Electronic cigarettes (EC) are battery-powered devices that deliver aerosolized nicotine to users.EC has been reported to contain less carcinogens than traditional cigarettes,cause less lung effects and may help with smoking cessation.EC are an increasingly popular device that could serve as a smoking cessation product.But the effect of smoking cessation has not been confirmed and use of EC may bring potential health problem.This study reviewed the research progress in smoking cessation by using EC.

OBJECTIVE To investigate the pathogenic bacteria distribution and susceptibility of lower respiratory tract infection in patients in our respiratory ward.METHODS All the clinical isolates from sputum or secretion of lower respiratory tract from 2003 to 2007 were analyzed retrospectively.RESULTS A total of 1529 clinical isolates were collected,including 1326 strains of Gram-negative bacilli(86.7%) and 203 strains of Gram-positive cocci(13.3%).The proportion of Gram-negative bacilli was higher in lung underlying diseases group when compared with non-lung underlying diseases.Haemophilus parainfluenzae and H.influenzae were susceptible to spectinonycin,doxycycline and third-generation cephalosporins.Pseudomonas aeruginosa and Acinetobacter baumanni were susceptible to meropenem,cefoperazone/sulbactam and cefepime.Klebsiella pneumoniae and Escherichia coli were susceptible to meropenem,cefoperazone/sulbactam and amikacin.The major Gram-positive isolates were highly resistant to azithromycin,erythromycin,penicillin.All Staphylococcus aureus isolates were susceptible to vancomycin.Streptococcus pneumoniae isolates were highly susceptible to meropenem,levofloxacin,cefazolin and vancomycin.CONCLUSIONS Infection caused by Gram-negative bacilli are predominant in lower respiratory tract infection patients,especially in the patients with lung underlying diseases.Antibiotics resistance of some pathogens become increasingly severe.Therefore,the rational use of antibiotics is important for the containment of bacterial resistance.

Objective To investigate the clinical manifestations, imaging features, diagnosis and management of pulmonary mycosis.Methods Fifty-four patients were identified with pulmonary mycosis by pathological examination in our hospital from January 2002 to June 2008. Data of clinical manifestations, imaging features, diagnosis and management were retrospectively reviewed.Results Of the 54 cases, 30 (55.6%) were pulmonary aspergillosis, 15 (27.8%) were pulmonary cryptococcosis. Underlying disease was reported in 42 of 54 (77.8%) cases. The diagnosis of all the patients was confirmed by pathological exami-nation. Lung or bronchi tissue was obtained by operation in 30 (55.6%) cases, by bronchofibroscope in 12 (22.2%) cases, by CT-guided percutaneous needle biopsy in 9 (16.7%) cases, and by lymphoid node biopsy in 4 cases. Main symptoms included cough (41, 75.9%), expectoration (30, 55.6%), hemoptysis (20, 37.0%), fever (16, 29.6%), and asymptomatic (6, 11.1%). The X-ray and chest CT showed masses or nodule lesions (41, 75.9%), patchy lesions (8, 14.8%), cavity (12, 22.2%), diffuse milliary nodules (1 case). Bilateral lungs were involved in 7 cases (13.0%);right lung alone in 26 cases (48.1%);left lung alone in 21 cases (38.9%). Among the 54 cases, 41 (75.9%) were misdiagnosed before pathological examination. Thirty (55.6%) cases underwent surgical resection of pulmonary lesions. One patient suffered from cryptococcal meningitis after operation. Twenty (37.0%) patients received systemic anti-fugal therapy. Cure or significant improvement was found in 16 cases. Conclusions The most frequently isolated fungi were Aspergillus, followed by Cryptococcus. Final diagnosis is mainly dependent on pathological examination. Clinical manifestations, imaging features, diagnostic procedures and management are different due to the difference of pathogenic fungi. Satisfactory Results can be obtained by anti-fungal therapy combined with surgical management.

Objective To investigate the effect of berberine on proliferation of neural stem cells(NSCs)induced by hydrogen peroxide(H2O2). Methods NSCs from Sprague-Dawley rats were isolated and purified by suspension culture. Cells were divided into a control group,H2O2group(NSCs exposed to H2O2injury),berberine group(NSCs were incubated with berberine concentrations ranging from 0.5 to 20 μmol/L and exposed to H2O2), and DAPT(a blocker of the Notch signaling pathway)group. Cell viability was evaluated using the Cell Counting Kit-8 assay. Proliferation of NSCs was evaluated by a neurosphere formation assay and Ki67 protein expression. Expression of key proteins in the Notch signaling pathway(including notch1 and hes1)in response to berberine treatment or DAPT(a Notch inhibitor)was determined by Western blotting. Results Cell viability of NSCs was significantly increased by berberine compared with the H2O2group. The neurosphere growth assay showed that 5 or 10 μmol/L berberine increased NSC proliferation. The ratio of Ki67 +/DAPI cells and notch1 and hes1 protein expression increased significantly compared with the H2O2group. Conclusions Berberine treatment upregulates Notch signaling in NSCs,whereas DAPT attenuates these effects. Berberine is a drug that promotes NSC proliferation and exerts a protective effect on NSCs via the Notch signaling pathway.

Objective: To establish a risk assessment system for the prevention and control of infectious diseases in primary and secondary schools in Tianjin and reduce the risk of infectious disease prevention and control through risk assessment and control. Methods: Based on the failure modes and effect analysis method, a quantitative risk assessment of infectious disease prevention and control in 45 primary and secondary schools in Tianjin was carried out. Risk based supervisory process was assessed, while control effect was evaluated for contined improvement in the prevention and control of infectious diseases in the primary and secondary schools. Results: The top three risk aspects found in the infectious disease prevention and control system in primary and secondary schools in Tianjin included failure to provide sanitation professionals (82.22%) in accordance with regulations, no hand sanitizer or disinfectant (35.56%) in wash basins, and drinking water related products without approval (28.89%). The results of the risk assessment indicated that the three risk aspects with the highest risk priority number (RPN) included failure to provide health professionals( n = 144), no morning and afternoon inspection arrangement( n =126), and low quality of morning and afternoon inspections( n =126). After optimizing the supervision measures for the risk aspects with a detectable degree≥7 points, a quantitative risk assessment was carried out again, the RPN values of all risk points fell below 125, indicating reasonable control effect. Conclusion Based on the failure mode and effect analysis method, the establishment of a risk assessment system for the prevention and control of infectious diseases in primary and secondary schools and regular risk assessments can timely detect risk aspects in the infectious disease prevention and control, to promote effective prevention of infectious diseases in schools.

BACKGROUNDAcute kidney injury (AKI) is a common complication of sepsis, which is associated with higher risks of adverse outcomes. Recently, kidney disease: improving global outcomes (KDIGO) recommended a new guideline for AKI, including a little modification on the AKI staging criteria.

METHODSThis retrospective study included 211 septic patients admitted to the intensive care unit (ICU) at Xiangya Hospital, Central South University from January 2008 to January 2011. AKI was diagnosed and classified according to the KDIGO or acute kidney injury network (AKIN) criteria. Differences between the AKI and non-AKI groups for baseline characteristics, laboratory examinations, etiology, outcomes, as well as the risk factors for AKI and 28-day mortality were analyzed. The reliability of the KDIGO criteria was also evaluated by comparing it with the AKIN criteria.

RESULTSThe overall incidence of AKI in septic patients was 47.9%, and the 28-day mortality was 32.7%. The incidence of AKI was significantly higher in patients with more severe sepsis. Indicators of hepatic and respiratory function were significantly worse in the AKI group. Furthermore, a higher proportion of patients were infected with Enterobacter cloacae in the AKI group. The independent risk factors for AKI were shock, the number of organ failures, blood urea nitrogen (BUN) levels, and the use of vasopressors. The independent risk factors for mortality were BUN and creatine kinase-MB (CK-MB) levels. Both the KDIGO criteria and the AKIN criteria were significantly associated with 28-day mortality.

CONCLUSIONSThe incidence and 28-day mortality of AKI were very high in ICU septic patients. Greater attention should be paid to AKI-induced hepatic and respiratory dysfunction in clinical practice. Patients with an intra-abdominal source of infection were more likely to develop AKI. KDIGO criteria are reliable in AKI staging.

Acute Kidney Injury ; epidemiology ; etiology ; Adult ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Sepsis ; complications ; epidemiology

The clinical application of immune checkpoint inhibitors (ICIs) lead to dramatic changes in the treatment strategy for patients with advanced non-small cell lung cancer (NSCLC), but the efficacy of ICIs in oncogene-driven NSCLC is controversial. Existing research shows that the efficacy of ICIs may be related to different types of driver genes, programmed cell death-ligand 1 (PD-L1) level, and tumor mutational burden (TMB). It may involved in other factors, such as clinical characteristics, and immune cell density. ICIs monotherapy or combination therapy may play a role in a subset of oncogene-driven NSCLC patients, but further studies are needed to select these patients, which may be an important direction for the future development of advanced NSCLC.
B7-H1 Antigen ; genetics ; Biomarkers, Tumor ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; Humans ; Immunotherapy ; Lung Neoplasms ; drug therapy

This paper explores the intersection and integration of narrative medicine and clinical spiritual care,especially the importance and value of spiritual narrative in medical services.Spiritual narrative is based on the three elements of narrative medicine,combined with the professional competence of clinical spiritual care,to achieve multi-angle attention to patients'physiology,psychology,society,and spirit.The connections and situations between individuals in the disease story are reproduced in the spiritual narrative,allowing the narrator to deeply understand the relationship between themselves,others,and natural events from a more diverse perspective,thereby enhancing the role identity and professional happiness of doctors,and ultimately promoting the narrator's exploration of their own inner selves and understanding of life philosophy.Integrating narrative medicine into undergraduate teaching,research,and clinical practice of the clinical spiritual care program at Hunan Cancer Hospital,conducting spiritual narrative,is of great significance for improving the empathy and communication skills of medical students and clinical medical staff,promoting their thinking and understanding of the meaning of life,and enhancing their patient-centered clinical critical thinking ability.

Anti-tumor immunotherapy has made remarkable breakthroughs in the past few decades,demonstrating unprecedented efficacy in certain types of cancer,but the emergence of drug resistance not only limits the long-term effectiveness of immunotherapy,but can also lead to cancer recurrence and progression. Therefore,how to overcome immunotherapy resistance has become a key problem to be solved in current cancer research. Tumor-associated macrophages (TAM) have gradually become an important option and potential therapeutic target in cancer treatment in recent years. Their unique role in the tumor microenvironment (TME) makes them promising in anti-tumor therapy. For the study of TAM in cancer treatment,the current exploration includes multiple aspects and challenges. These studies not only involved the mechanism of action of TAM in different tumor types,but also covered the interaction of TAM with other immune cells and signaling pathways in TME. Therefore,this article reviews the application of TAM in anti-tumor immunotherapy,aiming to provide reference for future related studies.

Traditional antibody drug conjugates(ADC)combine monoclonal antibodies with cytotoxic drugs to accurately strike cancer cells,but there are still many shortcomings in stability,targeting,efficacy,and safety.Novel ADC,such as bi-specific,site-specific,dual-payload,and pro-drug type ADC,can be optimized by simultaneously binding 2 different antigens or epitopes,selecting more stable linkers,coupling with specific amino acid sites of antibodies,carrying different drug payloads,and adopting prodrug strategies,while retaining the characteristics of traditional ADC.Significantly improving the stability,targeting,efficacy and safety of drugs can better meet the needs of clinical treatment.Novel ADC will play a more important role in cancer treatment in the future.Discussing the progress of novel ADC in cancer treatment and analyzing their advantages and challenges can provide theoretical support for the development of anti-cancer strategies and provide directions for drug research and development.