Objective: To explore the change of fractional exhaled nitric oxide (FeNO) and its correlation with forced expiratory volume in the ifrst second (FEV1), the ifrst second forced expiratory volume percentage of forced vital capacity (FEV1/FVC) in bronchial asthma and chronic obstructive pulmonary disease (COPD). Methods: FeNO, FEV1 and FEV1/FVC were measured in 57 suspected asthmatics (21 acute onsets, 12 non-acute and 24 non-asthma), 38 COPD patients (25 acute exacerbations and 13 stable stages) and 26 healthy subjects. Results: In the 57 suspected asthmatic patients, when the optimal cut off value of FeNO was 20.15 PPb, which was used to diagnose asthma and differentiate asthma and non-asthma, the positive predictive value, the negative predictive value, the sensitivity and the speciifcity was 94.1%, 95.7%, 97.0%, and 91.7% respectively. hTere was signiifcant difference in the FeNO level between the 33 asthmatics and 26 healthy subjects (P<0.05). There was also significant difference in the FeNO level between the acute onset and the non-acute (P<0.05), but not in the FEV1 and FEV1/FVC level (bothP>0.05). hTere was no signiifcant correlation between FeNO and FEV1, FEV1/FVC in patients with asthma (r=-0.186,-0.236, bothP>0.05). hTere was signiifcant difference in the levels of FeNO, FEV1 and FEV1/FVC between the 38 COPD patients and the 26 healthy subjects (all P<0.05), and also between the 25 acute exacerbations and 13 stable COPDs (allP<0.05), but not between the 13 stable COPDs and 26 healthy subjects (allP>0.05). FeNO was not correlated with FEV1 and FEV1/FVC level in COPD patients (r=-0.167,-0.285, bothP>0.05). Conclusion: FeNO level is increased obviously in patients with asthma. hTe optimal cut off value of FeNO at 20.15 PPb can differentiate asthma and non-asthma with high sensitivity and speciifcity. FeNO is higher for the acute onset than non-acute, which may be useful to evaluate the control degree. FeNO level is increased in COPD patients in the acute exacerbations, but there is no change in stable COPD patients compared with the healthy subjects.

Objective To investigate brachial artery endothelial function and carotid intima-media thickness (IMT) in patients with H-type hypertension.Methods One hundred and twenty patients with newly-diagnosed mild to moderate hypertension were enrolled in the study,including 58 cases with normal homocysteine (HCY) level (＜ 10 μmnol/L,non H-type group) and 62 cases with high HCY (≥10 μ moL/L,H-type group).Systolic pressure,diastolic pressure,blood lipid (TC,TG,LDL-C,HDL-C),fasting plasma glucose and two hours postprandial plasma glucose were measured in all patients.Brachial artery endothelial function and carotid IMT were determined with ultrasonography and compare between two groups.The factors related to brachial artery endothelium-dependent dilation (EDD) and carotid IMT were analyzed with multiple linear stepwise regression.Results Compared with non H-type group,the brachial artery EDD was reduced [(6.85 ± 0.77) ％ vs.(5.98 ± 0.85) ％,t =2.552,P =0.041] and carotid IMT was increased [(0.90±0.13)mm vs.(1.01 ±0.17)mm,t =2.426,P=0.048] in H-type group.The multiple linear stepwise regression analysis showed that EDD was negatively correlated to systolic pressure,diastolic pressure,fasting plasma glucose,two hours postprandial plasma glucose and HCY (r =-0.685,-0.654,-0.571,-0.627,-0.529,respectively,all P ＜ 0.05).IMT was positively related to systolic pressure,diastolic pressure,TC,TG,LDL-C and HCY (r =0.596,0.584,0.652,0.665,0.673,0.541,respectively,all P ＜ 0.05).Conclusion Patients with H-type hypertension are at a higher risk to arteriosclerosis than those with non H-type hypertension,which may be related to high HCY levels.

To improve the diagnosis and treatment of pulmonary alveolar proteinosis, clinical data for the first successfully treated case of pulmonary alveolar proteinosis with severe hypoxemia by large-capacity whole lung lavage in our hospital were analyzed, and relevant literatures were reviewed. A 35-year-old Han male initially presented two years ago with increasing cough and dyspnea was admitted to our hospital. Admission examination revealed severe hypoxemia, interstitial lung disease, and heavy protein deposition in the alveoli by lung biopsy. The patient received large-capacity whole-lung lavage in the operation room under general anesthesia and treatment of granulocyte-macrophage colony stimulating factor (GM-CSF). The patient's symptoms of dyspnea were alleviated markedly, and radiological findings improved and A-aDO2 decreased.
Adult ; Anesthesia, General ; Biopsy ; Bronchoalveolar Lavage ; Granulocyte-Macrophage Colony-Stimulating Factor ; Hospitalization ; Humans ; Lung ; Male ; Pulmonary Alveolar Proteinosis ; Pulmonary Alveoli

Objective To evaluate the clinical benefits of denosumab in treatment of sacral giant cell tumor of bone(GCTB) when used preoperatively or postoperatively along with surgery, and to analysis the improvement of sacral nerve function. Methods Thirty patients diagnosed as sacral GCTB in Musculoskeletal Tumor Center of Peking University People's Hospital from April 2014 to July 2016 were divided into control group (10 cases), post-operative group (9 cases), and neoadjuvant group (11 cases). Patients in the post-operative and neoadjuvant group were treated with 120 mg of subcutaneous denosumab every 4 weeks with loading doses on days 8 and 15 of the first cycle. Results Three patients in the control cohort 1 had recurrence (3/10), no recurrence occurred in the post-operative group (0/9), and 3 patients in the neoadjuvant group had recurrence(3/11).There were no significant differences in event-free survival(EFS) among the three groups (P = 0.133). The objective response rate (OTR) was 63.6 % (7/11) in the neoadjuvant group based on the RECIST 1.1 criteria for evaluating the efficacy of solid tumors. Five cases had significant pain improvement (defined 2 points improved) and had much better bladder and bowel functions. Four patients were able to have their indwelling catheters removed after neoadjuvant denosumab treatment. Conclusions Neoadjuvant therapy with denosumab can relieve the symptoms and neurologic deficits caused by nerve compression and can diminish the intraoperative blood loss. Surgical removal of the tumor is still the basic treatment of sacral GCTB.

Objective To evaluate the safety and efficacy of denosumab in treatment of patients with pelvic giant cell tumor of bone (GCTB) during perioperative period. Methods This is a retrospective observational study. Twenty-three patients diagnosed with pelvic GCTB undergoing perioperative denosumab treatment in Musculoskeletal Tumor Center of Peking University People's Hospital from January 2014 to December 2016 were reviewed. The subjective adverse reactions and mandibular X-ray films were used to assess the drug safety. As for efficacy, imaging findings (including X-ray, CT, magnetic resonance imaging) were reviewed. MSTS-93 scoring system was applied in the postoperative functional assessment. Histological response rate, objective response rate, clinical benefit rate and event-free survival rate were all used to deficit the efficacy of denosumab in the treatment of pelvic GCTB combined with surgery. All the results of postoperative were compared statistically with pelvic GCTB patients who underwent surgery in the same hospital from 1999 to 2009. Results All the patients were firstly diagnosed as classic GCTB except for one case which was malignant pelvic GCTB. All patients received denosumab preoperatively and/or postoperatively, and the average number of medications was 8.43. According to the surgical patterns, patients were divided into intralesional surgery group (13 cases) and wide resection group (10 cases). The follow-up was 5-47 months(mean:27.30 months),recurrence was observed in 2 cases in the intralesional surgery group, none in the wide resection group. After drug administration, 13 cases were partial response, 7 cases were stable disease, the objective response rate was 65.0 % (13/20), and the histologically clearance rate of giant cells was 85.0 % (17/20). No case of osteonecrosis of the jaw was observed in this study, and all laboratory indicators were normal. The average postoperative MSTS-93 score was 26.87. Compared with pelvic GCTB patients who underwent surgical treatment from 1999 to 2009, in the intralesional surgery group, there was no significant difference in the recurrence rate [15.4 % (2/13) vs. 30.8 % (4/13), P = 0.514], but the limb function was significantly increased (P= 0.002). Conclusions Denosumab combined with surgery plays an important role in the multidisciplinary treatment of pelvic GCTB. The neoadjuvant strategy can reduce patient's intraoperative blood loss by shrinking the tumor size which makes the intralesional curettage surgery possible, and also diminishing the recurrence rate. But more attention should be paid to secondary malignant GCTB during the use of denousmab.

Objective The prevalence of obesity is constantly increasing. Multiple metabolic complications are related to obesity, including type 2 diabetes mellitus and non-alcholic fatty liver disease(NAFLD). Our study aimed to investigate the prevalence of obesity comorbidities and its association with BMI. Methods 765 individuals who visited the multidisciplinary clinic for obesity in Peking University First Hospital from 2015, Jun. to 2018, Sept. were enrolled in this study. The height, body weight, waist circumference, hip circumference were measured during the first visit. Body adipose percentage and basal metabolic rate were recorded. Questionnaires for daily food intake, comorbidity, and lifestyle were recorded. Fasting insulin, C peptide, glucose, HbA1C , uric acid, liver enzymes and lipid profile were measured. Statistical analysis was performed using SPSS 16. 0, and P<0. 05 was considered as statistical significant. Results Daily energy intake was higher in obesity group [ obese vs non-obese, (2136.6±739.4vs1905.7±468.4)kcal/d,P=0.046].Hypertension,NAFLDandgoutriskincreasedsignificantly in obesity group (obese vs non-obese, 36.0％vs 24.5％, P=0.02;76.5％ vs 60.6％, P<0.01;6.9％ vs 1.8％, P=0.04, respectively) . Family history of obesity and diabetes increased in obesity group ( obese vs non-obese, 64.5％vs 53.6％, P=0.03;47.4％vs 37.3％, P=0.048). Fasting insulin and C-peptide levels were higher in obesity group [obese vs non-obese, (24.8 ± 15.3 vs 13.6 ± 9.5)μIU/ml, P<0.01;(3.72 ± 1.40 vs 2.70 ± 1.16)μIU/ml, P<0.01). Liver enzymes increased significantly in obesity group [obese vs non-obese, (47.2±45.4 vs 23.3±21.4)U/L, P<0.01; ( 30. 4 ± 24. 0 vs 19. 9 ± 8. 5 ) U/L, P=0. 001 ] . Conclusions Obesity population had higher risk of hypertension, NAFLD and gout. Fasting insulin, C-peptide, liver enzymes, and UA also increased significantly in these patients. It is critically important to those obese individuals for regular screening of NAFLD and diabetes mellitus.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) in elderly and patients with chronic respiratory diseases (COPD) had a poor prognosis. COPD is one of the most common chronic respiratory diseases. We explore the epidemiological characteristics of patients with severe COVID-19 with COPD patients in order to provide medical evidence for the prevention and treatment of severe COVID-19. METHODS: We retrospectively analyzed the clinical baseline characteristics, treatment strategies, disease progression and prognosis of 557 severe COVID-19 patients admitted to the West Court of Union Hospital of Huazhong University of Science and Technology from January 29, 2020 to April 8, 2020. RESULTS: A total of 465 patients with severe COVID-19 were enrolled in the study, including 248 (53.3%) males and 217 (46.7%) females. The median age of severe COVID-19 patients was 62.0 years, and 53 patients were complicated with COPD. Common symptoms at the onset included fever (78.5%), dry cough (67.1%), shortness of breath (47.3%) and fatigue (40.9%). Compared with non-COPD patients, patients with COPD had significantly lower levels of SpO2 in admission (90.0% vs 92.0%, P=0.014). In terms of laboratory examinations, patients with COPD had higher levels of C-reactive protein, interleukin-6, procalcitonin, total bilirubin, blood urea nitrogen, serum creatinine, lipoprotein (a), high-sensitivity troponin I, and D-dimer, while had lower levels of platelet counts, albumin and apolipoprotein AI. Severe COVID-19 patients with COPD had higher Sequential Organ Failure Assessment scores [3.0(2.0, 3.0) vs 2.0(2.0, 3.0), P=0.038] and CURB-65 score [1.0(1.0, 2.0) vs1.0(0.0, 1.0), P<0.001], and a higher proportion of progressing to critical illness (28.3% vs 10.0%, P<0.001) with more complications [e.g. septic shock (15.1% vs 6.1%, P=0.034)], had higher incidence rates of antibiotic therapies (90.6% vs 77.2%, P=0.025), non-invasive (11.3% vs 1.7%, P<0.001) and invasive mechanical ventilation (17.0% vs 8.3%, P=0.039), ICU admission (17.0% vs 7.5%, P=0.021) and death (15.1% vs 6.1%, P=0.016). Cox proportion hazard model was carried out, and the results showed that comorbid COPD was an independent risk factor for severe COVID-19 patients progressing to critical type, after adjusting for age and gender [adjusted hazard ratio (AHR)=2.38(1.30-4.37), P=0.005] and additionally adjusting for chronic kidney diseases, hypertension, coronary heart disease [AHR=2.63(1.45-4.77), P<0.001], or additionally adjusting for some statistically significant laboratory findings [AHR=2.10(1.13-3.89), P=0.018]. CONCLUSIONS Severe COVID-19 patients with COPD have higher levels of disease severity, proportion of progression to critical illness and mortality rate. Individualized treatment strategies should be adopted to improve the prognosis of severe COVID-19 patients.
Male ; Female ; Humans ; Aged ; Middle Aged ; COVID-19/complications* ; SARS-CoV-2 ; Retrospective Studies ; Critical Illness ; Pulmonary Disease, Chronic Obstructive/epidemiology*

Humans ; Noninvasive Ventilation ; Cannula ; Airway Extubation ; Retrospective Studies ; Pulmonary Disease, Chronic Obstructive/therapy* ; Hypercapnia/therapy* ; Oxygen Inhalation Therapy ; Respiratory Insufficiency/therapy*