Objective To evaluate the effect of health education combined with lung function test on smoking cessation in smoking sanitation workers. Methods Sixty-nine sanitation workers who smoke were divided into two groups by using the table of random number, routine group (n=35) and lung function test group (n=34). The routine group was given health education. According to the lung function, those in the lung function test group were divided into normal lung function group (19 cases) and abnomal lung function group (15 cases) who received both health education and lung function test. Success rate of smoking cessation and the relapse rate were compared at 2 and 6 months follow-up. Results At 2 and 6 months follow-up, the smoking cessation rates of routine group were [10(29%), 4(11%)], which were lower than those of the normal lung function group [7(37%), 3(16%)], the differences were not statistically significant (P>0.05). The smoking cessation rates of routine group were lower than those in abnormal lung function group[11 (73%), 10(67%)] (P<0.05). The smoking cessation rates of the normal lung function group were significantly lower than those of abnormal lung function group (P<0.05). The relapse rate of routine group[6(17%) and the normal lung function group[4(21%)]at 6 months follow-up were not significantly different. The relapse rate of the normal lung function group and that of abnormal lung function group were not significantly different. Conclusion Health education combined with lung function test could help smokers with abnormal lung function to give up smoking successfully.

Objective To clarify whether the NADPH oxidases (NOXs) family contributed to the reactive oxygen species (ROS) production and subsequent interstitial fibrosis in unilateral ureter obstruction (UUO) rats.Methods Male Wistar rats were randomly divided into sham operation group (n =8),sham operation + apocynin treatment group (n =8),UUO operation group (n =8) and UUO operation+apocynin treatment group (n =8).Either vehicle or apocynin (100 mg/kg per day) were given by gavage for 7 days after surgery.Rats were sacrificed at 7th day.ELISA was used to detect the activity of superoxide dismutase (SOD) and catalase (CAT),and the level of 8-iso-prostaglandin F2alpha (8-isoPGF2α) in renal tissue.Western blotting was used to detect the protein expressions of NADPH oxidase subunit NOX2 and NOX4,α-smooth muscle actin(α-SMA),collagen Ⅰ (COL-Ⅰ) and the level of ERK1/ 2 phosphorylation (p-ERK1/2).Results UUO rats with vehicle displayed increased oxidative stress,as measured by renal tissue 8-iso-PGF2α,accompanied with increased renal expression of NADPH oxidases (NOX2,1.5-fold and NOX4,1.7-fold,respectively),compared with sham-operated rats (P ＜0.05).Furthermore,vehicle treated UUO rats showed increased renal COL-Ⅰ and α-SMA levels,compared with sham-operated rats (P ＜ 0.05).ERK1/2 was also activated as detected by p-ERK1/2 expression in UUO rats with vehicle (P ＜ 0.05).Apocynin treatment significantly decreased renal tissue 8-iso-PGF2α level and expressions of NOX2 (-28.7％) and NOX4 (-31.0％) in UUO rats,respectively,compared with vehicle treated rats (P ＜ 0.05).And significant decrease of COL-Ⅰ (-26.4％) and α-SMA expression (-80.0％) were also observed (P ＜ 0.05).The activation of ERK1/2 in UUO rats was greatly inhibited by apocynin treatment (P ＜ 0.01).Despite the pronounced dysregulation of pro-oxidative NOXs family,no compensatory increase of antioxidative enzyme activities occurred.Conclusion The NOXs family contributes largely to the production of ROS and subsequent interstitial fibrosis after ureter ligation,and inhibition of the NOXs family may be a choice for preventing interstitial fibrosis.

Objective To explore influence and variation of smoking and occupational exposure to air pollution on lung function.Methods Ninety eight sanitation staffs from Panyu District were divided into smoking and non-smoking sanitation groups; and all subject accepted the Chronic Obstructive Pulmonary Disease Assessment Test (CAT) scales,questionnaires,lung function test,and data statistical analysis.Healthy people accepted health examination from Guangzhou Panyu medical health center were used as the control group.Results (1) Forced expiratory volume in the first second (FEV1％),forced expiratory volume in the first second/ forced vital capacity(FEV1/FVC),maximal expiratory flow in 50％ vital capacity (FEF50％),maximal expiratory flow in 75％ vital capacity (FEF75％),maximal mid-expiratory flow (MMEF) of non-smoking sanitation group was significantly lower than non-smoking healthy group (P ＜ 0.01).(2) Abnormal rates of FEF50％,FEF75％,and MMEF of non-smoking sanitation group were significantly higher than non-smoking healthy group (P ＜ 0.01).(3) Abnormal rates of FEF50％,and FEF75％ of sanitation group were significantly higher than healthy group with or without smoking.(4) Abnormal rates of FEV1％ and FEV1/FVC did not have significant difference between non-smoking sanitation group and non-smoking healthy group,but had significant difference between non-smoking and smoking healthy groups.It means smoking and occupational exposure had different impacts on pulmonary function.(5)Moderate score of nonsmoking sanitation group and smoking healthy group were significantly higher than non-smoking healthy group by P =0.049 and P =0.001,respectively.Conclusions Occupational exposure to air pollution and smoking can lead to small airway damage,which was not as obvious as pulmonary function changes.It is necessary to regularly monitor lung function for sanitation staffs who risk occupational exposure to air pollution.Increasing physical exercise would benefit to improve sport lung endurance of the people in our country.

Objective To understand the cognitive level of chronic obstructive pulmonary disease (COPD) disease management and pulmonary rehabilitation among medical staff in the respiratory departments and community of public health institutions in Panyu of Guangzhou, in order to assess the status of prevention and treatment of COPD in this area. Methods From March to October 2017, a questionnaire survey was conducted among 339 medical staff in Panyu, including respiratory doctors, nurses and therapists of four tertiary hospitals, five secondary hospitals, and three first-level hospitals, GPs, nurses and therapists at 16 community health service centres, among them, there are 147 respiratory and general practitioners (hereinafter referred to as doctors), 171 respiratory and general nurses (hereinafter collectively referred to as nurses), and 22 rehabilitation therapists (hereinafter collectively referred to as therapists). Using Epidata software to create questionnaire database entry data. Results The awareness rate of COPD airflow limitation severity of nurses was only 19.9％, which was lower than that of doctors (39.7％) and therapists (22.7％). Doctors, nurses, and therapists are familiar with the low percentage of the GOLD guidelines, which are respectively only 12.3％, 7.6％, and 4.5％. Nurses were diagnosed with pulmonary function as a basis for COPD, and the awareness rate was only 60.2％ lower than that of doctors (82.9％) and therapists (81.8％). In alleviating COPD patients′shortness of breath, only 31.8％therapists chose short-acting beta-agonists, lower than doctors (61％) and nurses (45％). There is disagreement about the long-term use of inhaled corticosteroids in COPD. Medical staff have the highest awareness of lip-reducing and abdominal breathing, followed by Taiji and Ba Duan Jin exercises, and low awareness of modern rehabilitation programs such as elastic bands, upper and lower limb exercises. The effective pulmonary rehabilitation program should last at least 8 weeks, and the awareness rate of this therapy practice was 40.9％, higher than doctors (13.7％) and nurses (18.1％). Medical staff believe that the main factors affecting patient compliance are the cost of the drug and the patient′s lack of understanding of the benefits of the treatment. Additionally, 40.4％ of doctors, 51.5％ of nurses, and 54.5％of therapists believe that community health services cannot manage COPD. The reasons that affect community management of COPD, doctors believe that patient compliance and lack of man power, nurses believe that the main shortage of manpower and equipment, the therapist believes that the lack of medical awareness and poor patient compliance. Conclusion Doctors, nurses, and therapists have inconsistent understandings of COPD disease management and pulmonary rehabilitation, and each has its own focus. It is necessary to strengthen learning exchanges for each weak knowledge point. The awareness rate of modern rehabilitation exercise for pulmonary rehabilitation is not as high as that of traditional Chinese medicine. It is necessary to pay attention to the promotion of the benefits and significance of COPD pulmonary rehabilitation treatment and improve compliance.

Objective:This study aims to analyze of the quality of diagnosis and treatment data of community medical institutions on the national health information platform in a district of Beijing from the perspective of scientific research informatization, to provide experience and reference for promoting the informatization construction of primary medical units and tapping the scientific research potential of the regional data platform.Methods:Based on the data backup database of the national health information platform in the region, the data quality was analyzed and evaluated mainly in three dimensions: integrity, integration, and consistency.Results:Through the construction of the national health information platform, the district successfully achieved the effective collection of diagnosis and treatment data from community medical institutions, covering the main data such as patients′ basic information, visit information, test information, prescription information, etc. However, the data collected so far were still insufficient in terms of data integration and consistency.Conclusions:A regional medical data center is suggested to construct to break down the barriers between data systems, conduct pre-structuring of diagnosis and treatment data, improve data integration and consistency, and at the same time, carry out effective scientific research prospective design to promote the effective transformation of clinical data to scientific research data.

Objective:To explore the effectiveness and complications of non-incision removal of tunneled cuffed catheter (TCC).Methods:The clinical characteristics, surgical plans and complications of patients with TCC removal in the Renal Division of Peking University First Hospital from January 1, 2015 to December 31, 2020 were collected and analyzed retrospectively. The patients were divided into non-incision removal group and traditional incision removal group. The clinical characteristics, procedure success rate, procedural duration and complications were compared between the two groups.Results:A total of 349 patients were included in this study, for whom 368 catheter removal procedures were performed, including 286 procedures in the non-incision removal group, 75 procedures in the traditional incision removal group, and 7 procedures without records of surgical plans. There was no significant difference in age, sex, basic kidney diseases and catheter remaining time and location between the two groups (all P>0.05). Two procedures in the non-incision removal group and 1 procedure in the traditional incision removal group failed respectively, and there was no significant difference in the procedure success rate between the two groups (99.3% vs 98.7%, χ2=0.290, P=0.590). The procedural duration in the non-incision removal group was lower than that in the traditional incision removal group [(5.36±1.70) min vs (17.55±3.28) min, t=44.198, P<0.001]. Among the patients who needed TCC exchange, there was no significant difference in the selection of new catheter position between the two groups ( P=0.330). In terms of complications, there were 2 procedures of local hematoma in the non-incision removal group and 1 procedure of infection in the traditional incision removal group, and there was no severe complication in both groups. Conclusions:There was no significant difference in the procedural success rate and complications between non-incision removal group and traditional incision removal group, and non-incision procedure may be superior in reducing the procedure duration and harm less to the patients. Non-incision procedure is a safe and effective method to remove TCC.

Objective:To analyze the evolution path and diffusion mechanism of the unified drug management system of countywide medical communities in China, and provide references for the deepening implementation of the system.Methods:The policy documents of the central and provincial governments were retrieved with the keywords of " medical community" " drug management" " county-township-village integration" and " central pharmacy". By means of the policy diffusion theory, the evolution path of the diffusion of the unified drug management system for the countywide medical communities was identified from such dimensions as time, space and hierarchy. On the other hand, the action mechanism of the diffusion of the system was summarized from such aspects as competition, administrative instruction, learning and imitation.Results:A total of 36 effective policy documents were collected. The time diffusion of the drug unified management system of countywide medical communities was characterized by an " S" curve. By the end of 2022, there were 30 provinces implementing the countywide medical community drug unified management system, and the policy diffusion has entered a saturation and stagnation stage; spatial diffusion showed " proximity effect" ; hierarchy diffusion embodied the " leader follower" mode. In the process of policy diffusion, competition mechanism, administrative instruction mechanism, learning mechanism, and imitation mechanism coexisted, but there were difference in the dominant mechanism at different stages of policy diffusion.Conclusions:The unified drug management system of the countywide medical communities has been widely disseminated. It is recommended to promote the introduction of supporting policies, optimize the system evaluation system, and comprehensively use various diffusion mechanisms to promote the optimization of the system, so as to promote the deepening and sustainable operation of the system.

Objective To elucidate the clinical and pathological characteristics of the patients with thymoma-associated glomerulonephropathy.Methods In this retrospective study,the clinicopathologic characteristics of patients diagnosed as thymoma-associated glomerulonephropathy inPeking University First Hospital during the period between Oct 2008 and Jun 2017 were analyzed,including the histological classfication of thymoma,the clinicopathological features and the short-term prognosis.Results Altogether twelve patients were included with an average age of (55+ 16) years;male/female ratio was 3∶ 1.The B2 type thymoma was the most common type.Nine cases also suffered from myasthenia gravis,and eight cases of glomerulopathy accompanied by thymoma activity.The clinical presentation of glomerulopathy included nephrotic syndrome (11/12),acute kidney injury (10/12).Eleven patients received renal biopsy,among which five cases were minimal change nephropathy,three cases were membranous nephropathy,and the other three cases were focal segmental glomerulosclerosis,thrombotic microangiopathy and endocapillary proliferative glomerulonephritis,respectively.Eleven patients received immunosuppression therapy.After a median 12 months follow up,the proteinuria decreased in 7 cases,and renal function completely or partially recovered in 6 cases.Conclusions Minimal change disease is the most frequent pathological type of thymoma-associated glomerulonephropathy.Immunotherapy with glucocorticoid as first-line drug may be considered for thymoma-associated glomerulonephropathy with surgery,chemoradiation contraindications or non-remission of kidney disease after anti-tumor therapy.

Objective To investigate the clinical features and prognostic risk factors of pneumocystis pneumonia (PCP) in patients with glomerular disease. Methods The medical charts of all patients with confirmed PCP, diagnosed in Peking University First Hospital from August 2006 to February 2018 were retrospectively reviewed, and 36 cases with glomerular disease were enrolled. Clinical and imaging data were collected and analyzed. Thirty-six patients were divided into survival group and death group. The clinical data, baseline estimated glomerular filtration rate (eGFR), mechanical ventilation and APACHE II score were compared. Results A total of 27 males and 9 females were included, with age of (49.6 ± 17.5) years. All patients were receiving immunosuppressive therapy at the PCP onset, with a median duration of 2.5 months, and none of them was receiving PCP prophylaxis. The main clinical manifestations included fever (100.0% ), dyspnea (75.0% ) and dry cough (61.1% ). Hypoxemia occurred in 97.2% of patients and 17 cases presented as type 1 respiratory failure. Fifteen out of 30(50.0%) patients had CD4+ T cell counts below 200 cells/mm3. Ground glass opacity was the most common finding in CT imaging of 28 patients, followed with grid shadows, consolidation and nodules. Thirty-five patients received trimethoprim-sulfamethoxazole (TMP-SMX) as initial therapy, and 17.1% (6/35) of them developed acute kidney injury due to sulfonamide use. Ten patients died during hospitalization, with respiratory failure as the only direct cause of death. Elder age, delayed diagnosis of PCP, mechanical ventilation and high APACHEⅡscores were associated with poor survival. Conclusions PCP is a severe complication of immunosuppressive therapy in patients with glomerular disease. Early diagnosis and prompt treatment are critical to improve prognosis. Hydration prior to sulfonamide treatment and alkalization of urine are necessary to reduce the incidence of acute kidney injury.

As a new treatment option after conventional corticosteroids and immunomodulatory drugs, biologics have been widely used in the clinical management of non-infectious uveitis in many countries due to their approved efficacy and safety. Anti-tumor necrosis factor-alpha monoclonal antibody is the most commonly used one. However, the guidance on its standardized application is lacking. The Ocular Immunology Group of Immunology and Rheumatology Academy in Cross-Straits Medicine Exchange Association compiled the Chinese expert consensus on treatment of non-infectious uveitis with anti-tumor necrosis factor-alpha monoclonal antibody. This evidence-based consensus is made according to the principle of consensus building and combines the clinical experience of the experts. Twelve recommendations are formatted on the application of Adalimumab and Infliximab. The interpretation of this consensus point will help improve the normative and effective application of anti-tumor necrosis factor-alpha monoclonal antibody in ophthalmologists, rheumatologists and immunologists.