Objective To observe the pathological change of visceral pleura in patients with chronic obstructive pulmonary disease (COPD), and to discuss the relationship between the changes and COPD airflow limitation. Methods A total of 70 patients received the pulmonary lobectomy or partial resection because of lung tumor in Tianjin Chest Hospital from May 2014 to August 2015 were selected in this study. According to the results of pulmonary function test, the patients were divided into COPD group [forced expiratory volume in one second (FEV1)/ forced vital capacity (FVC) <70%,n=40] and control group (FEV1/FVC≥70%,n=30). The lung tissues, which was not the lesion areas, were used to make tissue sections. The Elastica Van Gieson (EVG) method was used to stain the sections. The thickness of visceral pleural and the proportion of elastic fibers in visceral pleural were observed and calculated under a microscope in the two groups. Results The specimens were derived from upper and middle lobes in 22 cases of COPD group, and from lower lobe in 18 cases. Specimens were derived from upper and middle lobes in 17 cases of control group, and from lower lobe in 13 cases. There were no statistical differences in sampling sites between two groups (χ2=0.019,P>0.05). The visceral pleural thickness and the proportion of elastic fibers in visceral pleural were significantly thinner in COPD group than those of control group ( P<0.01). In both COPD group and control group, visceral pleural thickness was significantly thinner in upper and middle lobes than that of lower lobe (P<0.05), but the proportion of elastic fibers in visceral pleural of upper, middle lobes showed no statistical difference compared with that of the lower lobe (P>0.05). Conclusion The thinner visceral pleural and the reduction of elastic fibers in visceral pleural are one of the causes of expiratory airflow limitation in COPD patients.

AIM To study the pharmacodynamics of Baijin Granules [Mallotus apelta (lour.) Muell.Arg.,Smilax china L.],Zhuang medicine,on model rats with sequelae of pelvic inflammatory disease.METHODS The rat model for sequelae of pelvic inflammatory disease was built with mixed bacteria (Escherichia coli and Staphylococcus aureus) and mechanical injury.Subsequently,the rats were randomly divided into eight groups,including model,Baijin Granules low-,middle-,high-dose,positive control (dexamethasone and Huahong Granules),blank control and sham operation groups,with ten rats in each group.After 14 days of successive administration,the hemorheology and blood routine in rats' abdominal aorta were measured by collecting blood in 24 hours of last administration.The pathological morphology of uterine tissue was observed.RESULTS The hemorheology indexes,WBC count and neutrophil percentage were significantly decreased in the model rats,and the pathological morphology of uterine tissue was markedly improved.CONCLUSION Baijin Granules have good therapeutic effects on sequelae of pelvic inflammatory disease in rats.

Objective To explore the distributions and clinical characteristics of pathogenic bacteria in SAP patients with secondary infection.Methods We collected clinical data from SAP patients with secondary infection,to analyze the source of samples,pathogenic bacteria and its resistance to commonly used antimicrobial agents.Results (1) Samples Source:A total of 156 positive specimens were obtained,with the largest number from sputum samples (46.79％);The blood samples (70.59％) were collected most within 1 week,sputum samples (64.38％) from 1 week to 2 weeks,and pancreatic necrotic tissues or peripancreatic fluid samples (51.79％) after 3 weeks,with statistically significant differnces.(2) Pathogenic bacteria:156 strains were isolated including 86 strains (55.13％) of gram-negative bacteria (55.13％),of which acinetobacter baumannii and escherichia coli were the most commonly seen,followed by gram-positive bacteria of 41 strains (26.28％),and then fungus of 27 strains (18.59％).(3) Drug resistance:There was a high tolerance rate of commonly used antimicrobial agents,and the drug resistance rate of cinetobacter baumannii to carbapenems antibiotics was 88.00％.Conclusions SAP combined with secondary infection is mainly caused by gram-negative bacteria,and there is a high proportion of multidrug-resistant bacteria.Selecting suitable antimicrobial agents according to bacterial culture is beneficial for the early control of infections.

Objective To analyze the unqualified air reasons of laminar flow clean operation room when monitored,to strengthen the prevention and make sure static air of the laminar flow clean operating room air 100％ qualified.Methods Each two of the 100 and 1 000 class laminar flow operation room had unqualified air before November 2013,and our department tried to find the reasons and countermeasures.From December 2013 to February 2014,we monitored air four times after carrying out countermeasures,and compared the qualified rate of operation room air with the air qualified rate before countermeasures used.Results The infection rate of Ⅰ type operative incision were always below 0.2％ in our hospital.After comprehensive improvement of operation room,the air qualified rate was beyond the rate of before improvement 85.7％ with statistical significance (P ＜ 0.05).Conclusions It can increase air qualified rate of laminar flow clean operation room by the operational management,cleaning management,aseptic management for maintaining operation room clean system and the training of air sampling personnel.

Objective To explore the application effects of plan-do-check-action ( PDCA) circle in home care for cerebral stroke patients. Methods We divided the stroke patients of Neurology Department into experimental group and control group with 80 cases in each group randomly. Patients in experimental group were cared by PDCA circle home care, while those in control group received conventional outpatient care which included telephone follow-up and outpatient care. Patients in two groups were compared from daily life ability, compliance, pressure ulcers incidence, and rehospitalization rates in 6 and 12 months after discharged. Results 12 months after discharged, daily life ability score in experimental group was higher than that of control group[(46. 60 ± 10. 98) vs(42. 88 ± 9. 80)] (t = 2. 26,P < 0. 05). Patient′s compliance in experimental group was better than that of control group(P<0. 05). Pressure ulcers incidence in experimental group was obvious lower than that of control group (3. 75% vs 16. 25%) (χ2 =6. 94,P<0. 05). Rates of readmission in experimental group was lower than that of control group (5. 00% vs 16. 25%) (χ2 =5. 33,P<0. 05). Conclusions PDCA circle home care is considered to be an advanced service model with continuing care which can improve the patient′s quality of life, improve patient′s compliance, reduce the incidence of pressure ulcers and readmission rates, reduce the family financial burden and save medical resources.

Dyslipidemia is an important risk factor of atherosclerotic cardiovascular disease (ASCVD). Statins delay the occurrence and development of ASCVD, and reduce the risk of cardiovascular events and death. Due to safety concerns, there exist insufficient use of lipid-lowering agents and a high withdrawal rate of the agents in the elderly. To promote the prevention and treatment of ASCVD, this expert consensus is issued and focuses on the management of dyslipidemia of Chinese elderly basing on the clinical evidence of the use of lipid-lowering drugs by the elderly, and the lipid management guidelines and expert consensus recommendations at home and abroad.

Polyphyllin Ⅰ(PPⅠ)and polyphyllin Ⅱ(PⅡ)are the main active substances in the Paris polyphylla.However,liver toxicity of these compounds has impeded their clinical application and the potential hepatotoxicity mechanisms remain to be elucidated.In this work,we found that PPⅠ and PⅡ exposure could induce significant hepatotoxicity in human liver cell line L-02 and zebrafish in a dose-dependent manner.The results of the proteomic analysis in L-02 cells and transcriptome in zebrafish indicated that the hepa-totoxicity of PPⅡ and PⅡwas associated with the cholesterol biosynthetic pathway disorders,which were alleviated by the cholesterol biosynthesis inhibitor lovastatin.Additionally,3-hydroxy-3-methy-lglutaryl CoA reductase(HMGCR)and squalene epoxidase(SQLE),the two rate-limiting enzymes in the choles-terol synthesis,selected as the potential targets,were confirmed by the molecular docking,the over-expression,and knockdown of HMGCR or SQLE with siRNA.Finally,the pull-down and surface plasmon resonance technology revealed that PPⅠ could directly bind with SQLE but not with HMGCR.Collectively,these data demonstrated that PPⅠ-induced hepatotoxicity resulted from the direct binding with SQLE protein and impaired the sterol-regulatory element binding protein 2/HMGCR/SQLE/lanosterol synthase pathways,thus disturbing the cholesterol biosynthesis pathway.The findings of this research can contribute to a better understanding of the key role of SQLE as a potential target in drug-induced hepatotoxicity and provide a therapeutic strategy for the prevention of drug toxic effects with similar structures in the future.

Objective:To evaluate the efficacy and safety of nimotuzumab in the treatment of advanced head and neck tumors by using meta-analysis.Methods:Randomized controlled trials (RCT) of locally advanced head and neck squamous cell carcinoma (LA-HNSCC) treated with nimotuzumab were searched from databases (Cochrane Library, PubMed, Embase, Wanfang Data and CNKI) for meta-analysis. The efficacy evaluation indexes included overall survival, progression-free survival, disease-free survival, objective response rate, and complete response rate. Adverse reactions were analyzed for safety evaluation. The heterogeneity results were evaluated by Chi-square test, the degree of heterogeneity was evaluated by I2, and the literature was statistically analyzed by random effects model. Results:A total of 11 RCT were included, consisting of 1 202 patients (602 in the intervention group and 600 in the control group). Compared with the control group, the overall survival was significantly prolonged, death risk was decreased by 22% ( HR=0.78, 95% CI=0.63-0.95, P=0.014), the progression-free survival was prolonged and the risk of disease progression was declined by 35% ( HR=0.65, 95% CI=0.53-0.81, P<0.01), and the disease-free survival was prolonged and the risk of recurrence was decreased by 29% ( HR=0.71, 95% CI=0.55-0.91, P<0.01), the objective response rate ( RR=1.37, 95% CI=1.20-1.55, P<0.01) and complete response rate ( RR=1.30, 95% CI=1.15-1.46, P<0.01) were significantly improved in the intervention group. In addition, adding nimotuzumab did not increase the incidence of adverse reaction ( RR=0.98, 95% CI=0.93-1.03, P=0.41). Conclusion:Nimotuzumab can significantly prolong long-term survival and improve short-term efficacy with high safety in LA-HNSCC patients.

Objective:To analysis the clinical features and prognosis in oropharyngeal carcinoma with secondary primary tumor. Methods:A retrospective analysis was performed on 468 pathologically confirmed oropharyngeal cancer as the primary tumor patients with p16 status, excluded distant metastasis, and admitted to the Chinese Academy of Medical Sciences from January 2010 to December 2020. The clinical features and prognosis of the secondary primary tumor were analyzed. Results:Among 468 patients with oropharyngeal cancer treated at initial diagnosed, 222 cases were P16-negative. With a median follow-up time of 64.3 months, 66 cases developed second primary cancer, with an incidence of 29.3%, among which 63.6%（42/66） were synchronous and 36.4%（24/66） were heterochronous, esophagus was the most commonly involved site. The 5-year OS of p16-negative oropharyngeal carcinoma with synchronous second primary cancer, without second primary cancer and with heterogeneous second primary cancer were 26.3% and 57.3% and 73.2%（P=0.001）; The second primary cancer accounted for 11.2%（12/107） of the deaths in the whole group, among them, the heterochronous second primary accounted for 75.0%（9/12）. There were 246 patients with p16 positive, with a median follow-up time of 52.4 months, 20 patients developed second primary cancer（8.1%）. Among them, 65.0%（13/20） were synchronous and 35.0%（7/20） were heterochronous. Esophagus was the most commonly involved site. The 4-year OS of p16-positive with synchronous, heterochronous and non-second primary cancer group were 51.9%, 80.7% and 83.3%. Secondary primary cancer accounted for 3.8%（2/52） of all deaths in p16 positvie group. Conclusion:The incidence of second primary cancer of p16 positive and negative oropharyngeal carcinoma were different. The esophagus was the most commonly involved site regardless of p16 status. Regardless of p16 status, the survival of patients with synchronous second primary cancer was worse than those without second primary cancer. For p16-negative oropharyngeal carcinoma, the prognosis was better in patients with heterogeneous second primary cancer, the second primary cancer is one of the main causes of death.
Humans ; Carcinoma/diagnosis* ; Oropharyngeal Neoplasms/diagnosis* ; Retrospective Studies ; Neoplasms, Second Primary/diagnosis*