Volume 97  ·  Issue 30  ·  2017

Bronchial asthma (asthma for short) is a common chronic respiratory diseases. The prevalence of asthma is increasing due to the global industrialization and urbanization, environmental pollution and climate change. The disease burden of asthma is manifested both as an increase in the socio-economic burden caused by the loss of labor force and as a consumption of health resources. The acute attack of asthma is an important reason that leads patients to miss work and study, which affects the quality of life and increases the economic burden. Although most asthma patients require only outpatient visits, the proportion of costs incurred by emergency or hospitalization for acute asthma attacks is high.

To study the seasonal characteristics of patients hospitalized for asthma exacerbation in China.

This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout mainland China during 2013—2014. The number of patients hospitalized for asthma exacerbation in each hospital was calculated, as well as the ratio of asthmatic patients to all the hospitalized patients. The analysis by month was conducted. The number and ratio of asthmatic patients in the northern and southern cities were calculated respectively.

During the study period, there were 6 480 patients hospitalized for asthma exacerbation, accounting for 3.14% (6 480/206 135) of all the hospitalized patients of the respiratory department in 29 hospitals. The analysis by month showed that the ratio of patients hospitalized for asthma exacerbation was highest in March (3.49%), then declined from April to June, then rose again from July, reaching a second peak at September (3.28%), and then declined again from October to December. The ratio of asthmatic patients in every month was higher in northern cities than in southern cities.

The ratio of patients hospitalized for asthma exacerbation in China fluctuates with the changes of seasons, and March and September are the two peak months. Northern cities have a higher ratio of asthmatic patients than southern cities.

To investigate warning symptoms of asthma attack and evaluate asthma self-management status of asthma patients in urban China.

A multi-center, cross-sectional, questionnaire-based survey was carried out from 30 general hospitals dispersed in 30 provinces of mainland China (except for Tibet) during Oct 2015 to May 2016. Information of frequency and warning symptoms of asthma attack, the time from warning symptoms to asthma attack, the impact of asthma attack and asthma self-management were collected from asthma patients of outpatient department.

Altogether 3 875 asthmatic outpatients were recruited. 78.1% (3 026/3 875) of the patients reported restriction of exercise and daily activities during asthma exacerbation. 82.5% (3 160/3 829) of the patients had warning symptoms before asthma attack, the most common warning symptoms were cough, chest tightness and shortness of breath. The median time from warning symptoms to asthma attack was 2 h, the mean time was 90 h. Only 4.4% (167/3 829) of the patients had definite confidence to control asthma when symptoms deteriorated. 76.7% (2 937/3 828) of the patients used medications to control asthma when asthma symptoms deteriorated. Medication choice: inhaled corticosteroid (ICS) + formoterol 45.8% (1 776/3 875), short-acting beta-agonist (SABA) 23.9% (927/3 875).

Most asthma patients have warning symptoms before asthma attack, the most common symptoms are cough, chest tightness and shortness of breath. The proportion of patients conducting effective asthma self-management remains low.

To study the phenotype of memory CD4⁺ T cells in peripheral blood of asthmatics and its relationship with asthma severity.

From Dec 2014 to Aug 2015, thirty-three asthmatics, twenty-six chronic obstructive pulmonary disease (COPD) patients and twenty-two healthy volunteers were enrolled in Respiratory Clinics of Zhongshan Hospital, Fudan University. Peripheral blood mononuclear cells (PBMCs) were isolated from peripheral blood. Cell surface markers (CD45RO, CRTH2, CD62L, and CCR7) and intracellular protein[interleukin (IL)-5, IL-17, interferon (IFN)-γ]staining was performed using flow-cytometric techniques. CD4⁺ T cells were cultured under neutralization and then Th2, Th2+ Lipopolysaccharide (LPS), Th2+ Home dust mite (HDM) conditions for 6 days and then intracellular proteins were analyzed using flow cytometry. Correlation analysis between memory CD4⁺ T cells, asthma severity and drug consumption were performed.

The percentage of memory CD4⁺ T (CD4⁺ Tm) cells in circulating white blood cells was higher in asthmatics, than that in healthy subjects (48.0%±5.7% vs 32.0%±4.1%, P<0.05). The cytokine profiles of CD4⁺ Tm cells in asthma patients were substantially different from those of COPD and healthy subjects, with increased IL-5 and IL-17 production. For COPD patients, the predominant cytokines were IFN-γ instead. IL-17-producing CD4⁺ Tm cells were associated with the severity of disease and the level of medication consumption in asthma patients (R²=0.829 6, P<0.05).

The cytokine profile is IL-5 and IL-17 predominant in memory CD4⁺ T cells from asthmatics. The amount of IL-17⁺ CD4⁺ memory T cells is positively correlated with asthma severity.

To evaluate the clinical value of fractional exhaled nitric oxide (FeNO) and impulse oscillometry (IOS) in screening out cough variant asthma (CVA) from patients with subacute cough.

Patients with subacute cough were included from the outpatient department of Respiratory Medicine of Zhujiang Hospital of Southern Medical University from May to October in 2016. Based on "the guidelines for the diagnosis and treatment of cough (2015 edition)" , patients were classified into CVA group, and non CVP group with other causes of subacute cough. Lung function, bronchial provocation test, FeNO and IOS were measured. The diagnostic efficiency and optimal cut-off points of FeNO and IOS indicators to diagnose CVA from subacute cough were respectively assessed by the receiver operating characteristic (ROC) curves.

A total of 85 patients with subacute cough were included. Among them, 35 patients were diagnosed with CVA (CVA group), the others are classified as non CVP group (n=50). In CVA group, the levels of FeNO and total respiratory impedance (Zrs) were significantly higher, while maximal mid expiratory flow (MMEF)%pred, and mid expiratory flow (MEF)75/50/25%pred, reactance at 5 Hz (X5) levels were significantly lower than those in non CVP group (all P<0.05). Furthermore, the FeNO had a positive correlation with Zrs and Fres (ρ=0.312,P=0.003 and ρ=0.318, P=0.003, respectively), had a negative correlation with X5 (ρ=-0.288,P=0.007). A ROC analysis indicated that the area under ROC curve (AUC) of FeNO in diagnosis of CVA was 0.786 (95% CI: 0.684-0.889), the best cut-off point of FeNO volume ratio was 24.5×10^-9. When FeNO volume ratio=24.5×10^-9, the sensitivity of in diagnosing CVA was 77.8%, specificity was 70.0%. The AUC for Zrs and X5 were 0.679 and 0.687, respectively. The combination of FeNO and X5 had a greater AUC than other indicators (AUC: 0.817, 95% CI: 0.726-0.908), the sensitivity and specificity were 80.6% and 66.0%, respectively.

Both FeNO level and IOS index can be used to screen CVA in patients with subacute cough, and the combination of both have better value in diagnosing CVA.

To investigate the value of serum free light chain (FLC) in differential diagnosis of monoclonal gammopathy of renal significance (MGRS).

Forty-nine hospitalized patients who underwent renal biopsy in Peking Union Medical College Hospital between January 2013 and December 2015 were included. Monoclonal gammopathy was detected by serum protein electrophoresis (SPE), serum immunofixation electrophoresis (IFE), urine IFE and serum FLC. All patients were classified as MGRS (n=32) and monoclonal gammopathy of undetermined significance (MGUS) (n=17).

Renal lesions in MGRS subgroup included light chain amyloidosis (n=24, 75.0%), light chain deposition disease (n=7, 21.9%), and fibrillary glomerulopathy (n=1, 3.1%). Renal diseases in MGUS subgroup included membranous nephropathy (n=10), focal segmental glomerulosclerosi (FSGS) (n=3), diabetic glomerulopathy (n=1), Henoch-Schonlein purpura nephritis (n=1), anti-GBM disease concurrent with membranous nephropathy (n=1) and glomerulomegaly (n=1). Positive number of SPE, serum IFE, urine IFE and abnormal number of serum FLC ratio in MGRS subgroup were 12, 16, 23 and 30, respectively. Positive number of SPE, serum IFE, urine IFE and abnormal number of serum FLC ratio in MGUS subgroup were 11, 17, 6 and 3, respectively. MGRS and MGUS subgroups differed significantly in positive rate of serum IFE (P<0.001), as well as positive rate of urine IFE (P=0.02) and abnormal rate of serum FLC ratio (P<0.001). The sensitivity, specificity, total consistent rate of serum FLC ratio for diagnosis of MGRS were 93.8%, 82.4%, and 89.8% respectively. The sensitivity for diagnosing MGRS could be increased to 100% by combining serum FLC ratio and urine IFE.

The significance of monoclonal gammopathy in patients with renal disease should be evaluated by renal pathology.On the premise of excluding lymphoplasmacytic malignancy, serum FLC ratio had promising diagnostic value for MGRS, which was helpful for differential diagnosis of patients who had contraindication to renal biopsy.

To explorethe correlation between Neo-Bioscore and disease-free survival (DFS) after neoadjuvant therapy in patients with breast cancer in China.

The clinical and pathological data of 429 patients with early or locally advanced breast cancer who received neoadjuvant therapy at the No.307 Hospital of PLA from January 1, 2005 to December 31, 2015 were analyzed and we followed up their DFS.

Neo-Bioscore were closely related to DFS (χ²=47.662, P<0.001). When the groups were divided by Neo-Bioscore 3, they weremore relevantto DFS (HR=5.093 vs HR=2.044), equivalent tothe role of traditional recurrence risk grouping in guiding the choice of adjuvantendocrine regimen for hormone receptor (HR) positive patients who were premenopausalafter neoadjuvant chemotherapy, andmore relevantto DFS than whetherthe pathologic complete response (pCR)grouping in the same molecular pathology subgroup of HR positive/human epidermal growth factor receptor 2 (HER-2)negative (P<0.001 vsP=0.166), HER-2 positive (P<0.001 vsP=0.166), HRnegative/HER-2 negative (P<0.001 vsP=0.166).

Neo-Bioscore could be used as an early indicator of predicting DFS for breast cancer patients after neoadjuvant therapy.When the groups were divided by Neo-Bioscore 3, they were more relevant to DFS, equivalent to the role of traditional recurrence risk grouping in guiding the choice of adjuvantendocrine regimen for premenopausal HR positive patients, andmore relevantto DFS than whetherthe pCRgrouping in the same molecular pathology subgroup.

To evaluate the efficacy and safety of Saccharomyces boulardii Sachets combined with bismuth quadruple therapy for initial Helicobacter pylori(H.pylori) eradication.

From March 2014 to March 2015, 240 participants from the third hospital of Hebei medical university with H. pylori infection were recruited and randomized into three groups: Quadruple therapy group received bismuth potassium citrate 220 mg bid + Rabeprazole 10 mg bid + amoxicillin 1 000 mg bid+ furazolidone 100 mg bid for 10 days. Short-term group and long-term group received the same quadruple therapy for 10 days as above, as well as Saccharomyces boulardii Sachets 500 mg bid for 14 days and 28 days, respectively. H. pylori eradication was confirmed by ¹³C/¹⁴C-UBT at least 4 weeks after completion of therapy. And side effects were investigated during the therapy.

The H. pylori eradication rates in quadruple therapy, short-term and long-term group were 80%, 87.5% and 87.5% by ITT analysis (P=0.321) and 92.8%, 94.6% and 95.9% by PP analysis (P=0.717), respectively. The overall side effect rate and occurrence of diarrhea and abdominal distension were significantly lower in short-term or long-term group as compared with quadruple therapy group(P=0.007, 0.003, 0.004), but there was no significant difference between the two probiotics groups.

Both short and long-term Saccharomyces boulardii Sachets reduced the overall side effect rate and occurrence of diarrhea or abdominal distension when combined with bismuth quadruple therapy for initial H. pylori eradication and no difference was observed in efficacy or safety between the two groups.

To explore the expression of cathepsin S (Cat S) and Hepatitis B virus X protein (HBx) in HBeAg(-) and HBeAg(+ ) hepatocellular carcinoma (HCC), and discuss the effects of Cat S and HBx interaction on HepG2 cell.

Seventy HCC tissue specimens were collected from the surgical resection which were confirmed by pathology in the Fifth Affiliated Hospital of Guangxi Medical University. The tissue samples were separated into two groups: HBeAg(-) group and HBeAg(+ ) group according to the serology of HBeAg. The expression of Cat S and HBx in the para-carcinoma tissue and the HCC tissue was determined by immunohistochemical staining. The recombinant plasmid of pcDNA3.1-HBx and empty plasmid were constructed and transfected transiently into HepG2 cell. Cells were harvested, and Western blot assay was performed to detectthe protein expression of Cat S and HBx. The cell proliferation was measured by methyl thiazolyl tetrazolium (MTT) assay, wound healing assay and transwell migration assay.

Immunohistochemical staining showed that Cat S expression was up-regulated in HBeAg(+ ) HCC cancer tissues, compared with HBeAg(-)HCC cancer tissues (52.67%±0.33% vs 41.23%±0.52%, P<0.05). HBx expression was up-regulated in HBeAg(+ ) HCC cancer tissues (92.89%), but not in HBeAg(-)HCC cancer tissues. Compared with HepG2 control group, cells in HepG2-HBx group had significantly higher protein level of Cat S and HBx, more obvious proliferation and migration (21.98%±1.69% vs 58.23%±1.47%) and invasion (24.12%±1.15%vs 64.25%±1.42%) (allP<0.05).

The expression of HBx and Cat S had a linear positive correlation in liver tissues, and increased expression of HBx can promote the cell proliferation of HepG2-HBx cell line.

To study the preoperative computed tomography (CT) data of patients with pancreaticoduodenectomy (PD) and to explore the effective of predicting the risk of postoperative pancreatic fistula (POPF).

CT images of patients with PD were analyzed retrospectively from June 2010 to January 2017 in Zhengzhou University of People′s Hospital. The pancreas index, pancreatic duct width, pancreas CT value, pancreas-spleen CT value, and pancreas thickness were collected. The relationship between the indicators and the POPF was determined, and the receiver operation characteristic (ROC) curve was calculated and the area under the curve (AUC) was evaluated. The maximum predictive performance of the critical value was determined by using the different cut-off values to calculate the Youden index and other indicators.

A total of 154 patients with PD were involved in the study and 27 (17.5%) had POPF. Seven indicators were significantly associated with POPF. The pancreas index had the largest AUC (AUC: 0.865, P<0.001) and pancreatic duct width (AUC: 0.834,P<0.001) also had a higher predictive value. The pancreatic duct (P<0.001) was significantly associated with POPF. Pancreas thickness, pancreas and spleen CT ratio, abdominal wall fat thickness, pancreas CT value, pancreatic abdominal aorta CT ratio and POPF were also related. Using 0.15 as the cut-off value, the sensitivity, specificity, Jordan index, and accuracy of pancreatic index were 83%, 86%, 0.69, and 0.88 respectively, with the highest performance prediction. Abdominal circumference, spleen CT value and other six indicators had no correlation with POPF.

Analysis of preoperative CT indicators of patients can predict the risk of POPF in patients after PD. The pancreas index has the greatest predictive efficacy, while pancreatic duct width, pancreatic spleen density ratio and other indicators also associated with POPF.

In order to explore the effects of human umbilical cord mesenchymal stem cells (UCMSC) transplantation on the treatment of two noncontinuous segments spinal cord compression injury and to investigate whether repeated intravenous injection UCMSC was more beneficial for the recovery of spinal cord function.

A total of 30 adult rabbits were randomly divided into three groups: control group (received PBS), single injection group, repeated injection group with 3 days intervals. A noncontinuous two segments SCI model was established by using the 2F Fogarty balloon catheter. Rabbits were infused with either a single total dose or three divided doses of 2×10⁶ UCMSC (3 intervals) at first day post-decompreesion. Behavioral scores, somatosensory evoked potentials (SSEP) and histopathological were used to evaluate therapeutic effects. The rates of stem cell homing were studied by immunofluorescence test and the apoptosis of the spinal cord was evaluated by TUNEL test.

Behavior alanalyses showed that the rabbits in the UCMSC injection groups showed better motor performance than those in the control group (P<0.01), and the motor performance in the repeated transplantation group was better than that in the single transplantation group (P<0.01). The SSEP latencies were (22.53±0.75) ms, (24.52±0.45) ms and (26.31±0.69) ms in the repeated injection group, single injection group and control group (allP<0.01), respectively. Treatment with UCMSC increased ventral horn motor neurons preservation and decreased the number of TUNEL-positive cells compared with control group (P<0.01). The rates of stem cell homing in the repeated injection group was significantly higher than that in single injection group (P<0.01).

Transplantation of UCMSC after spinal cord compression injury of two noncontinuous segments can promote functional recovery through enhancement anti-apoptotic and neuroprotective effects, and the recovery was more pronounced in the rabbits repeatedly injected at 3-day intervals.

To evaluate the safety and efficacy of peripheral arterial disease patients with critical limb ischemia who accepted BSX or EVT.

According to the requirements of systematic review, we searched MEDLINE (1980-2014), Emabse (1980-2014), Journals @ Ovid Full Text (1980-2014) databases, selected literature and extracted data, meta-analysis was performed through STATA11.2.

A total of 17 studies (3 RCTs, 14 non-randomized studies) and 5 515 patients (BSX group: 2 454, EVT group: 2 769) were deemed eligible. Meta-analysis showed there were no differences between the two groups in 30-day mortality (OR=1.110, P=0.523). However, BSX was significantly associated with increasing overall complications (OR=2.456, P=0.003), infections (OR=3.163, P<0.001) and thrombosis (OR=3.069, P=0.002), but showed a reduction in dissection and pseudoaneurysm (OR=0.537, P=0.012). During the follow-up, BSX had significant advantages. The 1-year and 3-year primary patency of BSX patients were higher than EVT group (1 year, OR=1.415, P=0.008; 3 years, OR=1.619, P<0.001); so were in secondary patency( 1 year,OR=2.156, P<0.001; 3 years,OR=2.547, P<0.001). Meanwhile, the 5-year overall survival rate was also higher in BSX group (OR=1.243, P=0.007).

EVT has potential advantages in reducing surgical trauma and early postoperative complications, shortening hospital stay and so on. Concerning long-term results, BSX is better in reducing long-term mortality and improving long-term patencies than EVT group.

To establish and evaluate the feasibility of a pretreatment method for matrix-assisted laser desorption ionization-time of flight mass spectrometry identification of filamentous fungi developed by the laboratory.

Three hundred and eighty strains of filamentous fungi from January 2014 to December 2016 were recovered and cultured on sabouraud dextrose agar (SDA) plate at 28 ℃ to mature state. Meanwhile, the fungi were cultured in liquid sabouraud medium with a vertical rotation method recommended by Bruker and a horizontal vibration method developed by the laboratory until adequate amount of colonies were observed. For the strains cultured with the three methods, protein was extracted with modified magnetic bead-based extraction method for mass spectrum identification.

For 380 fungi strains, it took 3-10 d to culture with SDA culture method, and the ratio of identification of the species and genus was 47% and 81%, respectively; it took 5-7 d to culture with vertical rotation method, and the ratio of identification of the species and genus was 76% and 94%, respectively; it took 1-2 d to culture with horizontal vibration method, and the ratio of identification of the species and genus was 96% and 99%, respectively. For the comparison between horizontal vibration method and SDA culture method comparison, the difference was statistically significant (χ²=39.026, P<0.01); for the comparison between horizontal vibration method and vertical rotation method recommended by Bruker, the difference was statistically significant(χ²=11.310, P<0.01).

The horizontal vibration method and modified magnetic bead-based extraction method developed by the laboratory is superior to the method recommended by Bruker and SDA culture method in terms of the identification capacity for filamentous fungi, which can be applied in clinic.

In vivo confocal microscopy (IVCM) is a non-invasive examination technique, which uses laser as the light source, and has the advantages of high resolution (1 μ m) and high definition. Through continuous confocal scanning, the images of tissues and cells of the cornea can be clearly obtained in vivo. It is one of the important research methods to explore the pathological mechanism of disease from the cellular level^[1]。 In this study, 50 patients with viral keratitis clinically diagnosed between August 2014 and May 2015 were collected. By using confocal corneal microscopy (HRT), the morphological changes of cells in each layer of patients with epithelial keratitis, stromal keratitis and endothelial keratitis before and after treatment were observed, so as to provide morphological basis for further exploring the pathogenesis and outcome of keratitis.

The patient was a male, born in February 1995. He was admitted to the Department of Endocrinology, Huashan Hospital affiliated to Fudan University on July 29, 2014 due to "polydipsia, polydipsia and polyuria for 9 months, aggravated for more than 1 month". In October 2013 (18 years old), he developed polydipsia, polydipsia and polyuria without obvious trigger. He drank 6,000~8,000 ml of water daily, urinated more than 10 times, nocturia 4~5 times, about 250 ml each time, and had pale urine color. One week later, he developed paroxysmal pain in the left chest and occasionally headache, but there were no other symptoms such as diplopia, blurred vision, rash, and swollen lymph nodes. The chest X-ray examination of the patient at the local hospital revealed left rib lesions. In February 2014, single photon emission computed tomography (SPECT) examination performed in a foreign hospital revealed a lesion of the left fifth rib, which was considered as a malignant bone tumor. "Tumor resection of the left fifth rib + wedge resection of the left upper lobe of the lung" was performed. The pathology considered "eosinophilic granuloma" of the left fifth rib, involving the surrounding soft tissue (Figure 1)。 After operation, the patient consciously relieved the symptoms of polyuria (consciously improved dry mouth, reduced urine output, and nocturia reduced to 0~1 times), and no further diagnosis and treatment of eosinophilic granuloma and polyuria was made. In June 2014, the symptoms of polydipsia and polyuria recurred and worsened, accompanied by fatigue, soreness in both lower limbs, and insomnia. In July 2014, enhanced pituitary magnetic resonance imaging (MRI) in external hospitals showed thickening of the pituitary stem (Figure 2), combined with the symptoms of polyuria, was diagnosed as central diabetes insipidus, and was treated with mass coagulation (desmopressin acetate) 0.1 mg/time, 2 times/d, and the symptoms of polydipsia and polyuria were significantly improved. In order to further clarify the diagnosis and follow-up treatment plan, the patient was admitted to our department in July 2014.

A 52-year-old female was admitted to the Second Affiliated Hospital of Fujian Medical University with the main complaint of "left upper limb weakness for 2 days". The patient had left upper limb weakness without obvious trigger before admission, accompanied by asthma when climbing stairs, weak legs, slow walking with supports when walking on a flat road, left upper limb weakness persisted without relief, and the remaining symptoms were relieved after a few minutes of rest. The outpatient clinic improved the head CT: considering the possibility of cerebral infarction, it is planned to be admitted to the hospital for "cerebral infarction". Usually, intermittent bloody stools are not regularly diagnosed and treated. Physical examination: vital signs stable. The skin and mucosa of the whole body were not pale, and the superficial lymph nodes of the whole body were not palpable and swollen. No tenderness in sternum, physical examination of heart, lung and abdomen (-). Improve the diagnosis after blood routine, complete set of coagulation, complete set of biochemistry, tumor markers, color ultrasound, MRI, CT and other related examinations: (1) ethylenediaminetetraacetic acid (EDTA) -related pseudoleukopenia; (2) cerebral infarction; (3) Colon cancer is incomplete intestinal obstruction and has multiple metastases throughout the body (liver, spleen, right adrenal gland, etc.); (4) The cause of myocardial injury to be investigated: ① Acute coronary syndrome? ② Infection related? (5) Anemia, thrombocytopenia, abnormal coagulation: diffuse intravascular coagulation? Tumor bone metastasis? (6) Pulmonary infection.

In the treatment of patients with acute myocardial infarction, reperfusion therapy such as thrombolysis and percutaneous coronary intervention (PCI) is an effective therapeutic strategy to reduce myocardial cell death. However, reperfusion therapy can trigger myocardial ischemia-reperfusion injury (MIRI) while saving ischemic myocardium. MIRI means that after myocardial tissue is ischemic or hypoxic for a period of time, the restoration of blood supply will aggravate the injury caused by original ischemia and hypoxia or cause new injury. This may be related to increased oxygen free radical production, increased inflammation, calcium overload and mitochondrial switching pore opening during revascularization^[1]。

Tuberculosis remains the world's most serious public health problem that threatens people's health^[1]。 At present, the course of chemotherapy for newly treated sensitive pulmonary tuberculosis is 6 to 9 months. The longer the course of tuberculosis treatment, the higher the rate of irregular medication. This irregular medication not only reduces the cure rate, but also easily makes Mycobacterium tuberculosis develop drug resistance. Shortening the course of treatment is the main means to ensure regular medication and obtain high efficiency. In recent years, some progress has been made in the research of shortening the course of treatment for tuberculosis, which is now reviewed below.