[Clinical analysis of primary lung tumors in 56 children].

Objective: To investigate the clinical manifestation, pathological type, treatment and prognosis of primary lung tumors in children. Methods: We collected and retrospectively analyzed the clinical manifestation, pathological type, therapeutic method and prognosis of 56 primary lung tumors patients who diagnosed from 2009 to 2019 in Guangzhou Women and Children Medical Center. Results: There were 56 patients identified as the primary lung tumors, including pleuropulmonary blastoma (PPB, n=28), pulmonary inflammatory myofibroblastic tumor(IMT, n=20), mucoepidermoid carcinoma(n=6), infantile hemangioma (n=1), pulmonary sclerosing hermangioma(n=1). Respiratory symptoms were the most manifestation at the time of diagnosis including 26 patients with cough, 3 with hemoptysis, and 17 with dyspnea. Others included 15 with fever, 3 with chest pain, and 2 with epigastiric pain. The primary tumor of 18 cases were located in the lower lobe of left lung, 11 cases in the lower lobe of right lung, 10 cases in the upper lobe of left lung, 7 cases in the upper lobe of right lung, 6 cases in the middle lobe of right lung, and 4 cases in pulmonary hilum. Among the 56 patients, 41 patients underwent thoracotomy, 13 thoracoscopy, and 2 fiberoptic bronchoscopy. Five patients with type Ⅰ PPB were still alive at the end of follow-up without chemotherapy. Among 5 patients with type Ⅱ PPB, 2 patients without chemotherapy died after recurrence, 3 patients suffered postoperative chemotherapy were still alive at the end of follow-up. All of the 18 patients with type Ⅲ PPB underwent postoperative chemotherapy with IVADo regimen. Recurrence occurred in 6 cases, distant metastasis occurred in 3 cases, and cancer-related deaths occurred in 8 cases. For 20 patients with IMT, recurrence occurred in 5 of 13 patients experienced wedge resection, 1 of 6 patients experienced lobectomy and 1 of 6 underwent fiberoptic bronchoscopy, respectively. For 6 mucoepidermoid carcinoma patients, lobectomy was carried on 5 patients, wedge resection on 1 patient, all of them were still alive at the end of follow-up. One hermangioma patient underwent fiberoptic bronchoscopy and other 1 sclerosing hermangioma patient underwent wedge resection, both of them were still alive at the end of follow-up. Conclusions: The clinical manifestations of the primary lung tumors in children are nonspecific. Complete resection and achieving negative marginattribute to the excellent outcome. Adjunctive treatment such as chemotherapy is necessary for patients with type Ⅱ and type Ⅲ PPB.

[The diagnostic performance of galactomannan detection in invasive pulmonary aspergillosis with severe and critically ill influenza].

Objective: To analyze the diagnostic performance of serum and bronchoalveolar lavage fluid (BALF) galactomannan (GM) test in invasive pulmonary aspergillosis(IPA) with severe and critically ill influenza. Methods: A retrospective study was performed for 157 patients with severe and critically ill influenza admitted to the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University from December 2017 to April 2019.Clinical characteristics and serum and BALF GM values were collected. The patients were divided into an IPA group (n=18) and a non-IPA group (n=139). The definition of IPA modified from AspICU algorithm taken as the gold standard (The corresponding clinical manifestations, imaging manifestations and microbiological diagnostic criteria should be met simultaneously), the performance of serum and BALF GM test and their combination to IPA with influenza were analyzed respectively and receiver operating characteristic curve (ROC) was drawn. Results: A total of 157 cases were enrolled, 95 were critically ill, and the mortality of IPA with influenza was 55.6%(10/18). The APACHE Ⅱ score, PSI score, urea nitrogen, influenza severity (Percentage of critically ill influenza) and invasive ventilator in IPA group were (16±6), (110±31), 10.7 (8.4, 17.8) mmol/L, 88.9% and 66.7%, respectively, which were significantly higher than those in non-IPA group [(10±5), (83±30), 5.2 (3.6, 7.6) mmol/L, 56.8% and 24.5%, P<0.05]. All patients received serum GM test and 32 patients performed BALF GM test at the same time. When the cut-off valve of serum GM test was 0.5 µg/L, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 66.7% (12/18), 95.0% (132/139), 63.2% (12/19) and 95.7% (132/138) respectively. When the cut-off value of BALF GM test was 1.0 µg/L, the sensitivity, specificity, PPV and NPV were 80%(8/10),86.4%(19/22),72.7%(8/11)and 90.5%(19/21)respectively. The BALF GM cut-off value of 0.88 µg/L showed the highest diagnostic efficacy for IPA, for which the sensitivity and specificity were 90%(9/10) and 86.4%(19/22). The areas under the ROC curve of serum GM, BALF GM, and the combination of them were 0.81, 0.85, and 0.94 respectively. The difference was statistically significant (P<0.05) and the combined diagnosis efficiency was higher. Conclusions: Critically ill influenza patients should be alert for IPA. The sensitivity of serum GM test in the diagnosis of IPA with influenza was low, while the NPV was high. The optimum BALF GM cut-off value was 0.88 µg/L. The combination with BALF and serum GM test can improve the diagnostic performance.

[Clinicopathologic features and prognosis of 28 cases of pleuralpulmonary blastoma in children].

Objective: To explore the clinical characteristics, therapeutic methods and prognosis of pleuropulmonary blastoma in children. Methods: The clinical data of 28 patients with pleuropulmonary blastoma diagnosed in Guangzhou Women and Children's Medical Centre from November 2008 to May 2018 were collected and retrospectively analyzed. Results: Of the 28 patients, 18 were male and 10 were female, aged from 22 days to 5 years 10 month, the average age was 2 years 6 months. One patient underwent biopsy and other 27 underwent operation, 14 patients with type Ⅱ/Ⅲ pleuropulmonary blastoma received postoperative chemotherapy. Five patients were pathologically diagnosed as typeⅠpleuropulmonary blastoma, 5 were type Ⅱ pleuropulmonary blastoma and 18 were type Ⅲ pleuropulmonary blastoma. During the follow-up period of 24 patients, 15 patients were disease free survival, 3 patients relapsed within 6 months, 10 months and 18 months after chemotherapy, respectively. One patient who received postoperative chemotherapy suffered a bone metastasis within 11 months, 2 patient without chemotherapy relapsed within 2 months and suffered bone or renal metastasis within 3 months, respectively. Three patients who left hospital voluntarily died within 1 month. Conclusions: Pleuropulmonary blastoma is a highly malignant and rapidly progressed neoplasm. Patients with type Ⅰ pleuropulmonary blastoma have good prognoses while the prognoses of Ⅱ/Ⅲ pleuropulmonary blastoma are poor. Postoperative chemotherapy seems to improve the survival of patients withⅡ/Ⅲ pleuropulmonary blastoma.

[Willingness and influencing factors related to "centralized slaughtering, fresh poultry listing and marketing" strategy among the household chefs in Guangzhou].

Objective: To study the willingness and influence factors related to "centralized slaughtering, fresh poultry listing and marketing" strategy, among the household chefs, and provide reference for government to adjust and optimize the strategy on avian influenza prevention. Methods: According to the geographical characteristics and regional functions, 6 'monitoring stations' were selected from 12 residential districts of Guangzhou, respectively. Another 21 meat markets which selling live poultry, were selected in each station and 5 household chefs of each market were invited to attend a face to face interview. Basic information, personal cognitive, willingness and influencing factors to the policy were under study. Univariate and multivariate logistic regression methods were used. Results: A total of 664 household chefs underwent the survey and results showed that the rate of support to the "centralized slaughtering, fresh poultry listing and marketing" strategy was 44.6% (296/664). Results from the multi-factor logistic regression showed that those household chefs who were males (OR=1.618, 95% CI: 1.156-2.264, P=0.005), having received higher education (OR=1.814, 95% CI: 1.296-2.539, P=0.001), or believing that the existence of live poultry stalls was related to the transmission of avian influenza (OR=1.918, 95% CI: 1.341-2.743, P<0.001) were factors at higher risk. These household chefs also intended to avoid the use of live poultry stalls (OR=1.666, 95%CI: 1.203-2.309, P=0.002) and accept the "centralized slaughtering, fresh poultry listing and marketing" strategy. Conclusion: Detailed study on this subject and, setting up pilot project in some areas as well as prioritizing the education programs for household chefs seemed helpful to the implementation of the 'freezing-fresh poultry' policy.

[Analysis on the medication of the outpatients diagnosed with glaucoma at West China Hospital of Sichuan University].

Objective: To retrospectively investigate the medication structures and characteristics among the outpatients diagnosed with glaucoma at West China Hospital of Sichuan University in 2015. Methods: Based on retrospective study method, the data of glaucoma patients (6 236 people, and 13 693 person-times) who received medication at the outpatient department of West China Hospital in 2015 were collected from hospital information system, such data include date, doctor's advice date, doctor's advice ID, diagnosis, western medicine fee, Chinese medicine fee, etc. Excel 2011 software was used to analyze the drug use of glaucoma outpatients. Results: (1) The total of outpatients with glaucoma medication were 13 693 person-times, of which 4 247 persons-times patients who did not take intraocular pressure (IOP)-lowering drugs accounted for 31.02%. (2) There were 7 types of IOP-lowering drugs used, including 14 kinds of different drugs. The top three most frequently used drugs were prostaglandin analogs (PGA, 36.98%, 5 847 cases), ß-adrenergic receptor blockers (26.61%, 4 207 cases), and carbonic anhydrase inhibitor (CAI, 20.95%,3 312cases). (3) Among all the patients who have taken IOP-lowering drugs, the patients that received single-drug treatment accounted for 62.41% (5 895/9 446), and the most frequently used single IOP-lowering drug is PGA(44.94%,2 649/5 895). Patients that received two-drugs combined treatment accounted for 28.03% (2 648/9 446), and the most frequently used combined treatment is "ß-adrenergic receptor blockers+ PGA" (27.57%,730/2 648). Patients that received three-drugs combined treatment accounted for 7.88% (744/9 446), and the most frequently used combined treatment is "ß-adrenergic receptor blockers+ PGA+ CAI" (46.24%,344/744). Patients that received four-drugs combined treatment accounted for 1.57% (149/9 446), and the most frequently used combined treatment is "ß-adrenergic receptor blockers+α-adrenergic receptor agonist +PGA + CAI" (87.25%,130/149). And patients that received five-druges combined treatment accounted for 0.11% (10/9 446). Conclusions: The most frequently used single IOP-lowering drug for outpatients with glaucoma at West China Hospital of Sichuan University in 2015 is PGA. The most frequently used combined medications are "ß-adrenergic receptor blockers+ PGA" for two-drugs combined treatment and "ß-adrenergic receptor blockers+ PGA + CAI" for three-drugs combined treatment.(Chin J Ophthalmol, 2018, 54: 189-193).

The application of individual virtual nostalgic game design to the evaluation of cognitive function.

The aim of this study was to develop a task set based on personalized material for nostalgic experience, which could detect cognitive ability via a virtual experience system combined with Kinect somatosensory interactive operation applications without the user wearing any accessory input device. Fifty-nine subjects participated in the experiment. The receiver operating characteristic curve of the game system was statistically analyzed for determining the best cutoff-point in the cognitive function assessment. Correlation analysis and regression analysis were used to explore the correlations between the results and the clinical cognitive assessment scales. According to the MoCA scores, the results showed that the accuracy of the system was 86.4% in evaluating mild cognitive impairment. The system seems feasible and was strongly correlated with clinical cognitive assessment scales. We anticipate that daily use of our system could keep track of changes of cognitive function of the elderly in home life.

[Clinical characteristics, diagnosis and treatment of pulmonary inflammatory myofibroblastic tumor in children].

Objective: To explore the clinical characteristics, diagnosis and treatment of pulmonary inflammatory myofibroblastic tumor in children. Methods: The clinical data of 13 patients with pulmonary inflammatory myofibroblastic tumor between October 2009 and October 2015 were retrospectively analyzed, including 9 boys and 4 girls aged 1 to 12 years 4 months (mean 4 years 9 months). Seven patients underwent total tumor resection, 4 had lobectomy, 1 had partial tumor resection and 1 had biopsy. The follow-up time ranged from 2 months to 6 years and 2 months. Results: Among the 13 patients, 9 were cured. Two patients lived with tumor. One of them had tumor which shrinked gradually and the other had stable disease. One patient with multiple lesions encountered recurrence after 3 operations and developed suspicious hepatic metastasis. One died during the operation because of airway mismanagement. Conclusions: Pulmonary inflammatory myofibroblastic tumor in children has rather good prognosis while a few cases have the potential of recurrence and canceration. Surgery is the primary therapeutic approach. Close post-operative follow up is necessary.

Advanced oxidation protein products induce intestine epithelial cell death through a redox-dependent, c-jun N-terminal kinase and poly (ADP-ribose) polymerase-1-mediated pathway.

Advanced oxidation protein products (AOPPs), a novel protein marker of oxidative damage, have been confirmed to accumulate in patients with inflammatory bowel disease (IBD), as well as those with diabetes and chronic kidney disease. However, the role of AOPPs in the intestinal epithelium remains unclear. This study was designed to investigate whether AOPPs have an effect on intestinal epithelial cell (IEC) death and intestinal injury. Immortalized rat intestinal epithelial (IEC-6) cells and normal Sprague Dawley rats were treated with AOPP-albumin prepared by incubation of rat serum albumin (RSA) with hypochlorous acid. Epithelial cell death, nicotinamide adenine dinucleotide phosphate (NADPH) oxidase subunit activity, reactive oxygen species (ROS) generation, apoptosis-related protein expression, and c-jun N-terminal kinase (JNK) phosphorylation were detected both in vivo and in vitro. In addition, we measured AOPPs deposition and IEC death in 23 subjects with Crohn's disease (CD). Extracellular AOPP-RSA accumulation induced apoptosis in IEC-6 cultures. The triggering effect of AOPPs was mainly mediated by a redox-dependent pathway, including NADPH oxidase-derived ROS generation, JNK phosphorylation, and poly (ADP-ribose) polymerase-1 (PARP-1) activation. Chronic AOPP-RSA administration to normal rats resulted in AOPPs deposition in the villous epithelial cells and in inflammatory cells in the lamina propria. These changes were companied with IEC death, inflammatory cellular infiltration, and intestinal injury. Both cell death and intestinal injury were ameliorated by chronic treatment with apocynin. Furthermore, AOPPs deposition was also observed in IECs and inflammatory cells in the lamina propria of patients with CD. The high immunoreactive score of AOPPs showed increased apoptosis. Our results demonstrate that AOPPs trigger IEC death and intestinal tissue injury via a redox-mediated pathway. These data suggest that AOPPs may represent a novel pathogenic factor that contributes to IBD progression. Targeting AOPP-induced cellular mechanisms might emerge as a promising therapeutic option for patients with IBD.

The relationship between management safety commitment and patient safety culture.

AIM: The study aims to explore the relationship between management safety commitment and patient safety culture using data from a Chinese hospital. BACKGROUND: Developing a positive patient safety culture has been suggested as an important strategy to improve the quality of health services and patient safety. Management safety commitment has been identified as key to establishing a culture of safety. However, little empirical evidence could be found in the literature to substantiate the relationship between management safety commitment and patient safety culture. Even less is known about the relationship in a Chinese hospital setting. METHODS: The study used a correlational research methodology with a cross-sectional survey design. A total of 248 registered nurses, including 20 nurse managers and 228 staff nurses, were surveyed using self-administered questionnaires. Both descriptive and inferential statistics were used to explore the relationship between management safety commitment and patient safety culture. FINDINGS: The mean score of safety commitment was 8.38 on a 0-10 visual analogue scale. The mean score of patient safety culture was 148.66. Staff nurses scored patient safety culture significantly lower than those of nurse managers (F = 18.88, P < 0.01). In addition, management safety commitment was significantly related to patient safety culture (r = 0.46, P < 0.01) and was an important predictor of patient safety culture (F = 65.29, P < 0.01). CONCLUSIONS: The findings provide significant empirical evidence that management safety commitment is associated with the culture of patient safety. Thus, to build a positive safety culture, managers need to visibly commit to patient safety and be a role model to ensure patient safety.

Comparative morphological studies on the stereo structure of the lingual papillae of selected primates using scanning electron microscopy.

A scanning electron microscope was used to observe the lingual papillae and their connective tissue cores (CTCs) in five primates (tupai, tamarin, crab-eating monkey, mandrill, and human). There were some slender protrusions rising from the top of the filiform papilla in all five types of primate. After removing the epithelium the filiform CTC from the tupai, tamarin and crab-eating monkey displayed a U-shaped arrangement of rod-shaped protrusions. The filiform CTC from the crab-eating monkey also had a columnar base. The human filiform CTC consisted of a primary columnar base, numerous short rod-shaped secondary protrusions from its upper periphery, and a few central protrusions. The filiform CTC from the Mandrill was fundamentally similar to that of the human, however, its base was shorter. The fungiform CTC from the tupai was column shaped, with several depressions for taste buds on the top. There were three vallate papillae in the tupai, tamarin, and mandrill, approximately four in the monkey, and between five and twelve in the human. Moderately developed foliate papillae were found in the tamarin, monkey, mandrill and human. The tupai, however, possessed a finger-like lateral organ instead. The lingual root area of the tupai, tamarin, crab-eating monkey and mandrill was relatively small with a smooth surface. Only the human had a tonsil-structure, which was located on the surface of its larger lingual root.