Objective To investigate awareness of definition, diagnostic criteria, severity classification and standard diagnosis and treatment for chronic obstructive pulmonary disease (COPD) among primary-care physicians at the grassroots in urban and suburban Shanghai.Methods In total, 298 physicians were surveyed by unified questionnaire for COPD-related knowledge in two secondary-care general hospitals (one in urban and suburban areas each ) and 12 community primary-care centers (four in urban and eight in suburban areas) in Shanghai.One hundred and fifteen physicians in two urban hospitals and one suburban hospital were trained professionally and then evaluated for its effectiveness.Results Awareness of diagnostic criteria of COPD was only 22.4% (35/156), 25.6% ( 10/39), 4.3 % (3/69)and 26.5% (9/34) among physicians in urban primary-care hospitals, urban secondary-care hospitals,suburban primary-care hospitals and suburban secondary-care hospitals, respectively.Their awareness of knowledge about use of anti-cholinergic agents was 13.5 % (21/156), 35.9 % ( 14/39), naught (0/69),and 14.7 % ( 5/34 ), respectively.Only 0.67 % of them ( 2/298 ) knew about severity classification of COPD.Awareness of definition and diagnostic criteria for COPD in the physicians increased to 72.2 % ( 83/115) after training from 18.2% (21/115) before it, and their awareness of severity classification for COPD increased to 45.2% (52/115) after training from 0.8 % (1/115) before it.Conclusions Awareness of COPD-related knowledge, especially of standard diagnosis and treatment for COPD, was poor in primary-care physicians at the grassroots in Shanghai, so it is necessary to strengthen training for them in COPD-related knowledge, including pulmonary function tests.

Background::Heterogeneity of tumor cells and the tumor microenvironment (TME) is significantly associated with clinical outcomes and treatment responses in patients with urothelial carcinoma (UC). Comprehensive profiling of the cellular diversity and interactions between malignant cells and TME may clarify the mechanisms underlying UC progression and guide the development of novel therapies. This study aimed to extend our understanding of intra-tumoral heterogeneity and the immunosuppressive TME in UC and provide basic support for the development of novel UC therapies.Methods::Seven patients with UC were included who underwent curative surgery at our hospital between July 2020 and October 2020. We performed single-cell RNA sequencing (scRNA-seq) analysis in seven tumors with six matched adjacent normal tissues and integrated the results with two public scRNA-seq datasets. The functional properties and intercellular interactions between single cells were characterized, and the results were validated using multiplex immunofluorescence staining, flow cytometry, and bulk transcriptomic datasets. All statistical analyses were performed using the R package with two-sided tests. Wilcoxon-rank test, log-rank test, one-way analysis of variance test, and Pearson correlation analysis were used properly.Results::Unsupervised t-distributed stochastic neighbor embedding clustering analysis identified ten main cellular subclusters in urothelial tissues. Of them, seven urothelial subtypes were noted, and malignant urothelial cells were characterized with enhanced cellular proliferation and reduced immunogenicity. CD8 + T cell subclusters exhibited enhanced cellular cytotoxicity activities along with increased exhaustion signature in UC tissues, and the recruitment of CD4 + T regulatory cells was also increased in tumor tissues. Regarding myeloid cells, coordinated reprogramming of infiltrated neutrophils, M2-type polarized macrophages, and LAMP3 + dendritic cells contribute to immunosuppressive TME in UC tissues. Tumor tissues demonstrated enhanced angiogenesis mediated by KDR + endothelial cells and RGS5 +/ACTA2 + pericytes. Through deconvolution analysis, we identified multiple cellular subtypes may influence the programmed death-ligand 1 (PD-L1) immunotherapy response in patients with UC. Conclusion::Our scRNA-seq analysis clarified intra-tumoral heterogeneity and delineated the pro-tumoral and immunosuppressive microenvironment in UC tissues, which may provide novel therapeutic targets.