Volume 93  ·   Issue 34  ·  2013

To assess the human health damage due to particulate matter≤2.5μm (PM2.5) exposure during the haze pollution events in 12 cities of Beijing-Tianjin-Hebei region in January 2013.

The data were collected for urban population, ambient air quality, baseline mortality rate and emergency visits in Beijing, Tianjin, Shijiazhuang, Baoding, Chengde, Handan, Langfang, Hengshui, Qinhuangdao, Tangshan, Xingtai and Zhangjiakou.Then the exposureresponse relationship was constructed between short-term PM_2.5 exposure and mortality and emergency room visits with meta-analysis.Thus the excess deaths and emergency room visits due to PM_2.5 exposure were estimated during the haze pollution events using city-specific exposure population, PM_2.5;daily concentration and exposure-response coefficients.

Three serious PM_2.5 pollution events occurred on January 12, January 19 and January 27 in Beijing-Tianjin-Hebei region respectively.From January 10 to January 31,the 24 h mean concentrations of PM2.5 in Beijing, Tianjin, Shijiazhuang, Tangshan, Qinhuangdao, Handan, Xingtai, Baoding, Zhangjiakou, Chengde, Langfang, Hengshui were 705, 411,675,506,255,598, 698, 667, 231, 178, 718 and 405μg/m³. Xingtai, Shijiazhuang, Handan, Baoding, Langfang and Beijing were the more polluted areas.And there were 17 days (77.3%), 13 days (59.1%), 12 days (54.5%), 11 days (50.0%), 10 days (45.5%) and 8 days (36.4%) of Air Quality Index reaching the serious level respectively.The shortterm PM_2.5 exposure caused 2725 excess death including 846 excess deaths duo to respiratory disease and 1878 excess deaths due to circulatory disease in Beijing-Tianjin-Hebei region from January 10 to January 31.

The haze pollution events led to serious public health damage.And it is imperative to take actions of controlling PM_2.5 pollution.

To evaluate the adverse effects of particulate matter≤2.5μm in aerodynamic diameter (PM_2.5) on public health in four typical cities: Beijing, Shanghai, Guangzhou and Xi′an.

Daily health and meteorological data (including ambient temperature and relative humidity) were collected in the past several years.For the relative risk of PM_2.5 effects on mortalities, generalized additive model (GAM) was used to obtain the exposure-response coefficients between PM_2.5 and non-accidental mortalities after controlling time trend, week effects and meteorological factors.Then excess mortalities were calculated according to coefficients, health data and air pollution level.

The relative risks of PM_2.5 effects on mortalities were 1.0027 (1.0010-1.0044), 1.0020 (1.0007-1.0033), 1.0056 (1.0022-1.0091), 1.0036 (1.0011-1.0061) for Beijing, Xi′an, Shanghai, Guangzhou respectively.Compared with relative risks in northern cities (Beijing and Xi′an), relative risks in southern cities (Shanghai and Guangzhou) were higher.The numbers of excess mortalities caused by PM_2.5 in Beijing, Shanghai, Guangzhou, Xi′an were 2349, 2980, 1715, 726 and accounted for 1.9%, 1.6%, 2.2% and 1.6% of the total death number in 2010 respectively.

Although relative health risks caused by PM_2.5 vary geographically for urban residents, public health is endangered.More efforts should be devoted to reducing PM_2.5 pollution.

To evaluate the human health risks (premature death risk as an indicator) in Beijing, Shanghai, Guangzhou and Xi′an during extreme haze in January 2013.

The daily average particulate matter≤2.5μm in aerodynamic diameter (PM_2.5) concentrations of Beijing, Shanghai, Guangzhou and Xi′an in January 2013 were collected and their characteristics explored.The populations and mortality rate of four cities in 2010 were collected from the statistical yearbook, the exposure-response relationships selected from the reference and then the premature death calculated according to the proportion risk model of Poisson regression.

In January 2013, the 24 h mean concentrations of PM2.5 in Beijing,Shanghai, Guangzhou and Xi′an were (240±165), (83±27), (94±49) and (210±98) μg/m3 respectively and they were all above the secondary level of Ambient Air Quality Standards (GB 3095-2012).The 24 h mean concentrations of PM_2.5 in Beijing and Xi′an were much higher than those in Shanghai and Guangzhou.Approximately 86.4% (19/22),58.1% (18/31),54.8% (17/31) and 93.5% (29/31) of 24 h mean PM_2.5 concentrations in Beijing, Shanghai, Guangzhou and Xi′an respectively exceeded the secondary level of Ambient Air Quality Standards (GB 3095-2012).The number of premature death due to the exposure to haze were 725 (95% CI: 457-977) for Beijing, 296 (95% CI: 96-502) for Shanghai, 310 (95% CI: 189-434) for Guangzhou and 85 (95% CI: 21-141) for Xi′an respectively in January 2013.

The PM_2.5 pollutions of four cities in January 2013 were serious enough to pose elevated risks of human health.

To explore the functional role of caveolin-1 in airway smooth muscle cells (ASMCs) proliferation and examine the regulatory effect of roxithromycin.

The rat model of bronchial asthma was established.Electron microscope was employed to observe the status of caveolae and light microscope for the histological changes in pulmonary tissues.The primarily cultured ASMCs were divided into 5 groups: control (group A), asthmatic ASMCs (group B), PD98059 (group C), roxithroymcin (group D) and methyl-β-cyclodextrin (group E).Cell proliferation was detected by Cell Counting Kit-8 (CCK-8).And the expressions of caveolin-1, extracellular regulated protein kinases (ERK) and monocyte chemotactic protein (MCP)-1 were detected by Western blot and reverse transcription polymerase chain reaction (RT-PCR).

The cell proliferation of asthmatic ASMCs (0.68±0.15, 0.63±0.13) in groups C and D were significantly less than those in group B (0.96±0.14)(both P<0.05) while group E was more than group B (1.26±0.11 vs 0.96±0.14,P<0.05).The content of caveolin-1 (0.392±0.064, 0.332±0.057) in groups C and D were higher than those in group B (0.237±0.032)(both P<0.05) while ERK1/2 protein level in groups C and D (0.241±0.017, 0.268±0.007) were less than those in group B (0.346±0.009)(both P<0.01).And MCP-1 protein level in groups C and D (0.198±0.015, 0.286±0.019) were less than those in group B (0.482±0.026)(both P<0.01).The ERK mRNA level in groups C and D (0.277±0.043, 0.338±0.026) were less than those in group B (0.591±0.022)(both P<0.01).And also MCP-1 mRNA in groups C and D (0.212±0.042, 0.249±0.032) were less than those in group B (0.676±0.053)(all P<0.01).

Caveolin-1 preventing the proliferation of asthmatic ASMCs is most likely mediated by ERK1/2 signal pathway and a down-regulation of MCP-1 expression.And roxithroymcin reduces the proliferation of asthmatic ASMCs through up-regulating the expression of caveolin-1 and inhibiting the expression of MCP-1.

To explore the effects of B-cell specific Maloney leukemia virus integration site 1 (Bmi1) gene on endothelial cells promoting glioma stem cell (GSC)-like phenotype.

Glioblastoma cell line GL261 and brain micro-vessel endothelial cell line b.END3 were used.Transwell co-culture system, limit dilution assay, xenograft, real-time polymerase chain reaction (PCR), Western blot, fluorescence activating cell sorter (FACS) and gene knock-down assay were used to determine the GSC-like phenotype and Bmi1 gene expression in glioma cells.

Compared with the control of GL261 cell alone, (1) more and larger tumor spheres formed after coculturing with endothelial cells (62.5%±1.5% vs 25.0%±4.6% at 40 cells/well, P=0.000).Xenografts generated by GL261 cells with b.END3 cells appeared earlier and were larger than that by GL261 cells alone ((0.798±0.297) cm³ vs (0.362±0.123) cm³, P=0.000); (2) CD133 positive glioma cells increased after co-culturing with endothelial cells (8.48%±0.78% vs 4.81%±0.37%, P=0.000); (3) the expression of Bmi1 in co-cultured glioma cells was up-regulated at mRNA level (2.72±0.18 vs 1.00±0.15, P=0.000) and at protein level; (4) the above phenomenon was attenuated when Bmi1 gene expression was inhibited by siRNA in glioma cells, CD133 positive portion of Bmi1-knockdown GL261 cells co-culturing with b.END3 cells decreased than that of wildtype GL261 cells (0.34%±0.21% vs 1.70%±0.69%, P=0.025).

Endothelial cells promote GSC-like phenotype by upregulating the expression of Bmi1 in glioma cells.

To explore the management strategies of acute toxication of 2,4-dinitrophenol by hemoperfusion.

A total of 14 patients with acute toxication of 2,4-dinitrophenol were admitted on September 14, 2009.And they were divided into severe and mild groups according to the severify of clinical manifestation.All patients in both groups received 2-hour blood perfusion within 2 hour post-admission.Their clinical manifestations, laboratory parameters and 2, 4-dinitrophenol levels were carefully observed before and after each perfusion.And oxygenation, intravenous use of furosemide, corticosteroids and symptomatic therapies were simultaneously given to improve general conditions.

In serious group, the levels of before and after the first perfusion were 28.21 (15.56-45.23) and 16.11 (10.10-27.52) mg/L (P<0.05), respectively.In both groups,all levels of 2,4-dinitrophenol were significantly reduced before and after each perfusion (all P<0.05).The patients in severe group would get relieved after 3 vs 2 perfusions in mild group.In severe group, there was a remarked decrease in neutrophil and platelet count after perfusion than those in mild group.The liver enzymes and blood lipids in both groups after therapy significantly elevated than those before therapy (all P<0.05).

Crucial for managing acute toxication of 2,4-dinitrophenol, early hemoperfusion reduces mortality.

To explore the effects of gender on treatment strategies for elderly patients with acute coronary syndrome (ACS).

March 2009 to March 2012,consecutive 619 aged ACS patients undergoing coronary angiography (CA) were screened at our hospital.There were 273 females and 346 males.Risk factors, ACS diagnosis, CA results, treatments and prognosis were compared between female and male groups.

The risk factors of body mass index, stroke history, smoking history, hemoglobin (Hb), serum cholesterol (TC), low density lipoprotein (LDLC) and blood uric acid (UA) levels were significantly lower in female group than those in male group (P<0.05).The morbidity of diabetes in female group was obviously higher than that in male group (27.8% vs 18.5%, P<0.05).The prevalence of myocardial infarction history, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) history in male group were significantly greater than that in female group (48.0% vs 39.9%,P<0.05; 30.6% vs 22.3%, P<0.05;19.9% vs 10.3%, P<0.01).The rate of combined multiple risk factors (3 or higher) increased significantly in female group (41.8% vs 29.8%, P<0.05).The incidence of unstable angina pectoris (UAP) and non-ST segment elevation myocardial infarction (NSTEMI) in female group was greater, but there was no statistical significance.The rate of 3-vessel and calcification lesions in female group was significantly elevated compared with male group (36.26% vs 28.61%, P<0.05).Regarding the choice of treatment strategy,conservative treatment was common in females, but there was no statistical significance between them.PCI, emergency PCI and selective CABG operation were performed more frequently in female group compared with male group (26.0% vs 14.2%, P<0.01; 14.7% vs 6.6%, P<0.01;19.1% vs 7.7%, P<0.01).The prognosis had no statistical significance between two groups.

The treatment strategies have certain limitations for female ACS patients.And an more aggressive treatment should be offered to improve the prognosis.

To explore the efficacy, safety and tolerance of ambrisentan, a highselective endothelin receptor antagonist, in Chinese patients with pulmonary hypertension (PH).

Twenty-eight PH patients (Group 1+ Group 4) came from Shanghai East Hospital, Zhongshan Hospital of Fudan University and Fifth People′s Hospital of Shanghai were recruited into this open-label, prospective multi-center trial between August 2012 and February 2013.They received 2.5- 5.0 mg ambrisentan once daily for 12 weeks.The primary endpoint was the change in exercise capacity showed by six-minute walk distance (6MWD) from baseline to 12 weeks.Secondary endpoints included the changes in World Health Organization (WHO) function class, N-terminal brain natriuretic peptide (NT-proBNP) and liver function test results.

There were 9 males and 19 females with an average age of (35±17) years.The value of 6MWD increased from (372±86) m at baseline to (443±96) m (P=0.000) after 12 weeks.WHO functional class improved after a 12-week therapy compared to the baseline level (P=0.000).NT-proBNP decreased from a median of 732 ng/ L at baseline to 329 ng/L after 12 weeks (P=0.046).The baseline liver function test was normal.And liver function test didn′t significantly change after a 12-week therapy.

Ambrisentan therapy is well-tolerated and it improves the exercise capacity and WHO function class in Chinese PH patients.

To explore drug resistance and virulence characteristics of clinically isolated Vibrio parahaemolyticus (VP).

The patient records were reviewed.The laboratory information system was employed to count the quantity of bacterial diarrhea pathogens at our intestinal clinic from 2009 to 2012.The drug resistant phenotype was tested by the method of disk diffusion.Polymerase chain reaction (PCR) was used to detect thermo-stable direct hemolysin (TDH) gene (tdh), TDH-related hemolysin gene (trh) and type Ⅲ secretion system 2 (T3SS2α, T3SS2β).

The VP infection rate was 37.90% (274/723).Susceptibility test showed that the resistance rates of ampicillin, cefalotin, cefuroxime and amikacin were 100% (216/216), 44.91% (97/216), 24.07% (52/216),9.26% (20/216).The other 11 kinds of antibiotics were sensitive or intermediate.96.76% (209/216) VP harbored tdh gene, 1.39% (3/216) trh gene and 100% T3SS2 gene, with 213 strains T3SS2αpositive, 2 strains T3SS2βpositive and 1 strain both T3SS2αand T3SS2βpositive.

The resistant rate of VP to ampicillin is the highest and VP has different levels of resistance against other antibiotics.Most clinical isolates of VP harbor tdh gene and T3SS2 plays an important role in the pathogenicity of VP.

To summarize the early and midterm outcomes of artificial chordae transplant in mitral valve repair.

A total of 50 patients underwent mitral valve repair with artificial chordae transplant from January 2009 to January 2010 in General Hospital of Shenyang Military Command.Follow-up was conducted on 48 cases (96%) for 3-4 years.

No early postoperative mortality occurred.All cases had cardiac function New York Heart Association (NYHA) gradeⅠ/Ⅱ at discharge.Among 48 cases, one died of cerebral infarction after 13 months and the reminder survived and no one underwent reoperation.Among survivors, 45 cases were in cardiac function NYHA gradeⅠ and another 2 in gradeⅡ. Echocardiography showed that postoperative 3 years left atrial diameter, left ventricular end-diastolic dimension, left ventricular endsystolic dimension and the ratio of regurgitation beam area and left atrial area were significantly smaller than those preoperative ones (39.5%±9.7% vs 5.6%±0.1%, P<0.01) and left ventricular ejection fraction increased markedly (0.55±0.06 vs 0.67±0.07, P<0.01).There was no instance of artificial chordae rupture.

Gore-Tex artificial chordae transplant is a safe and effective technique in mitral valve repair with excellent early and midterm operative outcomes.

To explore the effects of parecoxib sodium multimode analgesia on postoperative analgesia in patients undergoing laparoscopic cholecystectomy (LC).

A prospective, double-blind, randomized and placebo-controlled study was conducted on 80 patients undergoing elective LC at Department of Endoscopic Surgery, First Affiliated Hospital, Wenzhou Medical College from March 2011 to June 2011.They were randomized to receive either 40 mg parecoxib infusion 30 min preoperative and at 12, 24, 36, 48 h post-operation (treatment group).And 2 ml normal saline infusion was administered similarily as a placebo (control group).All patients received ropivacaine infusion at port sites at the end of LC.The degree of postoperative pain was assessed with visual analog scale (VAS) at 1, 2,4, 8, 12, 24, 36, 48 h post-operation respectively.The consumption of pethidine in the first 24 h post-operation was also recorded.

The VAS pain scores at each timepoint were significantly lower in the treatment group than those in the control group (1 h:1.0±0.6 vs 1.8±0.6,t=-1.650, P=0.000;2 h: 1.3±0.6 vs 1.9±0.7, t=-4.302, P=0.000; 4 h:1.6±0.7 vs 2.7±1.2,t=-4.752, P=0.000;8 h:2.5±1.4 vs 5.0±1.8, t=-6.835, P=0.000; 12 h:2.2±1.1 vs 3.3±1.5, t=-3.902, P=0.000; 24 h: 1.6±0.8 vs 2.5±1.4,t=-3.649,P=0.000;36 h:1.2±0.6 vs 2.2±0.8,t=-6.390,P=0.000;48 h:1.0±0.5 vs 1.5±0.6,t=-3.710, P=0.000).And the amount of pethidine used in the first 24h after LC was also less in the treatment group (150 vs 950 mg,χ²=16.200, P=0.000).

The infusion multimode analgesia of parecoxib sodium 40 mg provides significant effect of postoperative pain relief after laparoscopic cholecystectomy.

To evaluate the efficacy of continuous wound infusion of ropivacaine for postoperative pain relief after open hepatectomy.

From May 2011 to December 2012, 60 patients undergoing open hepatectomy were randomized into normal saline continuous infusion group (n=30) and 0.3% ropivacaine continuous infusion group (n=30).The following variables were recorded for the 48 hours postoperatively: pain scores at rest and sedation score every 8 hours, total sufentanil consumption, first postoperative bowel movement, length of hospitalization, nausea and vomiting score, liver function change and other adverse events were also recorded.

Pain scores at rest were lower for the ropivacaine group and reached significance after 8 h (all P<0.05).The values of sufentanil consumption ((43.8±21.8) vs (78.2±35.2) μg, P<0.01), time to bowel recovery ((1.2±0.4) vs (1.5±0.5) days, P<0.01) and mean length of hospitalization ((6.1±2.6) vs (7.6±2.9) days, P<0.05) decreased significantly.Sedation score and liver function recovery were better in ropivacaine group.No surgical wound infection occurred in either group.

Surgical wound infusion with ropivacaine is safe and effective.And it improves postoperative pain relief and accelerates patients recovery and discharge with less damage to liver function.

To examine the prevalence of human papilloma virus (HPV) in penile squamous-cell carcinomas (SCCs), explore the relationship between HPV and clinicopathological variables and determine its value for predicting disease-specific survival.

We retrospectively collected clinicopathological data of 28 patients with penile squamous cell carcinomas from 2000 to 2009 at Beijing Cancer Hospital, Beijing Hospital and Peking University People′s Hospital.Polymerase chain reaction (PCR) was used to detect the presence of HPV DNA in tumor specimens.Regular follow-ups were conducted.Disease-specific survival plots were drawn with the Kaplan-Meier method and compared with the Log-Rank test.Cox proportional hazard analysis was applied to assess the independent effects of several prognostic factors on survival.

HPV DNA was detected in 7/28 samples.After sequencing, all 7 samples were confirmed to be HPV-16 type.The median follow-up period was 60 (6-150) months.By the time of analysis, 8/28 patients died.HPV DNA was not significantly associated with age,pathological grading,pathologic T stage or lymph node metastasis (P=0.191, 0.165, 1.000, 0.639 respectively).Cox multivariate regression analysis indicated that lymph node status (HR=5.5,P=0.023) was an independent predictive factor of disease specific survival, followed by pathological T classification (HR=11.0, P=0.035).The 5-year diseasespecific survival in patients with HPV DNA positive was higher than that in those with HPV DNA negative (67% vs 58%).But survival had no significant differences (P=0.431).

Higher pathologic T stage and lymph node metastasis are independent prognostic factors for worse survival.And mortality does not increase markedly in penile cancer patients with HPV DNA positive.

To explore the risk factors and short-term outcomes of acute kidney injury (AKI) in elderly patients.

A total of 232 elderly AKI patients at Chinese PLA General Hospital from June 2008 to December 2009 were enrolled.They were divided into two groups according to their outcomes at 28 days and at 29 days to 3 months after AKI respectively.Their clinical data were analyzed to explore the risk factors and their effects on the outcomes of AKI.

There were 215 males and 17 females with an average age of (86.7±5.3) years.Thirty-eight cases (16.4%) died within 28 days after AKI and 57 (24.6%) died within 3 months.Infection (43.1%) was the major cause of AKI.The other causes included hypovolemia (19.0%), use of nephrotoxic drugs (16.8%) and cardiovascular events (15.1%) respectively.Logistic regression analysis revealed that low body mass index (BMI), oliguria, mechanical ventilation, hypoalbuminemia and peak serum level of creatinine (Scr>246.5μmol/L) were the prognostic factors of AKI in those patients dying within 28 days after AKI (P<0.05).Low BMI, hypoalbuminemia and high blood level of urea nitrogen (BUN) were the prognostic factors of AKI in those patients dying within 29 days to 3 months after AKI (P<0.05).

Infection, hypovolemia, use of nephrotoxic drugs and cardiovascular events are common causes of AKI in elderly patients.Low BMI, oliguria, mechanical ventilation, hypoalbuminemia, high level of BUN and peak level of Scr (>246.5μmol/L) are the prognostic factors of AKI in elderly patients.

To explore the efficacy and safety of HLA-mismatched stem-cell microtransplantation in patients with refractory lymphoma.

This study included 10 patients with relapsing or refractory lymphoma at Department of Hematology, Second Artillery General Hospital from October 2009 to February 2012.All patients received programmed infusions of G-CSFmobilized HLA-mismatched donor peripheral blood stem cell (G-PBSC) after each cycle of Hyper-CVAD/MA conditioning without graft-versus-host disease (GVHD) prophylaxis.

A total of 31 cycles of microtransplantation were performed.Among them, 6 patients achieved a complete remission (CR) and 2 got partial remission (PR).And the overall response was 8/10.The occurrence of gradesⅢ-Ⅳ neutrocytopenia and thrombocytopenia was almost 100% after Hyper-CVAD/MA conditioning, but the median recovery times of neutrophils and platelets were 9 days and 14 days respectively because of programmed infusions of G-PBSCs.And 18 bouts of G-PBSC infusion related fever were observed.No GVHD was observed in any of them during treatment.Up to March 2013,6 patients survived while another 4 died.The 1- and 3-year overall survival and disease-free survival rates were the same (60%).

The novel therapy of microtransplantation may improve outcome and avoid GVHD in patients with relapsing or refractory lymphoma.