The Effect of Ostracism on Adults' Materialism: The Roles of Security and Self-Construal.

With consumer culture becoming more prominent, the value of materialism is growing rapidly. This study explored the formation of materialism in adults, based on the temporal need-threat model of ostracism and the theory of materialistic values. Specifically, this study examined the link between ostracism and materialism from the perspective of security and the moderating role of self-construal in this process. A sample of 1,272 Chinese adults (M age = 35.90 ± 11.59, 47.2% male) was recruited to complete the Ostracism Experiences Scale, the Material Values Scale, the Security Questionnaire, and the Self-Construal Scale. The results showed that (1) ostracism positively predicted materialism in Chinese adults; (2) security partially mediated the relationship between ostracism and materialism; (3) and self-construal moderated this mediation model. The moderating effect of self-construal on the relationship between ostracism and security was significant. Specifically, the direct effect of ostracism on security was much stronger for adults with interdependent self-construal than for those with independent self-construal. However, self-construal had no significant moderating effect on the direct effect of ostracism on materialism. These findings suggest that ostracism may affect materialism by damaging adults' feelings of security, and independent self-construal can buffer the damage of ostracism on security.

Clinical analysis of 132 cases COVID-19 from Wuhan.

Numerous cases of pneumonia from a novel coronavirus (SARS-CoV-2) emerged in Wuhan, China during December 2019.We determined the correlations of patient parameters with disease severity in patients with COVID-19.A total of 132 patients from Wuhan Fourth Hospital who had COVID-19 from February 1 to February 29 in 2020 were retrospectively analyzed.Ninety patients had mild disease, 32 had severe disease, and 10 had critical disease. The severe/critical group was older (P < .05), had a higher proportion of males (P < .05), and had a greater mortality rate (0% vs 61.9%, P < .05). The main symptoms were fever (n = 112, 84.8%) and cough (n = 96, 72.7%). Patients were treated with antiviral agents (n = 94, 71.2%), antibiotics (n = 92, 69.7%), glucocorticoids (n = 46, 34.8%), intravenous immunoglobulin (n = 38, 27.3%), and/or traditional Chinese medicine (n = 40, 30.3%). Patients in the severe/critical group received mechanical ventilation (n = 22, 16.7%) or high-flow nasal can-nula oxygen therapy (n = 6, 4.5%). Chest computed tomography (CT) indicated bilateral pneumonia in all patients. Relative to the mild group, the severe/critical group had higher levels of leukocytes, C-reactive protein (CRP), procalcitonin (PCT), D-dimer, B-type natriuretic peptide (BNP), liver enzymes, and myocardial enzymes (P < .05), and decreased levels of lymphocytes and blood oxygen partial pressure (P < .05).The main clinical symptoms of patients from Wuhan who had COVID-19 were fever and cough. Patients with severe/critical disease were more likely to be male and elderly. Disease severity correlated with increased leukocytes, CRP, PCT, BNP, D-dimer, liver enzymes, and myocardial enzymes, and with decreased lymphocytes and blood oxygen partial pressure.

SMADs binding site polymorphisms rs9911630 is associated with susceptibility but not prognosis of gastric cancer: a case control study.

Background: Single nucleotide polymorphisms (SNPs) in transcription factor binding sites (TFBS) can change their binding strength, affecting the function of transcription factors (TFs). Small mother against decapentaplegic (SMAD) proteins are known as a family of TFs involved in tumorigenesis. We performed this study to investigate whether SNPs in SMADs binding sites affect the susceptibility or prognosis of gastric cancer (GC). Methods: Using bioinformatics tools, we focused on the association between rs9911630 polymorphism and GC. We performed this case-control study in 1275 GC patients and 1426 cancer-free subjects using TaqMan allelic discrimination method. Results: We found that rs9911630 A>G polymorphism was associate to an increased risk of gastric cancer (adjusted OR for additive model = 1.16; 95% CI = 1.03-1.30). Furthermore, we assess whether rs9911630 polymorphism affected the prognosis of GC. However, no significant association was discovered between rs9911630 A>G polymorphism and overall survival time of GC patients (HR for addictive model = 1.01; 95%CI = 0.88-1.15). Conclusions: Our results suggested that rs9911630 polymorphism in SMADs target site might influence susceptibility but not prognosis of gastric cancer.

Values of different specimen preparation methods for the diagnosis of lung cancer by endobronchial ultrasound guided transbronchial needle aspiration.

BACKGROUND: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has been become an important procedure for the diagnosis and staging of lung cancer. Our research identified the effects of different pathological preparation on the diagnosis of lung cancer for specimens obtained by biopsy. METHODS: Patients were clinically considered if lung cancer was accompanied by mediastinal or hilar lymph node enlargement between March 2014 and November 2017. Specimens obtained by EBUS-TBNA were treated by three methods: traditional smear cytology, liquid-based cytology (LBC) and histopathology. RESULTS: Of a total of 154 puncture sites from 153 patients, the total positive rate of combination for the three pathological treatment types (histopathology, direct traditional smear, and LBC) was 77.3%. The diagnostic positive rate for histopathology was 68.6%, direct traditional smear was 65.6%, and LBC was 60.4%; there was no significant differences among the three single pathological treatment types (P = 0.29), but there was a statistically significant difference between the combination of three treatments and any single pathological treatment type (P = 0.01). The diagnostic sensitivities of histopathology combined with traditional smear and histopathology combined LBC were 94.4 and 92.8%, respectively, the specificities and PPVs were both 100%, and the diagnostic accuracies were 95.5 and 94.2%, respectively; the sensitivities, specificities and diagnostic accuracies above were all higher than those of single specimen treatment and lower than those of the three combined. CONCLUSION: When EBUS-TBNA is used for the diagnosis and staging of lung cancer, the use of histopathological sections combined with direct cytological smear should be sufficient and is the most economical choice.

microRNA-501-5p promotes cell proliferation and migration in gastric cancer by downregulating LPAR1.

In spite of the achievement in treatment, the gastric cancer (GC) mortality still remains high. MicroRNAs (miRNAs) are a group of small noncoding RNAs that play a crucial part in tumor progression. In this study, we explored the expression and function of microRNA-501-5p (miR-501-5p) in GC cell lines. Quantitative real-time polymerase chain reaction assay results suggested that miR-501-5p was significantly upregulated in GC tissues and cell lines. And, the Cell Counting Kit-8 colony formation and cell migration assay results showed that the downregulation of miR-501-5p decreased GC cell proliferation and migration. Besides that, we found that GC cell cycle was arrested in G2 phase and cell apoptosis rate was increased by silencing the expression of miR-501-5p in GC cell lines using the flow cytometry. We also found that miR-501-5p could directly target lysophosphatidic acid receptor 1 (LPAR1) and negatively regulate LPAR1 expression in GC cell lines by performing dual-luciferase reporter gene assay and Western blot analysis. And, LPAR1 was significantly downregulated in GC tissues and inversely correlated with miR-501-5p expression. Furthermore, LPAR1 downregulation promoted cell proliferation and migration, which were attenuated by cotransfection of miR-501-5p inhibitor in GC cells. In conclusion, miR-501-5p can promote GC cell proliferation and migration by targeting and downregulating LPAR1. miR-501-5p/LPAR1 may become a potential therapeutic target for GC treatment.

Retropharyngeal abscess presenting as acute airway obstruction in a 66-year-old woman: A case report.

BACKGROUND: Adult retropharyngeal abscess (RPA) is extremely rare, and most cases reported in the literature were related to tuberculous infection. We present a case of RPA with acute airway obstruction as the main manifestation in a 66-year-old woman that was considered to be non-tubercular suppurative inflammation in the retropharyngeal space. CASE SUMMARY: A 66-year-old woman complaining of chills and fever was admitted to our hospital. She was initially diagnosed with an acute upper respiratory tract infection. She lost consciousness twice during hospitalization. She regained consciousness immediately upon emergency tracheal intubation. Acute upper airway obstruction was suspected as arterial blood gas analysis showed obvious acute retention of carbon dioxide before the second tracheal intubation. The diagnosis of RPA was confirmed by computed tomography and magnetic resonance imaging. Kocuria kristinae was isolated from blood samples taken from both hands. The patient recovered and was subsequently discharged after receiving antibiotic therapy together with surgical incision and drainage of the abscess. CONCLUSION: Clinicians should be alert to the possibility of RPA in patients with acute airway obstruction. Surgical incision and drainage is an effective treatment for RPA.

Bacterial etiology in early re-admission patients with acute exacerbation of chronic obstructive pulmonary disease.

BACKGROUND: Repeatedly hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are often exposed to more antibiotics, but the distribution of pathogenic bacteria in these patients is poorly understood. The objectives of this study were to analyze the distribution of pathogenic bacteria and the risk factors associated with multidrug-resistant (MDR) bacteria infection in early re-admission patients with AECOPD. METHODS: We retrospectively reviewed charts for patients with AECOPD admitted to our hospital between January 2011 and November 2012. The early re-admission group and non-early readmission group were determined by whether patients were readmitted within 31 days after discharge. Detection of potentially pathogenic microorganisms (PPMs) and MDR bacteria were analyzed. Logistic regression analysis was performed to identify independent risk factors for MDR bacteria infection. RESULTS: PPMs were isolated from 230 (32.0%) cases of respiratory tract specimens; MDR bacteria accounted for 24.7% (57/230). Pseudomonas aeruginosa (43.7%), Klebsiella pneumoniae (15.6%), and Acinetobacter baumannii (12.5%) were the top three PPMs in the early readmission group, while the top three PPMs in the non-early readmission group were K. pneumoniae (23.7%), P. aeruginosa (21.2%), and Streptococcus pneumoniae (17.1%). Multivariate analysis showed that use of antibiotics within 2 weeks (odds ratio [OR] 8.259, 95% confidence interval [CI] 3.056-22.322, p = 0.000) was the independent risk factor for MDR bacteria infection. CONCLUSION: Non-fermentative Gram-negative bacilli (NFGNB) and enterobacteria were the predominant bacteria in early readmission patients with AECOPD. The detection rate of MDR bacteria was high which was related to the use of antibiotics within 2 weeks before admission in these patients.

A rare case of an HIV-seronegative AIDS patient with Pneumocystis jirovecii pneumonia.

BACKGROUND: As technology progresses, several highly sensitive human immunodeficiency virus (HIV) screening kits are being researched and developed to quickly and efficiently identify serum HIV antibodies within the non-window period. In individuals who are HIV-seronegative, HIV infections that are not within a window period are rare. In such cases, all antibody detection methods will fail, and misdiagnosing these patients will have catastrophic consequences. CASE PRESENTATION: A 22-year-old male Chinese patient with diffuse exudative lesions in both lungs and initial symptoms of cough and dyspnoea was diagnosed with Pneumocystis jirovecii pneumonia (PJP) by aetiological examination, and the patient's plasma CD4+ T-cell count was extremely low. In China, PJP is prevalent in HIV-infected individuals. Pneumocystis jirovecii (P. jirovecii) has a high colonisation rate in patients with HIV infections. This patient was naturally suspected of being an HIV patient; however, serum HIV antibody tests were negative using both an enzyme-linked immunosorbent assay (ELISA) and a latex agglutination assay, and HIV was not detected by western blotting. Subsequently, the plasma HIV viral load was found to be extremely high on two repeated plasma HIV RNA tests, thus confirming HIV-seronegative acquired immunodeficiency syndrome (AIDS) in this patient. With administration of effective anti-P. jirovecii treatment and highly active antiretroviral therapy (HAART) after diagnosis, the patient's disease condition was rapidly controlled. CONCLUSION: This is the second reported case in China of an HIV-seronegative AIDS patient. Such cases are also rare worldwide. Although HIV-seronegative HIV infections are rare, AIDS should be considered in immunodeficient patients with opportunistic infections, even if the test results are HIV-seronegative. Plasma HIV RNA testing is important for such patients.

The miRNA hsa-miR-6515-3p potentially contributes to lncRNA H19-mediated-lung cancer metastasis.

Aberrant expression of long noncoding RNAs (lncRNAs) contributes to all phenotypes of cancer including metastasis, which is a major cause of death in many advanced malignancies. One particular lncRNA, H19, is found to be a crucial player in cancer progression by modulating multiple microRNAs (miRNAs). In this study, we screened miRNAs possibly associated with H19 using lung carcinoma cell lines and patient with lung cancer tissues, and selected one possible hit, hsa-miR-6515-3p, to perform in vitro functional assays. Its inhibition leads to decreased proliferation and migration of SPC-A1 lung cancer cells and is in good correlation with H19-knockdown groups. These results indicate that H19 may be an epigenetic regulator of miR-6515-3p, and its dysregulation may contribute to lung cancer progression and metastasis.

A positive feedback loop between ZNF205-AS1 and EGR4 promotes non-small cell lung cancer growth.

Accumulating evidences revealed that long noncoding RNAs (lncRNAs) are frequently implicated in non-small cell lung cancer (NSCLC). Herein, we reported the identification of a novel NSCLC-associated functional lncRNA ZNF205 antisense RNA 1 (ZNF205-AS1). ZNF205-AS1 was increased in NSCLC tissues and cell lines, and associated with poor prognosis of NSCLC patients. Bioinformatics prediction, combined with experimental verification revealed that early growth response 4 (EGR4) directly bound to ZNF205-AS1 promoter, increased the promoter activity of ZNF205-AS1, and activated ZNF205-AS1 transcription. Intriguingly, ZNF205-AS1 transcript directly interacted with EGR4 mRNA, increased EGR4 mRNA stability, and up-regulated EGR4 expression via RNA-RNA interaction. Thus, ZNF205-AS1 and EGR4 formed a positive feedback loop. Through regulating EGR4, ZNF205-AS1 activated its own promoter activity. EGR4 was also increased in NSCLC and the expression of ZNF205-AS1 was significantly positively correlated with EGR4 in NSCLC tissues. Gain-of-function and loss-of-function assays demonstrated that both ZNF205-AS1 and EGR4 promoted NSCLC cell growth in vitro and NSCLC tumour growth in vivo. Concurrently depleting ZNF205-AS1 and EGR4 more significantly repressed NSCLC tumour growth in vivo. Collectively, our study demonstrated that the positive feedback loop between ZNF205-AS1 and EGR4 promotes NSCLC growth, and implied that targeting this feedback loop may be promising therapeutic strategy for NSCLC.

Prognostic Role of MicroRNA-497 In Cancer Patients: A Meta-analysis.

Background: MicroRNA-497(miR-497) has been studied for its irreplaceable role of predicting the prognosis of various cancers, but there has been no systematic study to summarize the data. Consequently, we performed this meta-analysis to reveal the association between the expression level of miR-497 and cancer prognosis systematically. Materials and Methods: PubMed was searched for appropriate studies and a total of 12 eligible publications with 989 cancer patients were recruited into our analysis to assess the strength of the association. Hazard ratios (HRs) and odds ratios (ORs) were analyzed to finish this work. Results: The cancer patients who have high expressing level of miR-497 are less possible to have lymph node metastasis (OR = 0.25, 95% CI: 0.16-0.40, P < 0.001) and more likely to have favourable tumor-node-metastasis stage (OR = 0.29, 95% CI: 0.17-0.49, P < 0.001). Also, high miR-497 expression level was notably connected to better overall survival (pooled HR = 0.41, 95% CI: 0.32-0.53, P < 0.001). Conclusions: High expressing levels of miR-497 might be a potential biomarker which can be used to predict the better prognosis of different cancer types.

Association of MUC1 rs4072037 Functional Polymorphism and Cancer Risk: Evidence from 12551 Cases and 13436 Controls.

Objectives: The result of the relationship between the MUC1 rs4072037 polymorphism and cancer risk is controversial, we take this meta-analysis to investigate a more precise result. Methods: Electronic database Pubmed, Web of science and Cochrane library had been used to search relevant articles concerning the relationship between MUC1 rs4072037 polymorphism and cancer risk. We used odds ratios (ORs) and 95% confidence intervals (CIs) to assess the strength of the gene-disease association. We also conducted subgroup analysis, sensitivity analyses and publication bias in the meta-analysis. Results: In our meta-analysis, we involved 17 studies (19 datasets) with 12551 cases and 13436 controls eventually. It showed the MUC1 rs4072037 polymorphism was associated with decreased cancer risk in four genetic models (G vs. A: OR=0.79, 95%CI: 0.71-0.89, P< 0.001; AG vs. AA: OR=0.72, 95%CI: 0.62-0.82, P< 0.001; GG vs. AA: OR=0.78, 95%CI: 0.69-0.88, P< 0.001; AG+GG vs. AA: OR=0.72, 95%CI: 0.63-0.83, P< 0.001). In subgroup analysis, it showed a decreased cancer risk among Asians but not Caucasians and a significant decreased gastric cancer risk in all genetic models. Conclusion: MUC1 rs4072037 polymorphism is associated with decreased cancer risk and can probably be used as a tumor marker, especially for gastric cancer and for Asians.

Shikonin­mediated inhibition of nestin affects hypoxia­induced proliferation of pulmonary artery smooth muscle cells.

The imbalance between the proliferation and apoptosis of pulmonary artery smooth muscle cells (PASMCs) is of importance in pulmonary vascular remodeling. Shikonin, a naphthoquinone compound extracted from the Chinese medicinal herb Lithospermum erythrorhizon, inhibits the proliferation of rat smooth muscle cells (SMCs). The present study was designed to investigate the effects of shikonin on the proliferation of rat PASMCs and the possible mechanisms involved. Rat PASMCs were cultured under the following five treatment conditions: Normal control; hypoxia for 24 h; hypoxia + 1 µM shikonin for 24 h; hypoxia + 2 µM shikonin for 24 h; and hypoxia + 4 µM shikonin for 24 h. The viability of PASMCs was measured using the Cell Counting Kit­8 assay, the mRNA expression of nestin (NES) in each group was measured by reverse transcription­polymerase chain reaction and the protein expression of NES was measured by western blotting. The proliferation of hypoxic PASMCs transfected with NES­specific small interfering (si)RNA decreased compared with the non­transfected group. These results indicated that hypoxia induced the proliferation of PASMCs through the enhancement of NES expression. The treatment of hypoxic PASMCs with shikonin resulted in a significant downregulation of NES expression and the inhibition of PASMC proliferation.

The effects of carboplatin and etoposide on advanced small cell lung cancer and serum tumor markers in correlation with long-term survival rate.

Objective of the present study was to analyze the efficacy of recombinant human endo-statin combined with carboplatin and etoposide regimen (CE regimen) in treatment of patients with advanced small cell lung cancer and its effects on serum tumor markers of CY211, CEA and CA199. A total of 72 patients at Zhejiang Taizhou Hospital, Taizhou, Zhejiang, China were randomly divided into control group and observation group (36 cases each). The control group was treated with carboplatin and etoposide while the observation group additionally received recombinant human endo-statin. Clinical remission rate and adverse reaction rate were compared between the two groups. Before treatment, there was no significant difference (P>0.05) between the two groups in serum tumor markers of CY211, CEA and CA199 while after treatment, the CY211, CEA and CA199 levels of the observation group were significantly lower than those of the control group and no significant difference was found between the two groups in the incidence of side effects as well as in the 3 and 5 year-survival rate (X2=1.125, 1.248, P>0.05). Recombinant human endo-statin combined with carboplatin and etoposide was more effective in treating advanced small cell lung cancer as it managed to reduce the level of serum tumor markers of CY211, CEA and CA199 with less side effects and high tolerance in patients, thus worthy of popularization and application in clinical trials.

A rare fatal case of a novel bunyavirus-associated hemophagocytic lymphohistiocytosis.

Herein we describe a rare fatal case of a novel bunyavirus-associated hemophagocytic lymphohistiocytosis (HLH) in a 62-year-old female patient. The novel bunyavirus infects patients with or without HLH who have similar clinical features such as fever, thrombocytopenia, and leukocytopenia. Therefore, the diagnosis of HLH can be easily missed. When HLH occurs, the disease worsens and the fatality rate rises. Our finding highlights the importance of bone marrow biopsy performed as soon as possible for patients suspected of having a novel bunyavirus infection and showing marked cytopenia in three cell lines.

Tigecycline Therapy for Nosocomial Pneumonia due to Carbapenem-Resistant Gram-Negative Bacteria in Critically Ill Patients Who Received Inappropriate Initial Antibiotic Treatment: A Retrospective Case Study.

Background. Nosocomial pneumonia due to carbapenem-resistant Gram-negative bacteria (CRGNB) is a growing concern because treatment options are limited and the mortality rate is high. The effect of tigecycline (TGC) on nosocomial pneumonia due to CRGNB in patients who have received inappropriate initial empiric antibiotic treatment (IIAT) is unclear. Therefore, this study aimed to examine the effect of TGC on nosocomial pneumonia due to CRGNB in critically ill patients who had received IIAT. Methods. A retrospective study was conducted in an adult respiratory intensive care unit. Data were obtained and analyzed for all patients who were treated with TGC ≥ 3 days for microbiologically confirmed nosocomial pneumonia due to CRGNB and had experienced initial antibiotic failure. Clinical and microbiological outcomes were investigated. Results. Thirty-one patients with hospital-acquired pneumonia or ventilator-associated pneumonia were included in the study. The majority of the responsible organisms were carbapenem-resistant Acinetobacter baumannii (67.7%), followed by Klebsiella pneumoniae (16.1%) and Escherichia coli (9.7%). Twenty patients were treated with high-dose TGC therapy (100 mg every 12 h after a 200 mg loading dose), and the others received a standard-dose therapy (50 mg every 12 h after a 100 mg loading dose). The duration of TGC therapy was 14.3 ± 2.8 days. The global clinical cure rate and the microbiological eradication rate were 48.4% and 61.3%, respectively. The overall ICU mortality rate was 45.2%. A higher score on the Acute Physiology and Chronic Health Evaluation II and a longer duration of IIAT were associated with clinical failure. High-dose TGC therapy had a higher clinical success rate [65.0% (13/20) versus 18.2% (2/11), P = 0.023] and a lower ICU mortality rate [30.0% (6/20) versus 72.7% (8/11), P = 0.031] than the standard-dose therapy. Conclusions. TGC, especially a high-dose regimen, might be a justifiable option for critically ill patients with nosocomial pneumonia due to CRGNB who have received IIAT when the options for these patients are limited.

Endogenous lipoid pneumonia presenting as solitary pulmonary nodule: a case report.

A 63-year-old woman complained of hemoptysis was admitted to our hospital. Chest computed tomography (CT) showed a solitary pulmonary nodule (SPN) arising from the lower lobe of the right lung which was considered as lung malignancy. The patient underwent video-assisted thoracoscopic surgery (VATS) of pulmonary wedge resection to remove the nodule. Diagnosis of lipoid pneumonia was established by multiple lipid-laden macrophages found in surgical specimen. As there was no history of inhalation or aspiration of lipid containing substances, she was diagnosed as endogenous lipoid pneumonia. The patient discharged from our hospital after surgery and with no recurrence in 9 months period.

Pulmonary oncocytoma: a case report.

A 70-year-old man complained of no discomfort was admitted to our hospital because of a nodules was found in his lung. Chest computer tomography showed a nodules arising from the upper lobe of the left lung, and the lesion became larger in 2 years follow-up period. The patient underwent video-assisted thoracoscopic surgery of lobectomy to remove the nodules. Histologically, the tumor specimen contained multiple glandular structures with oncocytic cells lining. Immunohistochemical staining showed the tissue did not include some neuroendocrine granules. Finally, He was diagnosed as pulmonary oncocytoma. The patient discharged from our hospital after surgery and with no recurrence in 29 months period.

Risk factors associated with chronic obstructive pulmonary disease early readmission.

BACKGROUND: The 31 day readmission rate is deemed to be an important indicator of the quality of medical care in China. The objectives of this study were to identify the readmission rate of acute exacerbation for chronic obstructive pulmonary disease (COPD) and to evaluate associated risk factors. METHODS: We retrospectively reviewed charts for patients with acute exacerbation of COPD (AECOPD) admitted to our hospital between January 2011 and November 2012. The early-readmission group and non-early-readmission group were determined by whether patients were readmitted within 31 days after discharge. Logistic regression analysis was performed to identify risk factors for early readmission following an AECOPD. RESULTS: There were 692 patients with 925 admissions during the 23 month period; 63 (6.8%) admissions met our criteria for early readmission. Multivariate analysis showed that chronic cor pulmonale (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.26-3.64, p = 0.005), hypoproteinemia (OR 2.02, 95% CI 1.03-3.95, p = 0.040) and an elevated PaCO2 (OR 1.03, 95% CI 1.00-1.06, p = 0.027) were identified as risk factors for early readmission of AECOPD. CONCLUSION: The readmission rate for AECOPD was 6.8%. AECOPD patients with chronic cor pulmonale, hypoproteinemia, and a high PaCO2 are at higher risk for readmission with 31 days of hospital discharge, and medical care of these patients warrants greater attention.