Volume 100 ·  Issue 02 ·  2020

Chronic obstructive pulmonary disease (COPD) is highly prevalent in China. The latest data shows that the prevalence of COPD in people over 40 years old is as high as 13.7%, and it is expected to become the first disease burden by 2020. However, the prevention and treatment system and capacity building of COPD in China are seriously lagging behind. Doctors and patients have insufficient awareness of the disease, pulmonary function measurement has not been popularized, treatment is not standardized, and disease management needs to be strengthened. This paper expounds the existing problems in the diagnosis and treatment of COPD in China and thinks about the "ways to solve them".

In the past 40 years of immunization planning, China's vaccination work has made great progress, but it still faces problems such as single financing channels and inadequate coverage of key populations. This paper summarizes the general situation of vaccine programming and the sources of vaccine financing in four major developed countries: the United States, Britain, Germany and Japan, compares the differences of vaccine financing methods between these countries and China, and then puts forward the following suggestions on China's immunization programming and vaccine financing strategies: First, broaden the channels of vaccine financing and guide medical insurance to participate in vaccine payment for non-immunization programs; Second, pay attention to the poor and vulnerable groups, and improve the accessibility and fairness of vaccination services; Third, gradually expand the types of vaccines for immunization programs, especially those that have been universally included in immunization programs internationally.

HIPEC has made continuous breakthroughs in theoretical research and technology, and has become an effective auxiliary means for the treatment of PC at present, which has been widely concerned by foreign scholars for a long time. At the 2014 International PC Conference in Amsterdam, the Netherlands, CRS combined with HIPEC treatment strategy was used as the standard treatment for appendix mucinous carcinoma, colorectal cancer peritoneal metastases, and malignant mesothelioma, and as the recommended treatment for ovarian cancer and gastric cancer peritoneal metastases^[27]。 2018 New England Journal of Medicine report^[3]After the first multicenter randomized controlled clinical trial of HIPEC in the treatment of advanced ovarian cancer, the 2018 FIGO Cancer Report included HIPEC in the guidelines for the diagnosis and treatment of ovarian cancer, and the first edition of NCCN in 2019 also included HIPEC in the guidelines for the treatment of ovarian cancer. The American Association Against Cancer also uses HIPEC as a recommended treatment for patients with peritoneal metastases of gastric cancer.

To investigate differential genes (DEGs) between no/mild and severe emphysema by bioinformatics analysis.

The microarray dataset GSE1650, of lung tissue in no/mild and severe emphysema, was downloaded from the GEO database, and DEGs were obtained by t test. Analysis of DEGs based on DAVID database was used to obtain gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) pathway. The protein-protein interaction network (PPI) was established using STRING database to identify hub genes.

A total of 76 DEGs were obtained, of which 62 genes were up-regulated and 14 genes were down-regulated in severe emphysema group. Gene ontology showed that the DEGs were mainly involved in neutrophil chemotaxis, cellular response to interleukin-1, extracellular matrix organization, immune response, and KEGG pathway involved cytokine-cytokine receptor interaction, ECM-receptor interaction, PI3K-Akt signaling pathway, platelet activation. Seventeen hub genes were recognized by PPI analysis, including CXCL8, RRAD, CLU, TIMP1, SEPP1, ISLR, BGN, COL1A1, COLIA2, ACTA2, ACTN1, FIGF, TPM1, TPM2, LUM, COL6A3 and TAGLN. Among them, fifteen genes (CLU, TIMP1, SEPP1, ISLR, BGN, COLIA2, COL1A1, ACTA2, ACTN1, FIGF, TPM1, TPM2, LUM, COL6A3, TAGLN) were up-regulated and two genes (CXCL8, RRAD) were down-regulated.

Bioinformatics analysis based on GEO database showed that there were DEGs between non/mild and severe emphysema patients.

To explore the clinical effect of nutritional and psychological intervention combined with pulmonary rehabilitation exercise on patients with chronic obstructive pulmonary disease (COPD).

A total of 260 patients with COPD admitted to the Sixth Affiliated Hospital of Kunming Medical University from October 2014 to October 2017 were included. They were divided into mild, moderate, severe and extremely severe groups according to forced expiratory volume in one second predicted (FEV₁%prep) of pulmonary function. The patients were divided into control group and comprehensive management group according to the random number table method. The control group was given routine treatment including smoking quitting persuasion, vaccination, oxygen therapy and standardized medication. The comprehensive management group was given additional nutritional support, psychological intervention and pulmonary rehabilitation exercise. The data of the lung function indexes (FEV₁%prep, FEV₁/FVC, PaO₂, PaCO₂), nutritional indexes [body mass index (BMI), albumin (ALB), nutrition risk screening (NRS)2002], anxiety and depression scores, 6-minute walking distance (6MWD), modified medical research council (mMRC) dyspnea scale, COPD assessment test (CAT), St. George′s score, and frequency of acute exacerbations were compared between two groups after 12 months of treatment.

After 12 months′ treatment, PaO₂ in the comprehensive management group was significantly higher than that in the control group [(51.1±7.2) vs (47.0±9.1) mmHg] (1 mmHg=0.133 kPa); Nutritional risk (NRS2002) decreased obviously [(1.1±1.1) vs (2.2±1.0)]; anxiety score [(4.1±2.2) vs (5.6±2.7)]; depression score [(4.1±2.0) vs (5.5±2.6)] and St. George′s score [(36.8±20.8) vs (48.6±19.5)] decreased significantly (P<0.05). And the 6MWD was significantly farther [(368.4±72.0) vs (343.4±75.0) m] in management group. The frequency of acute exacerbations was significantly reduced in the mild, moderate and severe groups (P<0.05). But there was no significant difference in FEV₁%prep, FEV₁/FVC, PaCO₂, BMI, ALB, mMRC score and CAT score.

Nutritional and psychological intervention combined with pulmonary rehabilitation exercise can reduce the nutritional risk and the frequency of acute exacerbations in patients with COPD, relieve anxiety and depression state and improve the quality of life.

To investigate the association of plasma roundabout 4 concentration with pulmonary ventilation function decline in chronic obstructive pulmonary disease (COPD) patients.

To get the effective data, the study was conducted in the outpatient department of West China Hospital from September 2017 to September 2018. The subjects meeting the inclusion and exclusion criteria were continuously included. Among them, the COPD group (75 cases) was from the respiratory outpatient department, and the healthy control group (57 cases) was from the health examination center at the same time. Data of basic demographic characteristics, clinical characteristics, pulmonary ventilation function parameters and blood samples were collected. The concentrations of roundabout 4, C reactive protein (CRP), interleukin (IL)-6, IL-8, IL-1b and tumor necrosis factor (TNF)-α in plasma were detected, and the differences among groups were compared, the correlation between plasma roundabout 4 and pulmonary ventilation function parameters and inflammatory factors was analyzed. The diagnostic efficiency of roundabout 4 to COPD was analyzed according to receiver operating characteristic (ROC) curve.

The plasma concentration of roundabout 4 in COPD group was significantly higher than that in healthy control group [(41.3±14.2) vs (27.7±13.3) ng/L; P<0.001], the sensitivity and specificity of roundabout 4 in the diagnosis of COPD were 0.827 and 0.702 respectively. Correlation analysis showed that the plasma concentration of roundabout 4 was negatively correlated with lung function parameters forced expiratory volume in one second/forced vital capacity (FEV₁/FVC), the first second forced expiratory volume as a percentage of the estimated value (FEV₁%pred), forced exhalation of 50% and 25% lung capacity (MEF50, MEF25) and maximal mid-expiratory flow (MMEF) (r=-0.399, -0.321, -0.439, -0.363, -0.458; all P<0.001), positively correlated with CRP (adjusted r=0.311, P<0.001).

The increased concentration of roundabout 4 in plasma leads to the decline of pulmonary ventilation function in COPD patients.

To explore the role of pulmonary arterial pressure in chronic obstructive pulmonary disease (COPD) phenotypes based on cluster analysis and its prognostic value.

Three hundred and nineteen patients admitted to Beijing Chaoyang Hospital and Xuanwu Hospital from April 2013 to April 2016 were recruited in the study. All the patients were older than 40 years old and in stable COPD. One-year follow-up was performed and the endpoint was acute exacerbation of COPD or all-cause mortality. Age, body mass index (BMI), smoking index, history of exacerbation, modified British medical research council (mMRC), forced expiratory volume in first second (FEV₁), pulmonary arterial pressure and right ventricular transverse diameter measured by echocardiography were selected as cluster indicators to classify patients, survival analysis was performed.

Eight cluster indexes were converted into four independent principal components by principal component analysis (PCA), with a cumulative contribution rate of 70.1%. The extracted principal components were used for cluster analysis. Patients were divided into four categories, each contained different GOLD grades and had statistically significant differences in age, symptoms, degree of pulmonary function impairment and pulmonary arterial pressure (all P<0.001). The four categories were: class 1: young, pulmonary function damage was medium, lower pulmonary arterial pressure, good prognosis; class 2: elderly, pulmonary function damage was mild, higher pulmonary arterial pressure, poor prognosis; class 3: young, pulmonary function damage was serious, normal pulmonary arterial pressure, the best prognosis; class 4: elderly, pulmonary function damage was medium, pulmonary arterial pressure increased significantly, the worst prognosis.

Cluster analysis based on pulmonary artery pressure can be used to identify COPD patients with different risk of acute exacerbation or death, suggesting that pulmonary hypertension as a COPD phenotype plays a role in prognostic assessment.

This study was designed to investigate prognostic factors and the potential relationship between the expression of Ki67 and IDH of glioblastoma in the elderly (≥ 65 years old) and the clinical factors such as gender, the KPS score and treatments including surgical resection, radiotherapy and chemotherapy and the prognosis of such patients.

Fifty-four elderly patients (≥ 65 years old) with glioblastoma admitted to the First Affiliated Hospital of Zhengzhou University from 2013 to 2018 were enrolled in this study. The expression of Ki67 was detected by immunohistochemical SP method and the mutation of IDH was detected by Sanger sequencing. Finally, statistical analysis was performed to determine whether Ki67, the mutation of IDH, gender, the KPS score and the extent of resection, radiotherapy and chemotherapy were associated with the clinical prognosis of the patients.

Of the 54 elderly patients with glioblastoma, none was detected with IDH mutation. Univariate analysis showed that Ki67(P=0.033), the KPS score (P=0.008), the extent of resection (P<0.001) were factors influencing the prognosis of elderly patients with glioblastoma. Patients receiving postoperative adjuvant radiotherapy (P=0.002) and chemotherapy (P=0.034) had longer survival time. There was no significant correlation between gender (P=0.467) and prognosis. Multivariate analysis demonstrated that radiotherapy (OR 2.446, P=0.009) and the extent of resection (OR 6.976, P<0.001) were independent prognostic factors.

No IDH mutation was detected in all the patients in this study, indicating that IDH mutation is indeed rare in elderly glioblastoma, which suggests that geriatric population often harbor a molecular phenotype with poor prognosis. Ki67, KPS score, the extent of resection, radiotherapy and chemotherapy were the factors influencing the prognosis of patients.

To compare the improvement of quality of life in the patients with left main coronary artery disease and multi-vessel disease between off-pump coronary artery bypass grafting (OPCABG) and percutaneous coronary intervention (PCI) within one year after revascularization.

This study was a prospective study. Between January and July 2018, 840 patients with complex coronary heart disease accepted revascularization therapy, 420 of whom underwent OPCABG and 420 for PCI, with a mean age of 61 years and a male rate of 74% (622/840). European Quality of Life-5 Dimensions (EQ-5D) and Seattle Angina Questionnaire (SAQ) were employed to assess the quality of life and health status of patients. Inverse probability weighting (IPW) was used to adjust treatment selection bias.

All-cause mortality (3.6% vs 1.3%, P=0.045), major adverse cardiac and cerebrovascular events (MACCE) (11.3% vs 4.1%, P<0.001) and target lesion revascularization (8.3% vs 1.2%, P<0.001) were higher in PCI group than those in OPCABG group. EQ-5D scores in PCI group were significantly higher than those in OPCABG group at 1 month after operation (P<0.001), but there was no significant difference between the two groups at 12 months after operation (P=0.210). In SAQ scale, the frequency score of angina pectoris in OPCABG group was higher than that in PCI group in 1 month, 6 months and 12 months after operation (all P<0.05). The physical activity limitation score in PCI group was significantly higher than that in OPCABG group at one month after operation (P<0.01). There was no significant difference between OPCABG group and PCI group in terms of stable state of angina pectoris, satisfaction of treatment and the knowledge of disease.

In the short term, the quality of life of patients with left main coronary artery disease and multi-vessel disease treated with OPCABG is better than PCI. However, the improvement of quality of life in the medium and long term still needs to be identified in future follow-up study.

To study the relationship between the expression of Chromobox protein homolog (CBX) mRNA and the clinicopathological prognosis of breast cancer, and to investigate the possibility of Chromobox protein homolog 2 as a therapeutic target for breast cancer.

First, we analyzed the mRNA expression of 8 CBX family genes by METABRIC database, and investigated the relationship between the expression of CBX2 mRNA and the clinicopathological parameters of breast cancer. Then we explored its relationship with prognosis. CBX2 siRNA was used to treat breast cancer cell lines with high expression of CBX2(SUM159 and SUM1315). The effects of knockdown of CBX20 on mRNA and protein expression and cell proliferation were observed.

According to the analysis of METABRIC database, among the 8 CBX genes, the most obvious increase in mRNA expression was CBX2, and 22.47% (445/1 980) of the patients showed high mRNA expression. The high expression of CBX2 was closely related to tumor histological grade and the molecular type of breast cancer (P<0.001). Compared with the low-expression group of CBX2 mRNA, the proportion of HER2 breast cancer (28.1% vs 7.5%) and Basal-like (44.5% vs 8.5%) in the high-expression group were both higher. Patients with high CBX2 expression had significantly shorter disease-free survival (DFS) and overall survival (OS). The knockdown of CBX2 by siRNA inhibited the proliferation of breast cancer cells.

CBX2 is closely related to the prognosis of breast cancer and may be a target for breast cancer treatment.

Tuberous sclerosis complex (TSC) is a multi-system disease with TSC1 and TSC2 genes as the pathogenic genes. The purpose of our study was to analyze the gene mutation in patients with TSC with epilepsy as the main clinical manifestation. The relationship between genotype and phenotype, scalp EEG in patients was analyzed.

The peripheral blood was extracted from 43 patients and their families. TSC gene was detected by second-generation sequencing. Long-term video EEG monitoring and MRI examination were performed to determine the onset area, seizure type and location of nodules.

39 patients had TSC gene mutation, 4 patients did not detect the gene mutation.11 had TSC1 mutations and 28 had TSC2 mutations. 22 mutations were de novo. Patients with TSC2 mutations had earlier seizure and more nodules than patients with TSC1 mutations, but no significant difference in intelligence and spasm were observed. 28 patients had focal origin of scalp EEG, of which 85.7% of TSC2 mutations patients had focal origin.

Patients of TSC2 mutations always has an early onset age. Although MRI shows multiple nodules, the onset of EEG is mainly focal origin.

To observe the effect of autophagy of tibial growth plate chondrocyte on apoptosis in chronic renal insufficiency (CRI) rats.

Male 4-week-old SD rats were randomly divided into two groups: (1) Sham group: only the left ureter was exposed (n=10); (2) CRI group: the left ureter was ligated to cause CRI (n=10). The urine from all the rats was collected 6 weeks after the operation and the total protein content was measured. Then all the rats were sacrificed and the concentrations of creatinine and urea nitrogen in intracardiac blood were detected. The proximal tibia were fixed and decalcified to prepare histological sections, and the number of chondrocytes of column cells in the proliferative area of tibia growth plate was observed by saffron O staining. The expression rate of protein Light Chain-3, an autophagy marker of chondrocytes, was detected by immunofluorescence. The apoptosis rate of chondrocytes was detected by the method of TUNEL assay. The level of glycogenin-1, a glycogen formation marker of chondrocyte was detected by immunohistochemistry in chondrocytes.

The 24 h urine total protein was higher in CRI group [(163.5±11.3) mg vs (38.6±9.8) mg, t=25.620, P<0.001]. The levels of blood creatinine [(67.3±16.2) μmol/L vs (28.4±11.5) μmol/L, t=5.974, P<0.001] and urea nitrogen [(16.4±6.4) mmol/L vs (4.8±2.0) mmol/L, t=5.198, P<0.001] were higher in CRI group. The number of chondrocytes of column cells in the proliferating area of tibia growth plate was lower in CRI group (4.2±2.1 vs 9.1±3.8, t=3.109, P=0.006). The expression rate of LC-3 protein in chondrocytes of CRI group was lower [(27.2±12.6)% vs (51.4±18.2)%, t=3.457, P=0.003]. The level of glycogenin-1 of chondrocytes in CRI group increased significantly (6.1±2.5 vs 3.5±1.8, t=2.669, P=0.016). The apoptosis rate of chondrocytes in CRI group also increased [(17.2±4.8)% vs (5.1±3.4)%, t=6.505, P<0.001].

Malfunction of autophagy in tibial growth plate chondrocytes causes increased apoptosis rate in CRI rats, which might be caused by the failure of glycogen degradation in chondrocytes.

Takayasu arteritis is a full-thickness arteritis, mainly involving the aorta, aortic arch and its branches. It often occurs in young women. Some patients have an occult onset, and symptoms do not appear until the blood vessels are narrowed and occluded. At this time, the damage is often irreversible. Skin involvement in patients with Takayasu arteritis is uncommon. This paper reports a case of a young female patient with limb ulceration onset. Pathological diagnosis of pyoderma gangrenosum was performed by skin biopsy. During the follow-up, she developed dizziness and left upper limb weakness. The examination revealed multiple large artery occlusion and stenosis in the whole body. At the same time, echocardiography revealed aortic valve thickening, moderate aortic insufficiency, and mild-moderate mitral insufficiency. It is hoped that this case will deepen clinicians' understanding of Takayasu arteritis complicated by pyoderma gangrenosum and Takayasu arteritis cardiac involvement.

This paper reports the case of a rare patient with multi-system involvement caused by cryoglobulin vasculitis secondary to hepatitis B virus (HBV) infection and indolent lymphoma. The clinical manifestations were acute kidney injury, cardiac insufficiency and anemia. After active treatment with rituximab combined with cyclophosphamide and prednisone in the early stage, the damage to important organs was reversed, the symptoms gradually improved, and the cryoglobulin level decreased. The patient had headache and MRI abnormalities during treatment, but no obvious abnormalities were found through perfect cerebrospinal fluid examination and imaging, which suggested that we should be alert to this rare complication of reversible posterior encephalopathy syndrome and make a correct differential diagnosis.

This article reports the case of a 68-year-old female who was admitted to hospital with intermittent epigastric pain for half a year as the main complaint. Previous: Symphyseal adnexectomy due to uterine cyst 20 years ago. Physical examination: Mild tenderness in the upper abdomen, but no abnormalities were found. Whole abdominal CT showed that multiple round and irregular watery low-density shadows were seen in the spleen area, larger lesions were separated, and some lesions were calcified at the edges and separations. No clear abnormal enhancement was observed after enhancement. Surgical resection, later by pathological diagnosis of papillary cystadenocarcinoma of the spleen.

This paper reports the clinical data of a case of primary solitary granulocytic sarcoma (GS) in the cranium. This patient suffered from headache of unknown cause. MRI of the skull showed a circular abnormal signal shadow in the left occipital lobe, which showed slightly low and slightly high signal shadow at T1WI, and equal and high signal shadow at T2WI and FLAIR. The enhanced scan showed significant enhancement of the parenchyma and wall of the tumor. Routine blood examination showed an unknown increase in white blood cell count, bone marrow puncture biopsy did not support acute and chronic leukemia, and the final pathological diagnosis after craniotomy was granulocytic sarcoma.

This paper describes the research progress of anti-citrullinated alpha enolase polypeptide 1 antibody in the pathogenesis, diagnostic value and disease activity of rheumatoid arthritis at home and abroad, aiming to provide some theoretical basis for anti-citrullinated alpha enolase polypeptide 1 antibody in early diagnosis, guiding treatment and reducing complications of rheumatoid arthritis.