3 875), short-acting beta-agonist (SABA) 23.9% (927/3 875). Conclusions: Most asthma patients have warning symptoms before asthma attack, the most common symptoms are cough, chest tightness and shortness of breath. The proportion of patients conducting effective asthma self-management remains low.

[The level of asthma control in China from a national asthma control survey].

Objective: To assess the overall asthma control level in urban China. Methods: A multi-center, cross-sectional, questionnaire-based survey was carried out in 30 provinces in China (except Tibet). Asthmatic outpatients who met the inclusion criteria were recruited consecutively from 30 sub-centers from October 2015 to May 2016. Data of demographic characteristics, asthma control, asthma management, asthma exacerbations and self-management, and disease perception were collected by face-to-face interviews. Results: Totally 3 875 asthmatic outpatients were recruited. Asthma control level was assessed according to GINA 2015. The prevalence of asthma control was 28.5%(1 099/3 854). Among 10 cities, which were also involved in the asthma control survey in 2008, the level of asthma control improved from 28.7% in 2008 to 39.2%(533/1 361) in 2016. The rate of hospitalizations due to asthma exacerbations was 26.4%(1 017/3 858) and the rate of emergency visits was 22.4%(864/3 858). Among adult patients, 18.4%(568/3 092) of them had been absent from work while 63.6%(63/99) adolescent patients had been absent from school because of asthma attacks in the previous year. Conclusion: Although the level of asthma control in China is still far from ideal at present, the status has been improved in some cities. Poorly controlled asthma resulted in increase of hospitalizations, emergency department visits and work/school absences.

[A multi-center study for the association between the perception and control of disease among asthmatic patients in Chinese urban areas].

Objective: To investigate the current perception of disease among asthmatic patients in Chinese urban areas, and to address its association with asthma control. Methods: This was a nationwide, multi-center, cross-sectional study covering 30 third-level, grade A hospitals in 30 provinces, municipalities and autonomous regions (not including Tibet) across Chinese mainland. The survey was carried out from October 2015 to May 2016. Asthmatic outpatients were selected to receive face-to-face questionnaire survey on asthma control including Asthma Control Test (ACT) score, classification of asthma control level[according to the Global Initiative for Asthma (GINA) 2015 classification system, as assessed by the physician completing the survey], perception of asthma (including question 1: nature of asthma as a disease; question 2: selection of first-line therapeutic agents to be regularly used daily for asthma; question 3: appropriate timing of the use of short-acting aerosols of ß(2) receptor agonists; and question 4: therapeutic goals for asthma). Results: A total of 3 875 asthmatic outpatients were included; among them, 69.0% (2 660/3 857) were aware that asthma is "an airway inflammatory disorder resulting from the combined effects of heredity and environment" ; 60.2% (2 321/3 857) considered "inhaled glucocorticoids or their compound preparations" to be the first-line therapeutic agents to be regularly used daily for patients with persistent chronic asthma; 85.7% (3 277/3 823) considered it appropriate to use short-acting aerosols of ß(2) receptor agonists "as needed in the event of disease aggravation or acute exacerbation" ; and 75.4% (2 761/3 661) were aware that asthma "can be adequately or completely controlled in the long term" . The ACT score[20 (16, 23) vs 19 (16, 22) points; Z=-3.928, P<0.001]and asthma control rate (29.92% vs 25.31%; χ(2)=8.616, P=0.003) were significantly higher, and the rate of uncontrolled asthma (19.92% vs 23.48%; χ(2)=6.267, P=0.012) was significantly lower among the 2 660 (69.0%) patients correctly answering question 1 than among the 1 197 (31.0%) patients giving incorrect answer. The ACT score[21 (17, 23) vs 19 (15, 22) points; Z=-9.190, P<0.001] and asthma control rate (32.66% vs 22.20%; χ(2)=49.614, P<0.001) were significantly higher, and the rate of uncontrolled asthma (18.40% vs 25.00%; χ(2)=24.267, P<0.001) was significantly lower among the 2 321 (60.2%) patient correctly answering question 2 than among the 1 536 (39.8%) patients giving incorrect answer. Conclusions: Compared to previous surveys, there has been improved perception of disease among asthmatic patients in Chinese urban areas. Correct perception of disease is favorable for improving asthma control level.

[A multi-center retrospective study of clinical characteristics and hospitalization costs of patients hospitalized for asthma exacerbation in China during 2013-2014].

Objective: To study the characteristics of patients hospitalized for asthma exacerbation in 29 teaching hospitals in China and to evaluate the hospitalization costs of these patients. Methods: This was a retrospective study and involved patients hospitalized for asthma exacerbation in 29 hospitals throughout China during 2013-2014. Information about the demographic features, conditions before the admission, the outcome, the complications, and the costs was collected using the pre-designed case report form. The influencing factors of the hospitalization costs were analyzed. Results: 3 240 asthmatic patients (1 369 males and 1 871 females) were included and data were analyzed. There were 41.5% (1 346/3 240) patients who had a history of previous hospitalization or emergency department visits during the last year. Only 28.0% (907/3 240) patients had used asthma-controlling medications regularly before the admission. Seventy-three(2.3%) patients were admitted to ICU and used mechanical ventilation. Mortality among these patients hospitalized for asthma exacerbation was 0.25% (8/3 240). The median hospitalization costs was 9 045(6 431, 13 035) RMB. The costs of medications, examinations and treatment accounted for 52.1%, 27.6%, and 9.6% respectively. The costs of asthma medications accounted for only 22.7% of the total medication costs, while the costs of antibiotics accounted for 44.0%. The patients who were admitted to ICU, used mechanical ventilation, complicated with pneumonia, or had a history of hospitalization or emergency department visits during the last year due to asthma exacerbations tended to cost more. Conclusion: In this study, we demonstrated that only a minority of the patients had used asthma controllers regularly before the admissions with exacerbations. The in-hospital mortality of asthma patients in this study was much lower than that reported in other countries. The average cost of hospitalization was much higher than the yearly cost of maintenance therapy. Medication was the predominant component of the total hospitalization costs, and the costs of antibiotics made up the major part of the total medication costs.

Bioaccumulation of the rare earth elements lanthanum, gadolinium and yttrium in carp (Cyprinus carpio).

Widespread use of the rare earth elements (REEs) in China for agricultural purposes, together with many other applications, has resulted in a remarkable increase of REE concentrations in the environment. The comparative bioaccumulations of representative light, medium and heavy REEs in a variety of tissues of carp (Cyprinus carpio L.) were investigated for an evaluation of their impacts on aquatic animals. The fish were exposed continuously to solutions containing 0.50 mg litre(-1) of each element for 45 days at pH 6.0 and sacrificed at time intervals. Skeleton, muscle, gills and internal organs were analysed for REE contents. A method using cation-exchange resin separation and ICP-AES determination was developed for the quatification of individual REEs. The results show that carp has low ability to take up the REEs under the experimental conditions. The order of REEs under the experimental conditions. The order of maximum bioconcentration factors was mostly internal organs > gills > skeleton > muscle. Neither synergistic nor antagonistic effects of the mixed REE solutions for carp were observed. The relative distributions of different REEs in the investigated tissues exhibited similar patterns. Among the selected tissues studied, the concentration of a heavy REE (Y) was the smallest, while concentrations of a medium (Gd) and a light REE (La) showed only a slight difference.

[Pharmacokinetics of sodium selenite in human body at different levels of selenium].

Twelve health adults (6 M, 6 F) from the endemic area of Keshan disease and Kaschin-Beck's disease and 12 adults from nonaffected area were administered a single oral dose of 4 mg sodium selenite. Selenium in whole blood was determined by fluorescence spectrometry. Their basic levels of blood selenium were 64 +/- 16 and 220 +/- 20 ng.ml-1, respectively. The concentration-time data were treated by a computer with program 3P87, which revealed 2-compartment models with first order absorption and lag time. The pharmacokinetic parameters of low-Se group were T1/2g 1.8 +/- 0.6h, T1/2g 72 +/- 18 h, T1/2ka 3.2 +/- 1.8h, AUC 3,100 +/- 500 ng.h.ml-1, CL 32 +/- 7 ml.kg-1.h-1, Vc 1.45 +/- 0.19 L.kg-1, Tp 6.1 +/- 2.0 h, Cp 36 +/- 4 ng.ml-1, AUMC (S1) 130 +/- 26, VRT 174 +/- 17 h, MRT 55 +/- 4 h, and of normal-Se group were T1/2 3.4 +/- 0.7h, T1/2g 14 +/- 3 h. T1/2ka 2.3 +/- 0.6, AUC 1,420 +/- 210 ng.h.ml-1, Cl 57 +/- 7 ml.kg-1. h-1, Vc 0.54 +/- 0.09 L.kg-1, Tp 4.6 +/- 0.9h, Cp 75 +/- 5 ng.ml-1, AUMC (S1) 25 +/- 5, VRT 16 +/- 3 h, MRT 16.1 +/- 1.5 h.