Volume 97  ·  Issue 40  ·  2017

Chronic obstructive pulmonary disease (COPD) is a common preventable disease characterized by persistent respiratory symptoms and restricted airflow, usually caused by airway and/or alveolar abnormalities caused by significant exposure to toxic particles or gases^[1]。 China has a vast territory, and there are obvious regional differences in risk factors exposure, economic development and medical care level between urban and rural areas. The prevalence, mortality and disease burden of COPD reported in different regions are also quite different. Although several multicenter studies have hoped to clarify the epidemiological characteristics of COPD in China, due to regional differences and obvious heterogeneity of individuals, research data on the burden of COPD and patient characteristics in China are still insufficient.

Chronic obstructive pulmonary disease (COPD) is the most common chronic respiratory disease, with high prevalence and heavy disease burden, which poses a serious threat to people's health. The incidence and mortality rate of COPD in China remain high, and the total death population of COPD accounts for 31.1% of the global total^[1]； The reasons are closely related to the numerous risk factors and inadequate prevention and control measures^[2]At the same time, it also explains the many problems existing in the diagnosis and treatment of COPD in China. The present situation and existing problems of diagnosis and treatment of COPD in China are discussed as follows.

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease, which seriously endangers the physical and mental health of patients. Patients with COPD will increase the risk of postoperative pulmonary complications, heart, kidney and other extrapulmonary organs, and lead to prolonged hospital stay, increased medical expenses, and increased perioperative mortality^[1]。 In order to improve the quality of perioperative management of patients with COPD, an expert consensus on perioperative management of patients with COPD was specially formulated.

The Clinical pathway adopted by the Health and Family Planning Commission of the People's Republic of China is defined as a set of standardized treatment models and diagnosis and treatment procedures established for a certain disease, which is guided by evidence-based medical evidence and guidelines to promote treatment and disease management, and ultimately plays a role in standardizing medical behavior, reducing variation, reducing costs and improving quality. The World Health Organization (WHO) pointed out that the clinical path should also be developed under the guidance of evidence-based medicine methods. Its basic idea is to raise key questions in combination with the needs of diagnosis and treatment practice, find evidence for each key issue and give evaluation, and combine health economics factors, etc., to integrate evidence, and to form a consensus on the key evidence in the diagnosis and treatment plan through collective discussion by the expert committee. It can be seen that following evidence-based medicine is a key pathway to develop/revise clinical pathways.

Penicillin antibiotics are a kind of antibacterial drugs with important clinical value and widely used. The biggest clinical concern about the application of this kind of drug is that it may lead to serious allergic reactions such as anaphylactic shock. Therefore, the "Instructions for Clinical Use of Pharmacopoeia of the People's Republic of China" stipulates that a skin test (hereinafter referred to as a skin test) must be performed before using penicillin, and it can only be used if it is negative. This regulation is strictly followed by domestic medical institutions and doctors, but there are still many differences and wrong practices in the indications, skin test methods and interpretation of results of penicillin skin test. In view of this, the Expert Committee on Clinical Application and Bacterial Resistance Evaluation of Antibacterial Drugs of the National Health and Family Planning Commission organized experts from infectious diseases, allergies, pediatrics, critical care medicine, clinical pharmacy, laboratory, nursing and other disciplines to write this consensus through literature retrieval and evaluation, combined with domestic practical experience, existing conditions and regulations, in order to improve the understanding of penicillin allergic reaction and skin test among clinicians, pharmacists, nurses and other professionals, and gradually improve and standardize the practice of penicillin skin test.

To evaluate the effectiveness and safety of anti-fibrinolytic therapy in on-pump coronary artery bypass grafting (CABG).

Two hundred and eleven patients receiving on-pump CABG in Fuwai Hospital were recruited and randomized into treatment group (group T) and control group (group C) between October 2014 and February 2017. Tranexamic acid was given with a 10 mg/kg loading dose and 10 mg·kg^-1·h^-1 infusion dose to group T and equal volume of saline was given to group C throughout the surgery. Postoperative drainage, allogeneic transfusion, complications, adverse events and mortality were recorded.

Patients of group T had less postoperative drainage [860 (670, 1 190)ml vs 985 (783, 1 365)ml], decreased red blood cell [2 (0, 8)U vs 6 (2, 10)U] and fresh frozen plasma [1 (0, 3) U vs 2 (0, 3)U] transfusion volume, lower fresh frozen plasma transfusion rate (53.33% vs 70.75%) than patients of group C (allP<0.05). No statistically significant differences existed in the rate of postoperative complications, adverse events and death between the two groups (allP>0.05).

Tranexamic acid has definite anti-fibrinolytic effect, which can significantly reduce postoperative bleeding and allogeneic transfusion while no severe side effects were observed.

To determine the effect of the surgical and conservative approaches on the metabolic profiles in patients with subclinical Cushing′s syndrome (SCS) in adrenal incidentalomas (AI).

A hundred and thirty AI patients with SCS in Department of Endocrinology, PLA General Hospital between January 2008 and December 2016 were studied, surgery was performed in 88 patients (surgical group), and the rest received conservative approach (conservative group). The improvement/worsening of blood pressure, blood glucose, lipid profiles and body weight after a duration of >18 months follow-up were analyzed, respectively.

Baseline demographics, clinical characteristics were similar between surgical and conservative groups. In the surgical group, blood pressure, blood glucose, lipid profiles and body weight improved more frequently than that in conservative group (29.69% vs 3.12%, P=0.003; 10.94% vs 3.12%, P=0.262; 7.81% vs 3.12%, P=0.660; 39.06% vs 9.38%, P=0.004, respectively). In conservative group, blood pressure, blood glucose, lipid profiles and body weight worsened more frequently than that in surgical group (28.13% vs 0, P<0.001; 25.0% vs 0,P<0.001; 18.75% vs 0,P=0.003; 40.62% vs 20.31%, P=0.051, respectively). Logistic regression analysis indicated surgical treatment was associated with improvement of blood pressure (OR=10.687, 95%CI: 1.279-89.299) and weight loss (OR=5.541, 95%CI: 1.404-21.872) independently of gender, age, duration of follow-up, serum cortisol level after 1 mg-dexamethasone suppression test and the mass size.

In AI patients with SCS, surgery was beneficial in the aspect of metabolic profiles.

To investigate whether elevated levels of high sensitivity C-Reactive Protein (hsCRP) and neutrophil (NE) at baseline are associated with an increased risk of colorectal cancer in Kailuan male cohort.

Since May 2006, males from Kailuan cohort were included in this study. Information on demographics, medical history, anthropometry, hsCRP and NE were collectedat baseline for all subjects. Multivariable Cox proportional hazards regression models were used to calculate hazard ratios (HR) of association between baseline hsCRP and NE and colorectal cancer risk.

By December 31, 2015, a total of 73 869 participants were enrolled in this study. During the follow-up, 336 incident colorectal cancer cases were identified. All participants were divided into three groups according to the level of hsCRP (<1 mg/L, 1-3 mg/L and >3 mg/L). The cumulative incidence of colorectal cancer were 456/10^5, 510/10⁵ and 746/10⁵ in these 3 groups, respectively (χ²=10.79, P=0.005). Compared with participants with lower hsCRP levels (<1 mg/L), individuals with the highest hsCRP (>3 mg/L) levels had significant increased risks of colorectal cancer (HR=1.38, 95%CI: 1.05-1.81, P=0.020)after adjusting for age, gender, smoking, drinking, BMI, diabetes and income. Furthermore, subjects were divided into two groups according to the level of NE (≤ 4.08×10⁹/L and > 4.08×10 ⁹/L). Multivariable Cox proportional hazards regression models indicated that there is no statistical significance of association between NE and colorectal cancer.

Elevated levels of hsCRP at baseline might increase the risk of colorectal cancer in males.

To observe the biological characteristics of patients with hematological diseases and hepatitis C antibodies positive and to investigate features of HCV infection and reactivation.

A total of 85 patients with seropositive HCV at the hematology ward in Henan Cancer Hospital between October 2010 and October 2015 were analyzed. The clinical characteristics and laboratory data were retrospectively reviewed. Original disease treatment information was obtained from the medical records.

The positive rate of HCV-Ab was 1.2%, which was significantly higher than that of the general population(1.2% vs 0.4%, P<0.001). Of the 25 patients who showed anti-HCV seroconversion during the period of treatment or follow-up, serum ALT level was elevated in 15 patients(60.0%)and AST level got synchronous increase in 14 patients (56.0%). Of the 85 patients with positive HCV-Ab, 13 (15.3%) patients suffered from HCV reactivation with hepatic injury in varying degrees after chemotherapy or HSCT.

Patients with hematological diseases have high incidence of HCV infection and reactivation, and most of them have hepatic injury. Chemotherapy and HSCT are important risk factors for HCV reactivation.

To investigate the prevalence and clinical characteristics of peripheral blood eosinophilia (EOS) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

From July 2014 to June 2016, AECOPD patients in the Department of Respiratory Medicine of Affiliated Hospital of Chengdu University, were retrospectively stratified into two groups according to two standards of eosinophilic exacerbations (the peripheral blood eosinophil count ≥2% or ≥3% on admission). Demography, clinical symptoms, laboratory results, length of stay, total hospitalization expenses, and defined daily expenses were compared between groups.

A total of 559 cases with AECOPD were finally recorded, the prevalence of eosinophilia was 43.1% (241 cases by EOS≥2%) and 27.2% (152 cases by EOS≥3%), respectively. According to either standard, there were no significant differences in sexes, age, course of disease (P>0.05), and there were no significant differences in global initiative for chronic obstructive lung disease (GOLD) grades, parameters of pulmonary function, modified british medical research council (mMRC) scores, rate of antibiotic use, systemic glucocorticoids administration, and average daily expenses (P>0.05). According to 2% standard, leucocytes, neutrophils, monocytes, hs-CRP were lower than non-eosinophilic patients [(5.9±2.0)×10⁹/L vs (8.2±4.0)×10⁹/L, (3.9±1.6)×10⁹/L vs (6.5±3.8)×10⁹/L, (0.446±0.169)×10⁹/L vs (0.501±0.276)×10⁹/L, (25.8±35.9) vs (46.2±55.6) mg/L, all P<0.01]; basophils, lymphocytes were higher than non-eosinophilic patients [(0.043±0.025)×10⁹/L vs (0.029±0.021) ×10⁹/L, (1.3±0.6) ×10⁹/L vs (1.1±0.6) ×10⁹/L, both P<0.01]; length of stay, total hospital expense were shorter (or lower) than non-eosinophilic patients [(10.6±5.0) vs (11.6±5.8) d, (11 851±7 491) vs (14 254±10 751) RMB, bothP<0.05]. According to 3% standard, leucocytes, neutrophils, monocytes, hs-CRP were lower than non-eosinophilic patients (allP<0.05), and basophil were higher than non-eosinophilic patients (P<0.01), but no significant differences were observed in lymphocytes, length of stay and total hospital expense (allP>0.05).

Eosinophilia is of relative high prevalence in AECOPD patients, and basophil in eosinophilic patients is higher than non-eosinophilic patients.

To evaluate the effectiveness and safety of argon plasma coagulation (APC) via thoracoscopy on the treatment of spontaneous pneumothorax with subpleural blebs.

Thirty patients with spontaneous pneumothorax with subpleural blebs were retrospectively analyzed during the period of Nov, 2012 to June, 2015 in Rizhao Hospital of Traditional Chinese Medicine. According to the classification of pulmonary bullae through medical thoracoscopy by Reid, type Ⅱand partial type Ⅲ pulmonary bullae (2 cm ≤ diameter <5 cm) were coagulated by argon, and pleural adhesions were mutilated by high frequency electrocision. Two years′ follow-up was carried out to observe short-term and long term effect.

Thirty-nine pulmonary bullae were found in thirty patients, mainly in the upper lung (28 cases, 71.8%), including 28 type Ⅱ bullae (71.8%), 11 type Ⅲ bullae (28.2%) and most of them were single transparent bullae (24/39, 61.5%). Follow-up of short-term (72 h) effective rate was 70.0% and long-term effective rate was 89.3%.

The application of APC via thoracoscopy in the treatment of subpleural bullae is safe and effective.

To explore reactive oxygen species (ROS) generation and its role on A549 cell migration under hypoxic condition.

Human non-small cell lung cancer (NSCLC) cell line A549 was incubated in a hypoxic environment (1%O₂, hypoxia group) or in a normoxic environment (21%O₂, normoxia group). The generation of ROS was measured by flow cytometry. The cell motility of A549 cells was detected by Transwell assay. The protein levels of protein kinase B (AKT), p38 mitogen-activated protein kinase (p38) were determined by Western blot analysis.

After 16 h hypoxic treatment, the migration of A549 cells in hypoxia group was significantly more than that of normoxia group [(85±10) vs (56±7) per lower magnification, P<0.001]. Besides, the generation of ROS was in a time-depended manner in hypoxia group. The ROS level was increased with the prolonged hypoxia time. It was significantly higher at 24 h than that in normoxia group [(273±4)% vs (102±6)%,P<0.001]. The migrated cells in hypoxia group co-treated with 2 mmol/L NAC for 16 h were less than that with hypoxic treatment alone [(47±13) vs (105±14) per lower magnification,P=0.011]. Meanwhile, the phosphorylation of AKT and p38 increased after 12 h hypoxic treatment in hypoxia group, however, 2 mmol/L NAC co-treatment attenuated this effect. Furthermore, inhibition of phosphorylated AKT with 0.1 μmol/L allosteric AKT inhibitor (MK-2206) in hypoxia group for 16 h reversed the hypoxia-induced A549 cell migration. The migrated cells in hypoxia+ MK-2206 group were significantly less than that in hypoxia group [(155±21) vs (249±32) per lower magnification, P<0.001].

Hypoxia increases the generation of ROS in A549, resulting from oxidative stress under hypoxia. The increased ROS level promotes cell motility through the activation of AKT.

To study the effect of Bmi1 gene overexpression on hematopoietic differentiation colony-forming assay of human embryonic stem cells.

Human embryonic stem cell H1 was co-cultured with mouse bone marrow mesenchymal stem cells OP9 to simulate hematopoietic differentiation in vitro. On the eighth day of co-culture, CD34⁺ hematopoietic progenitor cells were selected for colony- forming assay to induce hematopoietic colonies. The expression of Bmi1 gene and BMI1 protein in the process of H1 in vitro hematopoietic differentiation to CD34⁺ precursor cells was respectively detected by real-time PCR and Western Blot. The human embryonic stem cell H1 which overexpress Bmi1 gene was subjected to hematopoietic differentiation in the same way. Compare the colonies generated by hematopoietic differentiation of the two types of H1 cells.

The expression of Bmi1 gene was first increased and then decreased in the process of in vitro hematopoietic differentiation to CD34⁺ hematopoietic progenitor cells of human embryonic stem cells. Colony-forming assay showed H1 cells which overexpress Bmi1 gene produced significantly more erythroid colony forming units and mixed colony forming units than normal H1 cells.

Overexpression of Bmi1 gene promote the production of erythroid and mixed colony forming units during hematopoietic differentiation of human embryonic stem cell H1.

A 53-year-old male developed fever without obvious trigger in March 2016, with a body temperature of 36.7~38.2℃ and fatigue. Blood routine showed a significant increase in white blood cells; The bone marrow smear showed acute lymphoblastic leukemia (ALL) -L2, which was admitted to our hospital for further diagnosis and treatment. Past history: Hypertension for more than 10 years, which can be controlled by medication. Personal history: Smoking for more than 30 years, about 10 cigarettes/d, intermittent drinking. The history of marriage and childbirth and family history are no different. Physical examination at admission: body temperature 37.5 ℃, heart rate 80 beats/min, breathing 18 beats/min, blood pressure 125/60 mmHg (1 mmHg =0.133 kPa), oxygen saturation 99% in natural state, bilateral dorsal hands and dorsal feet scattered in bleeding points, unpalpable swelling of superficial lymph nodes in the whole body, no gingival hyperplasia, sternal tenderness, no abnormality of heart, lung and abdomen, no subcostal and subsword of liver and spleen, negative meningeal irritation sign, no testicular enlargement, and no swelling of both lower limbs.

The 27-year-old male was admitted to the First Hospital of Jilin University on June 1, 2015 due to intermittent nausea and vomiting for 2 years. The patient suffered from intermittent nausea and vomiting 2 to 3 times/d 2 years ago. The vomit was stomach content, no blood, accompanied by fatigue, and went to the local hospital. Ultrasound examination showed: superficial gastritis with erosion; Hypoechoic nodules in the left lobe of thyroid gland did not improve significantly after symptomatic treatment of gastritis. One year ago, the patient went to the local hospital again due to nausea and vomiting. The examination results showed: urine protein + +, alkaline phosphatase 838 U/L, blood phosphorus 1.19 mmol/L, and blood calcium was not measured. During hospitalization, a right chest wall mass (2 cm ×2 cm) was found and surgically resected. Pathology showed: glomus tumor with hemorrhage and ossification, and malignancy was not excluded. Then the pathological consultation in the superior tertiary hospital showed that the tumor with epithelioid differentiation may be benign or potentially low-grade malignancy. Nausea and vomiting occurred again 3 months after discharge, and no recurrence of tumor was found after re-examination of chest radiograph. One week ago, the patient was admitted to the local hospital due to both femoral fractures caused by a fall. The admission examination: parathyroid hormone (PTH) 1 322 ng/L and blood calcium 3.95 mmol/L. He was transferred to our hospital for further diagnosis and treatment. Past history: 1 year ago, he underwent surgical resection of right rib hemangioma in an external hospital; The fracture of left tibia, fibula and radius ulna was operated 5 months ago.

A 25-year-old woman, 44 kg and 156 cm tall, was admitted to the hospital due to a neck mass for 20 d. She was diagnosed as thyroid mass occupation and was proposed to undergo thyroidectomy (radical thyroidectomy) under general anesthesia. Preoperative white blood cells (WBC): 6.0×10⁹/L, hemoglobin (Hb): 132 g/L, platelets (PLT): 160×10⁹/L, alanine aminotransferase (ALT): 22 U/L, aspartate aminotransferase (AST): 11 U/L, urea nitrogen (BUN): 2.45 mmol/L, creatinine (Cr): 61 μ mol/L, blood calcium: 2.15 mmol/L, free triiodothyronine (FT₃): 4.74 pmol/L, free thyroxine (FT₄): 17.09 pmol/L, thyrotropin (TSH): 2.02 mU/L. Electrocardiogram showed sinus tachycardia, heart rate (HR): 101 beats/min; Color ultrasound showed that systolic and diastolic function of the heart were normal; Chest X-ray showed that the chest was basically normal, and the right trachea of the neck was compressed. The patient was an orphan with no history of epilepsy. He was usually taciturn and picky eater. He was discarded by his parents because of polio and grew up in an orphanage. After marrying and having children, the spouse is also a polio patient, and the children are in good health.

1,5-Anhydroglucitol (1,5-AG) is a naturally occurring polyhydric alcohol with a structure similar to glucose, and its content in human serum is second only to glucose. In human body, 1,5-AG is mainly derived from food and rarely metabolized. About 99.9% of it is reabsorbed in renal tubules, forming a stable metabolic pool of about 500~1 000 mg in the body and maintaining dynamic equilibrium^[1]。 In recent years, as an index to assess the mean blood glucose level in diabetic patients within 1 to 2 weeks^[2]The advantage of serum 1,5-AG in reflecting postprandial hyperglycemia has been gradually paid attention to, and its clinical value in screening diabetes has begun to emerge. At the same time, in the saliva^[3]And vitreous humoral fluid^[4]The clinical value of measuring 1,5-AG level in other body fluids and its own physiological effects make the research of 1,5-AG become a hot spot again. In this paper, the clinical application and influencing factors of 1,5-AG, its detection value in other body fluids and its physiological effects are described as follows.

Reviewing the clinical research data of statins in the primary and secondary prevention of cardiovascular diseases in recent years, the effect of statins is good, and the application of statins has increased significantly^[1]。 With the increase of its application, its two most common adverse reactions are highly valued by doctors and patients, namely muscle damage and liver damage. Many doctors will avoid the use of statins in patients with pre-existing liver disease because of their adverse hepatic reactions. However, studies have shown that the risk of cardiovascular disease is significantly higher in patients with liver disease than in those without liver disease, especially in patients with non-alcoholic fatty liver disease, viral hepatitis and primary biliary cirrhosis^[2]。 A recent study showed that patients with liver cirrhosis are more likely to develop cardiovascular disease (20% vs. 12%,P＝0.001)^[3]。 So whether statins can be used in people with liver disease and high risk of cardiovascular disease is currently controversial. In recent years, the pleiotropy of statins has attracted attention. In vitro and animal experiments, statins have shown anti-proliferative, anti-angiogenic, pro-apoptotic, and immunomodulatory effects^[4]。 Moreover, the data related to the effects of statins on the liver are constantly updated and changed. In this paper, the recent related research is reviewed in order to re-understand the effects of statins on the liver.

In the past 50 years, with the progress of human exploration of the North and South Pole, long-term scientific expeditions at the Earth's poles, especially the Antarctic, have become the norm. Due to the extreme climate at high latitude and altitude in Antarctica, such as strong cold, windy and snowy, diurnal cycle changes, strong ultraviolet exposure, and the relatively isolated living environment similar to the primitive, similar to the exploration of aerospace, it causes stressful changes in human hormone level, metabolism, immune function and psychological and mental aspects, thus deriving the concept of polar medicine. Polar medicine mainly studies the psychological and physiological changes of human beings in extreme environments in the polar regions, as well as the adaptation and response changes of original basic diseases in extreme environments, including the relationship between polar environment and people, and interpersonal relationships in polar environment. In this paper, the research progress of polar medicine at home and abroad in recent years is reviewed.