Volume 96  ·  Issue 34  ·  2016

In 1998, the Global Initiative to Prevent and Treat Chronic Obstructive Pulmonary Disease (GOLD) was launched in collaboration with the National Institute of Heart, Lung and Blood, the National Institutes of Health and the World Health Organization, and the first report was published in 2001 (GOLD 2001)^[1]。 For more than 10 years, the GOLD Scientific Committee has continuously updated the GOLD report by searching and screening out influential literature and research results. Of the newly retrieved 173 studies from July 2014 to May 2015, 15 were considered to have an impact on the 2015 report. Recently, GOLD 2016 was released online^[2]。 The main updated parts and related literature are interpreted as follows.

Concord centuries, talents have emerged in large numbers, fruitful results. It is worth remembering, worth summing up, and even more worth looking forward to and looking forward to.

Although the industrialization process has promoted the rapid development of China's economy, the ensuing environmental deterioration, especially air pollution and high smoking rate, make the prevention and control of respiratory diseases face severe challenges. Respiratory diseases are the most common among urban and rural residents in China, with the highest mortality rate and the heaviest economic burden. Nebulized inhalation therapy is an important treatment for respiratory diseases. Compared with oral administration, intramuscular injection and intravenous administration, aerosol inhalation therapy is widely used at home and abroad because the drug directly acts on the target organ, has the advantages of rapid onset of action, good curative effect, few systemic adverse reactions, and does not require deliberate cooperation of patients. In China, due to the lack of drugs, equipment and clinical experience, many primary hospitals and even high-level hospitals have many irregularities in aerosol inhalation therapy, which in turn affects the curative effect of patients^[1]。 Based on this, the Respiratory Branch of Chinese Medical Association joined hands with well-known domestic experts in pediatrics, otolaryngology, thoracic surgery and pharmacology to formulate this consensus, in order to better guide medical staff at all levels to carry out standardized aerosol inhalation therapy.

To explore the efficacy of laparoscopic surgery in treatment of advanced mid-low rectal cancer following a long-term neoadjuvant chemoradiotherapy.

Clinicopathologic and perioperative data were collected retrospectively from 74 patients with advanced mid-low rectal cancer, who received both neoadjuvant chemoradiotherapy and resections between January 2010 and January 2013 at Xinjiang tumor hospital. Routine follow-up was conducted. The safety and long-term survival of 36 patients who underwent laparoscopic resection were compared with those of 38 patients who received conventional resection.

The laparoscopic group had less amount of blood loss during surgery (50 ml vs 100 ml, P<0.05). The time needed for recovery of gastrointestinal function in the laparoscopic group was significantly shorter than that in the open surgery group (2.0 d vs 3.0 d,P<0.05). The rate of postoperative complication was 19.4% and 42.1% (P<0.05), respectively. In terms of the range of radical surgery and the numbers of dissected lymph nodes (8 and 10,P>0.05), no significant difference were found in the two groups. The operation duration and hospital stay in the laparoscopic group was longer than that in the open surgery group (240.0 min vs 231.5 min ,P>0.05) (22.0 d vs 21.5 d ,P>0.05), but no significant difference was found between the two groups. There were no significant difference in the incidence of 3 disease-free survival rate (53.0% vs 43.8%,P>0.05) and overall survival rate (70.0% vs 62.9%,P>0.05) between two groups.

Laparoscopic surgery is a safe and feasible option for advanced mid-low rectal cancer patients who undergone the neoadjuvant chemoradiotherapy because of the similar rate of radical resection and satisfied long-term outcomes, which will have a better prospect in the future.

To explore the application of new chest holder in the median sternotomy for open heart surgery in adults.

Two hundred adult patients in Henan Provincial People′s Hospital from May 2013 to May 2015 were enrolled in the study and randomly divided into two groups. Experimental group included 100 cases who accepted the new type of chest holder in the open heart surgery. Control group were also composed of 100 cases whose sternums were fixed with the pure steel wire cerclage. Sternal closure time was recorded since the sternum closing. All subjects were followed up to obtain the chest incision healing, the incidence of sternal dehiscence, infection and secondary thoracotomy, and thus to estimated the effect of new chest holder.

All patients in the experimental group reached the effect of firm closed chest surgery. Sternal closure time of experimental group was much shorter than that of control group[(10±2) vs (21±4) min, P<0.001]. No sternal instability, dehiscence, infection and secondary thoracotomy were found during the follow-up. However, in the control group, 3 secondary thoracotomy cases, 6 sternal dehiscence cases and 2 sternal infection cases were detected.

New type of chest holder in the median sternotomy for open heart surgery is more convenient with small surgical trauma. It can also effectively reduce the incidence of sternal instability, dehiscence, infection and secondary thoracotomy.

To investigate the association between hand-foot skin reaction (HFSR) in the treatment with vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) and the effectiveness of VEGFR-TKIs.

Clinical data of 155 patients with metastatic renal cell carcinoma (mRCC) treated with VEGFR-TKIs at the Cancer Hospital of Chinese Academy of Medical Sciences between January 2006 and January 2014 were retrospectively analyzed. All the patients received first-line VEGFR-TKI therapy. The treatment effectiveness and outcome between patients developing HFSR and those without HFSR were compared. Comparison of treatment response rate (RR) was performed with χ ² test, survival analysis was performed using Kaplan-Meier method, with a significance level of 0.05.

The median survival of all the 155 patients was 36.2 months. Among the 117 (75.5%) patients who developed HFSR, 19 patients (12.3%) had grade Ⅰ HFSR, 73 (47.1%) had grade Ⅱ, and 25 (16.1%) had grade Ⅲ; there were no grade Ⅳ events. The RR and median progression-free survival (mPFS) in patients who did not develop HFSR were 15.8% and 6.7 months, respectively; while the RR and mPFS in patients who developed HFSR were 52.1% and 13.8 months, respectively (P<0.001,P=0.002). The RR and mPFS in patients with grade Ⅰ HFSR were 42.1% and 9.5 months, respectively; those in patients with grade Ⅱ HFSR were 56.2% and 12.2 months, respectively, in patients with grade Ⅲ were 48.0% and 22.2 months, respectively, with statistically significant differences among the three grades of HFSR (P=0.001, 0.009).

HFSR might be an effective predictor for effectiveness of VEGFR-TKIs in mRCC patients. Large-sample studies are warranted to further prove these results.

The aim was to explore the strategy and clinical value of laparoscopic transection of median hepatic fissure (MHF) in difficult laparoscopic liver resections.

First the MHF was located and marked, then the transection plane of the MHF was set. Next, the laparoscopic Multifuctional Operative Dissector (LPMOD) and the technique of curettage and aspiration were utilized to transect the liver beginning from the middle portion of the gallbladder fossa, in a caudal-to-cranial and anterior-to-posterior direction, until the clear exposure of the anterior surface of the intrahepatic inferior vena cava. Transection of the MHF was accurately achieved. Finally, dissection of the second and third porta hepatis were carefully performed and mobilization of the transected liver was achieved. This technique of laparoscopic transection of MHF was successfully performed in 13 patients in difficult laparoscopic liver resections.

Between April 2014 and August 2015, 13 patients received the technique of laparoscopic transection of MHF in difficult laparoscopic liver resections, including 10 cases of laparoscopic right hepatectomy, two cases of laparoscopic left hepatectomy and one case of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). The maximum size of the transected tumor was 15 centimeter. Duration of surgery was 240-430 min[Mean, 324.4±50.0]; the time for transection of the MHF was 40-118 min[mean, 66.4±22.7]. Blood loss was 200-2 000 ml[583.3±452.9]. The length of postoperative hospital stay was 6-25 days[mean, 13.2±5.2]. Seven patients received intraoperative transfusions. No postoperative intraabdominal bleeding, liver failure or other severe postoperative complications occurred. No perioperative death occurred.

Application of laparoscopic transection of the MHF in difficult laparoscopic liver resections can help to clearly expose the second and third porta hepatis, especially in patients who have huge tumors and poor exposure for hepatic dissection. Moreover, precise location and transection of the MHF remains very important strategies of applying this technique.

To explore experience and methods in the microsurgical treatment of midline deep brain lesions.

The clinical data of patients with midline deep brain lesions were retrospectively analyzed. The clinical manifestation, imaging findings, lesion locations, surgical procedures, pathological diagnosis and follow-up results were summarized and analyzed. All the lesions were located deeply in the brain midline: corpus callosum (n=1), thalamus and basal ganglia (n=6), lateral ventricle (n=4), the third ventricle (n=2), pineal region (n=8), brainstem and fourth ventricle region (n=4).

Symptoms of 25 cases improved to varying degrees after operation and all the lesions got gross total removal without perioperative death. Followed by necessary adjuvant radiotherapy and/or chemotherapy, there were no recurrence during the follow-up period.

Suitable surgical approaches should be individually chosen according to lesion location, the surrounding neural and vascular anatomy, blood supply, the patient′s medical condition and the operator′s experience. Localization of minor lesions can be assisted by neuronavigation system. In addition to try to determine the border of the lesion during operation, we emphasize the protection of the surrounding vital neural structures and deep veins. Finally, adjuvant radiotherapy and/or chemotherapy based on histology should be adopted to prevent recurrence.

To investigate the effect of moluodan on gastric secretion and the underlying mechanism of moluodan in treating atrophic gastritis.

According to the random number table, 120 healthy male specific-pathogen-free (SPF) Sprague-Dawley rats were divided into 4 groups: control group, model group, moluodan low-dose group, and moluodan high-dose group, with 30 rats in each group. The control group was administered with normal saline 2 ml/d by gavage, the other three groups were administered with 2% sodium salicylate 1 ml/d, 20 mol/L sodium deoxycholate 1 ml/d, and N-methyl-N′-nitro-N-nitrosoguanidine (MNNG) 200 mg/kg for every 10 days. And 16 weeks later, the control group and model group were treated with normal saline 2 ml/d by gavage, meanwhile the moluodan low-dose group was treated with moluodan 0.9 g·kg^-1·d^-1and the high-dose group was treated with moluodan 1.8 g·kg^-1·d^-1, continuously for 12 weeks. Ten rats of each group were sacrificed at the end of 4, 8, 12 weeks. The effect of moluodan on atrophic gastritis was observed. The secretion function of gastric mucosa was assessed through detecting the numbers of gastrin-secreting cells (G cells) and somatostatin-secreting cell (D cells) in gastric mucosa using immunochemical staining, and measuring the serum levels of gastrin (GAS) and somatostatin (SS) using enzyme-linked immunosorbent assay (ELISA).

After 8 weeks, the numbers of G and D cells in gastric mucosa in the moluodan high-dose group significantly increased compared with the model group[(0.617±0.114) vs (0.476±0.116) cells/mm², (0.504±0.084) vs (0.369±0.148) cells/mm^2, both P<0.05]; the numbers of G and D cells in gastric mucosa in the low-dose group increased after 12-week′s treatment[(0.674±0.129) vs (0.528±0.103) cells/mm², (0.526±0.087) vs (0.371±0.058) cells/mm², both P<0.05]. The serum GAS levels increased markedly after 8 weeks in the moluodan high-dose group and after 12 weeks in the low-dose group[(1.313±0.080) ng/ml vs (0.964±0.080) ng/ml, (1.202±0.124) ng/ml vs (0.909±0.054) ng/ml, bothP<0.01]; the serum SS levels in both high- and low-dose groups were significantly lower than in the model group after 8-week′s treatment[(2.376±0.199) ng/ml, (2.238±0.155) ng/ml vs (2.605±0.183) ng/ml, bothP<0.05].

Moluodan may treat atrophic gastritis by repairing G and D cells in gastric mucosa and thus increasing serum levels of GAS.

To study the role of endoplasmic reticulum (ER) stress-mediated glycogen synthase kinase 3β (GSK3β) activity in the pathological process of liver injury in acute liver failure (ALF) mice.

ALF model was established by intraperitoneal injection of D-galactosamine/lipopolysaccharide (D-GalN/LPS) in C57BL/6 mice. The mice were divided into control group (n=10), ALF model group (n=18), 4-phenylbutyrate (4-PBA, an ER stress inhibitor) group (n=18) and SB216763 (a specific inhibitor of GSK3β) group (n=16). The serum alanine transaminase (ALT) and aspartate transaminase (AST) levels were measured to reflect the liver function, liver injury was assessed by observing pathological changes of liver tissue, the levels of proteins in liver tissue were analyzed by Western blotting, the activity of GSK3β in liver tissue was detected using GSK3β activity assay kit, and the survival rate of hepatocyte was measured by methyl thiazolyl tetrazolium (MTT) assay.

In in vivo experiment, the expression levels of ER stress markers, glucose-regulated protein 78 (GRP78) and CCAAT/enhancer-binding protein homologous protein (CHOP), were upregulated during the progression of D-GalN/LPS-induced ALF, indicating activation of severe ER stress and increased activity of GSK3β. Compared with the model group, inhibition of ER stress by 4-PBA improved liver function[ALT: (365.4±58.6) U/L vs (1 094.5±201.5) U/L,P<0.05; AST: (555.1±60.8) U/L vs (1 444.3±533.7) U/L,P<0.05)and pathological injury, also decreased the activity of GSK3β (2.6±0.3 vs 4.6±1.3,P<0.05). Inhibition of GSK3β activity was shown to alleviate liver injury in ALF by reducing the expression levels of GRP78 and CHOP. Thein vitro experiment of tunicamycin-induced hepatocyte apoptosis showed that inhibition of GSK3β activity increased the cell survival rate.

In ALF induced by D-GalN/LPS, severe ER stress may accelerate the development and progress of ALF by upregulating the activity of GSK3β.

To profile the gene expression changes associated with endoplasmic reticulum stress in INS-1-3 cells induced by thapsigargin (TG) and tunicamycin (TM).

Normal cultured INS-1-3 cells were used as a control. TG and TM were used to induce endoplasmic reticulum stress in INS-1-3 cells. Digital gene expression profiling technique was used to detect differentially expressed gene. The changes of gene expression were detected by expression pattern clustering analysis, gene ontology (GO) function and pathway enrichment analysis. Real time polymerase chain reaction (RT-PCR) was used to verify the key changes of gene expression.

Compared with the control group, there were 57 (45 up-regulated, 12 down-regulated) and 135 (99 up-regulated, 36 down-regulated) differentially expressed genes in TG and TM group, respectively. GO function enrichment analyses indicated that the main enrichment was in the endoplasmic reticulum. In signaling pathway analysis, the identified pathways were related with endoplasmic reticulum stress, antigen processing and presentation, protein export, and most of all, the maturity onset diabetes of the young (MODY) pathway.

Under the condition of endoplasmic reticulum stress, the related expression changes of transcriptional factors in MODY signaling pathway may be related with the impaired function in islet beta cells.

To study the mRNA and protein expression of aldehyde dehydrogenase 1A1(ALDH1A1)in rat cryptorchidism and normal testis.

We established the cryptorchidism model by flutamide and took normal testis as normal group.The testicular tissue samples were collected on 15 days, 45 days, and 90 days after birth respectively.The expression of ALDH1A1 in rat cryptorchidism and normal testis were investigated by real-time PCR, Western blot and immunohistochemisty intissue microarray.

The mRNA expression of ALDH1A1 in cryptorchidism group in infant, adolescent and adult period were 1.01±0.19, 1.60±0.32, 0.75±0.16, and 1.66±0.23, 0.52±0.08, 0.15±0.10 in normal group, respectively.The expression of ALDH1A1 in cryptorchidism group was significantly lower than that in normal group in infant period, but it was significantly higher than that in the normal group in adolescent and adult period(P<0.05).

The expression of ALDH1A1 was different in different age period during the process of testicular development of rat. It showed an important relationship between ALDH1A1 and cryptorchidism.

To investigate the prevalence of depression and anxiety and the related factors among new registered tuberculosis (TB) outpatients.

Questionnaire survey was conducted in 1 105 new registered TB patients from sixteen districts of Beijing city during Jan to Jun, 2015. Structured self-administered questionnaire including gender, age, education, occupation, history of smoking and drinking information was designed by epidemiological and psychiatric experts from Beijing Research Institute for Tuberculosis Control. Meanwhile the TB patients status including depression, anxiety and social supporting were investigated by using Self-rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS) and Social Support Rating Scale (SSRS). The survey data was then analyzed. A total of 1 132 questionnaires were issued and 1 119 were recovered including 1 105 valid questionnaires, and the effective rate was 98.7%.

There were 742 males and 363 females among 1 105 new registered TB patients. Age ranged from 16 to 65 years, the mean age was (35.7±13.8) years old. The total standard scores of SDS and SAS were (45.00±12.40) and (39.46±10.03) points, obviously higher than those in national norms (all P<0.05). The detection rates of depression and anxiety were 29.8% (329/1 105) and 13.5% (149/1 105). Multivariate Logistic regression analysis showed that TB patients with female (OR=1.75, 95% CI: 1.32-2.30), over 35 years (OR=1.82, 95% CI: 1.39-2.39), annual household income <50 000 ￥ ( OR=1.57, 95% CI: 1.19-2.06), rarely talking to someone about their worries (OR=1.41, 95% CI: 1.05-1.90) had high risk of depression (all P<0.05). Annual household income<50 000 ￥ (OR=1.69, 95% CI: 1.17-2.43), rarely talking to someone about their worries (OR=1.80, 95% CI: 1.19-2.74) also had high risk of anxiety (all P<0.05). The medians scores in social support, subjective support, objective support and support utilization were 38(32, 43), 22(18, 26), 8(6, 10) and 7 (6, 9) points, respectively, and these scores were negatively related to depression and anxiety.

Depression and anxiety prevalence in TB patients are obviously higher than those in normal people, and there are many factors that can cause or contribute to depression and anxiety.

Non-alcoholic fatty liver disease (NAFLD) is a clinicopathological syndrome characterized by diffuse hepatocellular bullous steatosis, including simple fatty liver, non-alcoholic steatohepatitis, cirrhosis, and even hepatocellular carcinoma. Studies have shown a close relationship between NAFLD and type 2 diabetes (T2DM)^[1], NAFLD is associated with insulin resistance^[2,3]。 At present, there are many studies on the factors related to NAFLD, and some studies have shown that hemoglobin is closely related to the occurrence of NAFLD^[4,5]Whether the occurrence of NAFLD is related to hemoglobin levels in patients with type 2 diabetes has not been reported. In this study, the hemoglobin level of type 2 diabetes mellitus with NAFLD was detected, and its correlation with NAFLD was observed, which provided a theoretical basis for screening high-risk groups of NAFLD in diabetic patients and taking intervention measures to reduce the incidence of NAFLD.

A 68-year-old female was admitted to the Department of Nephrology, Peking University First Hospital on June 26, 2015 due to intermittent macroscopic hematuria for 2 months and an increase in serum creatinine for 1 month. The patient started oral warfarin anticoagulation 4 months ago due to atrial fibrillation at a starting dose of 1.5 mg/dose, once/d. Warfarin was spiked to 2.25 mg/d 2 months ago according to the International Normalized Ratio (INR). Macroscopic hematuria with edema of both lower limbs and increased foam in urine occurred 2 months ago. Laboratory test: INR 5.4, urine routine: protein (+), microscopy: red blood cell full field/HP. Warfarin was suspended, and oral "cephalosporin antibiotics" and "Longqing tablets" were taken. After 1 week, hematuria was relieved, and oral warfarin 1.5 mg/d was continued. Laboratory test 1 month ago: serum creatinine 227 μ mol/L, discontinuation of "Irbesartan Hydrochlorothiazide". Macroscopic hematuria appeared again 23 days ago, and it was not diagnosed and treated. 2 weeks ago, I had loss of appetite, no nausea or vomiting, and went to our hospital. Laboratory examination: serum creatinine 246 μ mol/L, urea 17.69 mmol/L, urine routine: protein (+), microscopic examination: red blood cell full field/HP. Warfarin was reduced to 1.5 mg once every other day, and sodium bicarbonate tablets were given 0.5 g/time, 3 times/d. The urine color gradually returned to normal. The outpatient test in our hospital 5 days ago showed that blood creatinine was 233 μ mol/L, urea was 18.65 mmol/L, and INR was 1.25. 1 day ago, the patient adjusted warfarin to 1 mg/d by himself, and was admitted to our department for further diagnosis and treatment. The patient has a history of hypertension for 20 years, and has been orally administered "amlodipine besylate and irbesartan hydrochlorothiazide" for a long time. During physical examination 5 years ago, he was found to be positive for urine protein, but he was not diagnosed and treated. Discovered "arrhythmia, atrial fibrillation" 2 years ago. Physical examination after admission: body temperature 36.5 ℃, pulse 70 beats/min, breathing 18 beats/min, blood pressure 137/85 mmHg (1 mmHg =0.133 kPa); There was no edema on the face and both eyelids, the heart boundary was enlarged, the apical beat was located 0.5 cm outside the midline of the left clavicle of the fifth intercostal bone, the heart rate was 96 beats/min, the heart rhythm was absolutely irregular, the first heart sound was different in intensity, and no murmur and pericardial friction were heard in the auscultation area of each valve. Mild dactyloidal edema of both lower limbs. Preliminary diagnosis: acute kidney injury; arrhythmia, atrial fibrillation; Hypertension grade 3 (very high risk).

Gastric cancer is one of the common malignant tumors in China. According to the 2015 Chinese cancer statistics of the National Cancer Registry Center, the incidence of gastric cancer ranks second among common malignant tumors^[1]。 For a long time, most patients with gastric cancer in China are in the advanced stage when they see a doctor, and the effect of simple surgical treatment is poor. In order to improve the treatment effect of gastric cancer, a new treatment model of perioperative comprehensive treatment based on standardized surgery has been gradually established; Neoadjuvant chemotherapy, as an important element in this model, has received more and more attention. The efficacy and safety of neoadjuvant chemotherapy in advanced gastric cancer have been validated by large clinical trials^[2,3]Its status was gradually established.

Maintenance hemodialysis patients may have various ocular disorders due to primary disease, uremic toxin accumulation or the effects of hemodialysis therapy^[1,2,3]。 Eye disorders such as glaucoma are not uncommon in the population of maintenance hemodialysis patients^[4]。 Multiple case reports describe patients with acute intraocular pressure increase during hemodialysis, accompanied by severe eye pain, headache and other symptoms^[5,6,7,8,9]。 Hyperocular pressure is an important risk factor for the onset and progression of glaucoma^[3,4]。 However, previous clinical studies have not obtained accepted results on the relationship between hemodialysis and intraocular pressure changes, and the related mechanism of intraocular pressure increase during dialysis has not been completely clarified. This article reviews the changes of intraocular pressure during hemodialysis in order to draw more tendentious conclusions.