Volume 99 ·  Issue 22 ·  2019

Pulmonary function test is a commonly used examination in the diagnosis and treatment of respiratory diseases, including pneumometer examination and other examinations can produce many methods and indicators involving different physiological and pathological significance. China has successively released an overview and precautions of pulmonary function examination^[1]Pneumometry Examination Guidelines^[2]Guidelines for bronchial challenge testing^[3]Guidelines for bronchodilation testing^[4]And 8 guidelines for pulmonary function tests to standardize the methods, indicators, quality control standards and clinical applications of these pulmonary function tests.

To investigate the distribution of airway inflammation phenotypes in patients with bronchial asthma and its correlation with asthma control level.

Patients who met GINA 2017 asthma diagnostic criteria from October 2017 to April 2018 in respiratory outpatient department of China-Japan Friendship Hospital were included. The clinical data of non-acute asthma patients were prospectively collected, including general data, asthma control level, pulmonary function, induced sputum cell classification, serum total IgE, exhaled nitric oxide (FeNO), blood cell classification. The correlation between phenotype distribution of airway inflammation and airway inflammation markers (eosinophils in sputum, FeNO, blood eosinophil, serum IgE) and asthma control was analyzed by correlation analysis. The correlation between sputum eosinophil level and FeNO, blood eosinophil count, serum total IgE, forced expiratory volume in one-second (FEV₁) predicted (FEV₁%pred) was analyzed by correlation analysis too.

A total of 97 asthmatic patients were enrolled. There were 38 males (39.2%) and 59 females (60.8%), aged (48±14) (range 22 to 80). Control level of asthma:13 cases (13.4%) were controlled, 39 cases(40.2%) were partially controlled and 45 cases (46.4%) were uncontrolled. The phenotypes of airway inflammation were eosinophilic 51 cases (52.6%), neutrophilic 9 cases (9.3%), mixed 35 cases (36.1%) and paucigranulocytic 2 cases (2.1%). There was no significant correlation between airway inflammation phenotype distribution, airway inflammation markers and asthma control level (P>0.05). Sputum eosinophil level was positively correlated with FeNO level in controlled and uncontrolled patients (r=0.420, P=0.008 and r=0.325, P=0.031); sputum eosinophil level was positively correlated with blood eosinophil level in uncontrolled asthma patients (r=0.328, P=0.037). There was no significant correlation between sputum eosinophil level and FEV₁%pred (P>0.05).

Eosinophil type is the dominant type of airway inflammation in asthmatic patients, and there is no significant correlation between airway inflammation and asthma control level. At present, airway inflammation cannot be used to assess asthma control level.

To evaluate the diagnostic value of the heparin-binding protein (HBP), procalcitonin (PCT) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score in ventilator-associated pneμmonia (VAP).

A total of 160 patients who required tracheotomy or intubation and assisted breathing with invasive mechanical ventilator from the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2017 was included in this prospective study,and divided into VAP group and no-VAP group based on if VAP happened or not; the VAP group was further divided into deterioration group and improvement group based on the curative effect after anti-infective treatment for 1 week. A total of 40 community acquired pneumonia (CAP) patients and 30 healthy volunteers were also included as control groups. The levels of HBP and PCT in blood of the subjects were tested with enzyme-linked immuno sorbent assay (ELISA) and chemiluminescence immunoassay (ECLIA) respectively, APACHE Ⅱ score was utilized to assess the severity of illness. The difference of HBP, PCT levels and APACHE Ⅱ score among the groups were analyzed. Receiver operating characteristic(ROC) curve was utilized to analyze the diagnostic value of HBP, PCT, APACHE Ⅱ score in VAP.

A total of 230 subjects participated in this study, including 68 VAP patients, 92 non-VAP patients, 40 CAP patients and 30 healthy volunteers. Before administration of mechanical ventilation, there were no statistically significant differences in HBP, PCT and APACHE Ⅱ score between VAP group and non-VAP group (all P>0.05). The levels of HBP,PCT and APACHE Ⅱ score were (41.4±21.3) μg/L,(0.355±0.254) μg/L,(13.4±2.5) respectively when the VAP was diagnosed,which were higher than those within the first 12 h of mechanical ventilation (7.3±2.7) μg/L, (0.080±0.038) μg/L, (8.4±2.0), all P<0.001). The HBP, PCT and APACHE Ⅱ score had no significant difference between within the first 12 h of mechanical ventilation and after mechanical ventilation in non-VAP group (all P>0.05). The levels of HBP was positively correlated with PCT and APACHE Ⅱ score (r=0.82, 0.68, all P<0.001). In deterioration group,the HBP,PCT and APACHE Ⅱ score after 1 week of anti-infective treatment were higher than those when the VAP was diagnosed (all P<0.001). No matter it is when the VAP was diagnosed or after anti-infective treatment for 1 week,the levels of HBP, PCT and APACHE Ⅱ score in deterioration group were higher than those in the improvement group (all P<0.001). The area under curve (AUC) of HBP+APACHE Ⅱ score, PCT+APACHE Ⅱ score for VAP diagnosis was 0.98, 0.95 respectively. The sensitivity of HBP+APACHE Ⅱ score in the diagnosis of VAP was lower than PCT+APACHE Ⅱ score (94.1% vs 95.6%),and the specificity was higher (92.4% vs 82.6%).

The diagnostic value of HBP+APACHE Ⅱ score for early VAP is superior to PCT+APACHE Ⅱ score.

To study the role of dopamine receptor subtype DRD2 and DRD5 in the treatment of pituitary adenoma, and toprovide a novel strategy for the drug-resistant pituitary adenomas.

Immunohistochemistry was used to detect the expression of dopamine type 5 receptor (DRD5) and dopamine type 2 receptor (DRD2) in 33 primary pituitary tumor tissue samples. Cabergoline, DRD5 agonist (SKF38393),and DRD2 agonist (Quinypirol) were used to treat primary pituitary tumor cells,and MTS was used to evaluate cell activity,in order to analyze the correlation between drug efficacy and the expression of DRD5 and/or DRD2 in 33 pituitary tumor.

(1) Pathological analysis of 33 pituitary tμumor tissue samples indicated 17 cases of prolactinoma, 13 cases of non-functional adenoma, 3 cases of growth hormone (GH) tumor,among which 22 cases with high expression of DRD2 (66.7%) and 24 cases with high expression of DRD5 (72.7%). (2) Primary pituitary tumor cells were treated with Cabergoline at 50 μmol/L, Quinypirol at 50 μmol/L and SKF38393 at 25 μmol/L. Among the 33 primary cells,Cabergoline was effective in 25 cases (75.8%),Quinypirol in 16 cases (48.5%),and SKF38393 in 15 cases (45.5%). (3) The efficiency of Cabergoline, Quinypirol and SKF38393 in the primary cell with high expression of DRD2 and DRD5 were78.6%,71.4% and 50% respectively. The efficiency of Cabergoline,Quinypirol and SKF38393 in the primary cell with high DRD2 expression and low DRD5 expression were 75%, 62.5% and 12.5% respectively. The efficiency of Cabergoline,Quinypirol and SKF38393 in the primary cell with low DRD2 expression and high DRD5 expression were 80%, 10% and 70% respectively. The efficiency of Cabergoline, Quinypirol and SKF38393 in the primary cell with low DRD2 and DRD5 expression had no significant activity change.

(1) Both DRD2 and DRD5 are highly expressed in pituitary tumors; (2) cabergoline, DRD2 agonist and DRD5 agonist effectively inhibit the growth of pituitary tumor,among which Cabergoline has the highest efficiency; (3) in the absence of DRD2,DRD5 is an alternative target to treat the pituitary tumors.

To describe the status quo of short term quality of life after discharge in patients with colorectal cancer (CRC) following enhanced recovery after surgery (ERAS) pathway and to explore its influencing factors.

Surveys of 127 CRCs following ERAS pathway were conducted. The Readiness for Hospital Discharge Scale and Quality of Life Questionnaire-Core 30 (QLQ-C30) were issued at the discharge and 1 months after the operation,respectively.

The score of global quality of life was 66.8±18.8. Education,surgical type,stoma,and the readiness for hospital discharge were influencing factors of global quality of life.

CRC patients′ global quality of life is at the middle level. Patients with low education,open surgery,stoma and low readiness for hospital discharge are of poor global quality of life at 1 months after the operation,which should be regarded as the focus of medical attention.

To evaluate the correlation between single nucleotide polymorphisms (SNPs) of rs4778137 located in OCA2 gene and clinical response of breast cancer patients receiving neoadjuvant chemotherapy.

A total of 140 breast cancer patients receiving neoadjuvant chemotherapy were enrolled to detect DNA in blood sample by DNA extraction kit and the rs4778137 polymorphism by sequenom. The relationship between SNPs of rs4778137 and pathologic complete response (pCR) were analyzed.

The frequency of CC, GC and GG genetype of rs4778137 was 48.6%, 31.4% and 20.0%,respectively. Thirty cases (21.4%) achieved pCR with CC allele in 9 cases(13.2%),GC allele in 10 cases (22.7%) and GG allele in 11 cases (39.3%),respectively,with a statistically significant difference(P<0.05). When conducting stratified analysis in accordance with the estrogen receptor (ER) status,only in ER negative group pCR was significantly associated with SNPs of rs4778137 (P<0.05). SNPs of Rs4778137, targeted therapy,subtypes,tumor stage were independent predictors of pCR in multivariate logistic regression analysis (P<0.05),and SNPs of rs4778137 was an independent predictors of pCR in ER negative group (P<0.05), but not in ER positive group group (P>0.05).

SNPs of rs4778137 was associated with pCR only in ER negative patients receiving neoadjuvant therapy, and breast cancer patients with the GG allele were more likely to achieve pCR.

To investigate the clinical characteristics and risk factors of acute kidney injury (AKI) after pediatric congenital heart surgery among children aged<4 years old.

A total of 410 children<4 years old with congenital heart disease who underwent cardiac pulmonary bypass (CPB) surgery from Guizhou Provincial People′s Hospital between January 2017 and December 2018 were analyzed retrospectively. The patients were divided into two groups:AKI group (n=42) and non-AKI group (n=368) according to whether AKI occurred after surgery. The clinical data of patients was compared between two groups, including demographic data(sex, age, weight), preoperative, intraoperative and postoperative clinical data, the length of mechanical ventilation, hospitalization, intensive care unit (ICU) stay, hospital costs and death in hospital. Logistic regression analysis was used to screen the risk factors of postoperative AKI.

Compared with non-AKI group, children in AKI group had lower weight [(8.2±3.3) kg vs (9.9±2.6) kg,P=0.023] and mean arterial pressure (MAP) [(101.3±18.1) mmHg vs (118.2±15.6) mmHg,P<0.001], but longer duration of surgery [(210.3±74.8) min vs (149.1±52.2) min, P<0.001], CPB [(107.2±49.9) min vs (60.2±29.2) min,P<0.001],aortic clamping [62.0(50.0,88.0) min vs 34.5(18.3,52.3) min,P<0.001],mechanical ventilation duration, ICU stay, hospital stay, and higher mortality. Multivariate logistic regression analysis showed that lower weight (OR=0.489, 95%CI:0.298-0.802, P=0.005), lower MAP (OR=0.929, 95%CI: 0.891-0.969, P=0.001), longer duration of surgery (OR=1.035, 95%CI: 1.016-1.054, P<0.001) were the independent risk factors for AKI.

Children with lower weight, longer duration of surgery, lower MAP are at higher risk of getting AKI after congenital heart surgery.

To investigate the effect of iron overload on tumor marker CA199 in patients with type 2 diabetes mellitus (T2DM).

Between January 2017 and June 2018, three hundred and twenty-three hospitalized patients with T2DM in Department of Endocrinology, Tianjin Fourth Central Hospital were selected as diabetes group and another 100 healthy persons as control group. All the participants with major diseases and factors affecting serum ferritin and CA199 level were excluded. Serum ferritin and CA199 levels were measured by chemiluminescence assay. Patients with a ferritin level above the normal range were defined as iron overload group. According to serum ferritin level, 178 patients were divided into iron overload group and 145 into normal ferritin group in the diabetes group. The levels of CA199 were compared between iron overload group and normal ferritin group, and the correlation was analyzed.

The levels of serum ferritin [407.1 (346.7) μg/L vs 266.6 (201.1) μg/L in males, 184.7 (133.0) μg/L vs 77.4 (64.0) μg/L in females,both P<0.001] and CA199 [18.2 (19.3) μg/L vs 9.3 (9.7) μg/L, P<0.001] in diabetes group were significantly higher than those in control group. Serum CA199 levels in iron overload group were significantly higher than those in normal ferritin group (20.7 μg/L vs 15.0 μg/L, P<0.001; above intermediate value percent:53.9% vs 35.8%,P=0.001). CA199 was positively correlated with glycosylated hemoglobin (HbA1c) (r=0.280, P<0.001) and iron overload (r=0.210, P<0.001). Multiple linear regression analysis showed that iron overload (β′=0.203,P=0.002) and HbA1c (β^′′=0.202, P=0.001) had a significant effect on CA199 level.

In T2DM patients, iron overload is an important factor affecting serum CA199 level.

Toobserve the damage effects of cytomegalovirus (CMV) infection on hematopoietic cells and to investigate the clinical significance.

(1) ELISA assay wasused to detect IL-17 and IFN-γ levels in the peripheral blood serum of 36 patients on pretherapy and posttherapy. (2) Changes of peripheral blood lymphocyte subsets were detected by FACS. (3) Cytological observation of cervical lymph nodes was executed by needle aspiration cytology. (4) Cellular immunochemistry and immunofluorescence staining were performed to observe the POX release, HLA-DR expression, IL-17A and IFN-γ secretion-like expression status of activated immune cells in the bone marrow hematopoietic microenvironment. Serum samples from healthy individuals were used as controls. Bone marrow smears from patients without iron deficiency anemia were compared as bone marrow immunostaining.

(1) Serum levels of IL-17 and IFN-γ were significantly increased in CMV-infected patients [IL-17 (48.23±3.86) ng/L vs (20.16±1.05) ng/L,respectively; IFN-γ (40.16±3.11) vs (8.17±1.92) ng/L,P<0.01]. (2) The proportion of CD16+/CD56+NK cells was significantly increased in patients [(43.54±6.01)% vs (14.01±3.25)%, P<0.01]. The proportion of CD3+CD4+T and CD3+CD8+T cells decreased,(20.91±53.15)% vs (35.10±4.88)%, and (15.41±5.13)% vs (25.11±3.92)%,respectively,P<0.05. (3) Large numbers of abnormal lymphocytes and macrophages (MΦ) that engulf large quantities of CMV inclusion bodies were observed in bone marrow and lymph nodes. CMV infected and destroied the hematopoietic cells of various lines in the bone marrow. The activated MΦ phagocytizedthe CMV inclusion bodies and also phagocytosed CMV-infected blood cells. (4) Activated MΦ in bone marrow hematopoietic microenvironment released POX strongly positive, highly expressed class Ⅱ HLA-DR, and highly expressed inflammatory factors IL-17A and IFN-γ. (5) Twenty-twopatients with elevated WBC were treated with ganciclovir combined with antibiotics for 2 weeks after the disappearance of the foci, WBC counts and CMV-IgM levels of 16 cases were reduced to normal.Six patients with CMV who were not turned negative were tprolonged,and the granulocyte and/or platelet counts fell below normal range. Fourteenpatients withreduced granulocyte or platelet count, CMV-IgM levels were slow descend,and the ganciclovir treated more than 4 weeks.

CMV can infect hematopoietic bone marrow nucleated blood cells and destroy hematopoiesis. NK and MΦ cells are important effector cells against CMV infection. Activated macrophages are dual in nature, they can engulf CMV virus and virus-infected blood cells,and also aggravate bone marrow immune damage by releasing inflammatory factors such as POX and IL-17A and IFN-γ.

To assess the efficacy and safety of different opportunity of Saccharomyces boulardii (S. Boulardii) Sachets combined with bismuth quadruple therapy for Helicobacter pylori(H. pylori)eradication.

This experiment was a prospective study. A total of 300 H. pylori-infected patients were enrolled and randomized assigned into three groups. Quadruple therapy group received pantoprazole 40 mg+bismuth potassium citrate capsule 220 mg+amoxicillin 1 000 mg+furazolidone 100 mg, bid, oral for 14 days. The simultaneous probiotic group received pantoprazole 40 mg+bismuth potassium citrate capsule 220 mg+amoxicillin 1 000 mg+furazolidone 100 mg+S. Boulardii Sachets 500 mg,bid,oral for 14 days.There after probiotic group:S.Boulardii Sachets was added on the first day after the end of 14 days in the quadruple group, for 500 mg, bid 14 days. The eradication rates and adverse reactions of the three groups were compared.

The eradication rates of H.pylori were 89.0%,90.4% and 91.3% in the quadruple therapy group, the simultaneous probiotic group and the there after probiotic group according to Per-protocol(PP) analysis,respectively,with no statistical difference (P=0.870). According to intention-to-treat(ITT)analysis, 81.0%, 85.0% and 84.0%, respectively, the difference was not statistically significant (P=0.732).The overall incidence of adverse reactions and the incidence of diarrhea and nausea in the simultaneous probiotic group, and the there after probiotic group were lower than those in the quadruple group(P<0.05),and the difference was statistically significant.The overall incidence of adverse reactions and diarrhea in the simultaneous probiotic were lower than those in the there after probiotic group (P=0.021, P=0.007), and the difference was statistically significant.

S. Boulardii Sachets combined with quadruple therapy at the same time or after eradication treatment can not improve the H.pylori eradication rate,but can reduce the overall incidence of adverse reactions and the incidence of diarrhea and nausea. It is safer to add S. Boulardii Sachets at the same time than after eradication therapy.

To investigate the effects of probiotics(VSL#3, S. Boulardii) on intestinal flora of mice with DDS-induced acute colitis.

C57BL/6J mice were administered with 2.5% dextran sulfate sodium for 5 consecutive days to develop the acute colitis model except for the blank control group. Meantime,Mice were treated with drinking water (DSS model group),VSL#3 (1.5×10⁹ CFU),or S.Boulardii(5×10⁷ CFU) by gavage for 7 days respectively,and mice were sacrificed 2 days after the model of colitis was established. The fecal specimens before gavage (day 0),in the middle of experiment (day 4),and the end of gavage (day 7) and the intestinal mucosa after sacrifice were collected to analyze the differences between these four groups by 16s rDNA sequencing method.

Compared with the DSS model group, VSL#3 group showed a decrease in disease activity index (DAI) and histological scores, and there was no significant change in the S.Boulardii group. Fecal microbiota:in the middle of experiment,the alpha diversity of DSS model group,VSL#3 group and S.Boulardii group were lower than that of the blank control group(P=0.0135,P=0.0018,P=0.0151). After the end of gavage,the diversity of the VSL#3 group was lower than that of the blank control group(P=0.025), and the difference between any other two groups was not statistically significant. Mucosa-adherent microbiota:biodiversity of DSS model group,S.Boulardii group were lower than the blank control group(P=0.031,P=0.0437),while biodiversity of VSL#3 group was higher than DSS model group and S. Boulardii group(P=0.0394, P=0.0426). Compared with the blank control group, the DSS model group showed an increase in Bacteroides and a decrease in Lactobacillus. Abundance in the genus Turicibacter and Odoribacter increased in intestinal microbiota of mice with acute colitis, while VSL#3 inhibited them.

VSL#3 alleviates inflammation in DSS-induced colitis of mice.Both VSL#3 and S.Boulardii can affect intestinal microbiota. Compared with healthy mice,mice with colitis showed a reduced diversity of microbiota both in feces and in intestinal mucosa. VSL#3 increases biodiversity of mucosal microbiota in mice with acute colitis,while it does not increase biodiversity of fecal microbiota. Genera such as Turicibacter and Odoribacter increase in mice with acute colitis, and these genera can be inhibited by VSL#3.

Female, 57 years old, was admitted to hospital due to "elevated blood sugar for 11 years, polydipsia and polyuria with weight loss for 8 years". She was able to control blood sugar with nateglinide in the past, and there was no diabetic ketosis during the course of the disease. The level of glycosylated hemoglobin was repeatedly reduced, the level of glycosylated serum albumin was high, hemoglobin and albumin were normal, and bilirubin was slightly elevated. Screening of common causes of hemolytic diseases did not show autoimmune hemolysis, glucose-6-phosphate dehydrogenase deficiency, paroxysmal hemoglobinuria and other causes. Further examination of the life span of red blood cells was significantly shortened. Combined with the relevant examination and family history diagnosis of the patient, it was considered that the life span of red blood cells was shortened due to hereditary hemolytic disease, which led to a false reduction in the determination of glycosylated hemoglobin. In terms of treatment, nateglinide was changed to sitagliptin to reduce the burden on the pancreas.

Intestinal peripheral T-cell lymphoma is a rare lymphoma, and the diffuse involvement of small intestine is even rarer. Its diagnosis is difficult, mainly depending on multiple deep mucosal biopsies at multiple points, and the clinical prognosis is poor. This article reports a case of chronic diarrhea as the main clinical manifestation, anti-infection and hormone therapy effect is not good, PET-CT showed uneven increase of small intestine and colon metabolism, finally by gastrointestinal endoscopy and multi-point deep digging biopsy, HE staining combined with immunohistochemistry showed peripheral T cell lymphoma is non-specific type, the diagnosis process is difficult. It is hoped that this case will deepen clinicians' understanding of intestinal peripheral T cell lymphoma.

A 54-year-old female patient was reported. MRI examination showed multiple nodular and mass-like abnormal signal shadows in the liver due to physical examination. The larger lesions showed mixed slightly longer T1 and long T2 signals with clear boundaries, and necrosis, cystic degeneration and hemorrhage could be seen in them. The smaller lesions showed uniform signal, showing long T1 and long T2 signals, and DWI showed nodular and halo-like high signal. The final diagnosis was G1 grade primary hepatic neuroendocrine tumor with bone metastasis.

A 57-year-old male underwent sequential double lung transplantation due to end-stage chronic obstructive pulmonary disease 5 months ago. Two days before admission, he developed a small amount of bloodshot in sputum and no fever. Chest radiograph showed eccentric cavity in the right upper lung, white blood cell count, neutrophil count and procalcitonin were all negative, and empirical antifungal treatment was ineffective. After admission, the etiology of bronchoalveolar lavage fluid under bronchoscopy and the etiology of lung biopsy reported Pseudomonas aeruginosa, and the cavity of right upper lung was gradually absorbed after anti-Pseudomonas aeruginosa treatment.

Sarcoidosis is a multisystemic disease of unknown cause, which is clinically rare. This patient was a 67-year-old female with clinical manifestations of multiple system damage such as eye, joint, skin, lung, thyroid and kidney. The pathology of subcutaneous nodules was non-caseous granuloma, except tuberculosis, fungal infection, malignant tumor, vasculitis and immunodeficiency. The diagnosis of sarcoidosis was clear, and the symptoms improved after glucocorticoid treatment. After discharge, she was followed up for 1 year, and there was no recurrence at present.

This article reports a case of anti-Helicobacter pylori (H. pylori) A rare furazolidone adverse reaction manifested as severe skin pain throughout the body during treatment. The patient failed repeatedly three times within one year, all of which were regular treatment plans, and the course of treatment was 14 days. The fourth treatment was treated with standard quadruple therapy with amoxicillin and furazolidone. On the second day of treatment, he developed severe skin pain throughout the body, which was diagnosed as "neuropathic pain" by a dermatologist. Neuropathic pain caused by furazolidone has not been reported in China.

Nocturia caused by obstructive sleep apnea (OSA), which may be caused by repeated hypoxia at night, changes in intrathoracic pressure, sleep segments or high arousal index, involves complex mechanisms of the neuro-humoral-endocrine pathway. Renal hyperfiltration, reabsorption dysfunction caused by renal tubular injury and abnormal bladder function may also play a role in the formation of hypernocturia. To study the mechanism of nocturia associated with OSA, it is helpful to understand the regularity of body fluid distribution and the diurnal and night differences in OSA patients, and provide a focus and basis for correcting nocturia and possible circulatory complications in the later stage.