This paper reports the clinical characteristics as well as diagnosis and treatment processes of a patient with mixed pulmonary infection of Rhizopus microspores and Aspergillus.The patient had history of type 2 diabe-tes mellitus,and was admitted to the hospital due to diabetes ketoacidosis complicated with pneumonia.Clinical manifestations included cough,expectoration,and fever.Imaging examination showed inflammatory lesions of bila-teral lungs(mainly in the right lung)associated with local consolidation.Bronchoalveolar lavage fluid(BALF)smears and galactomannan antigen test(GM test)were both negative.Nucleic acid sequences of Rhizopus micro-spores and Aspergillus were detected by metagenomic next-generation sequencing(mNGS)at the early stage,while complicated infection of Klebsiella pneumoniae and COVID-19 were also found.The final pathological diagnosis was pulmonary mucormycosis combined with invasive pulmonary aspergillosis.The patient achieved clinical curing through the combination of isaconazole antifungal treatment and lobectomy of the right middle-lower lobes.

This paper reports the clinical characteristics as well as diagnosis and treatment processes of a patient with mixed pulmonary infection of Rhizopus microspores and Aspergillus.The patient had history of type 2 diabe-tes mellitus,and was admitted to the hospital due to diabetes ketoacidosis complicated with pneumonia.Clinical manifestations included cough,expectoration,and fever.Imaging examination showed inflammatory lesions of bila-teral lungs(mainly in the right lung)associated with local consolidation.Bronchoalveolar lavage fluid(BALF)smears and galactomannan antigen test(GM test)were both negative.Nucleic acid sequences of Rhizopus micro-spores and Aspergillus were detected by metagenomic next-generation sequencing(mNGS)at the early stage,while complicated infection of Klebsiella pneumoniae and COVID-19 were also found.The final pathological diagnosis was pulmonary mucormycosis combined with invasive pulmonary aspergillosis.The patient achieved clinical curing through the combination of isaconazole antifungal treatment and lobectomy of the right middle-lower lobes.

Objective:To investigate the prognosis of patients with initially resectable gastric cancer liver metastasis (GCLM) who were treated by different modalities, and analyze the influencing factors for prognosis of patients.Methods:The retrospective cohort study was conducted. The clinicopathological data of 327 patients with initially resectable GCLM who were included in the database of a nationwide multicenter retrospective cohort study on GCLM based on real-world data from January 2010 to December 2019 were collected. There were 267 males and 60 females, aged 61(54,68)years. According to the specific situations of patients, treatment modalities included radical surgery combined with systemic treatment, palliative surgery combined with systemic treatment, and systemic treatment alone. Observation indicators: (1) clinical characteristics of patients who were treated by different modalities; (2) prognostic outcomes of patients who were treated by different modalities; (3) analysis of influencing factors for prognosis of patients with initially resectable GCLM; (4) screening of potential beneficiaries in patients who were treated by radical surgery plus systemic treatment and patients who were treated by palliative surgery plus systemic treatment. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and Log-Rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the COX proportional hazard regression model. The propensity score matching was employed by the 1:1 nearest neighbor matching method with a caliper value of 0.1. The forest plots were utilized to evaluate potential benefits of diverse surgical combined with systemic treatments within the population. Results:(1) Clinical characteristics of patients who were treated by different modalities. Of 327 patients, there were 118 cases undergoing radical surgery plus systemic treatment, 164 cases undergoing palliative surgery plus systemic treatment, and 45 cases undergoing systemic treatment alone. There were significant differences in smoking, drinking, site of primary gastric tumor, diameter of primary gastric tumor, site of liver metastasis, and metastatic interval among the three groups of patients ( P<0.05). (2) Prognostic outcomes of patients who were treated by different modalities. The median overall survival time of the 327 pati-ents was 19.9 months (95% confidence interval as 14.9-24.9 months), with 1-, 3-year overall survival rate of 61.3%, 32.7%, respectively. The 1-year overall survival rates of patients undergoing radical surgery plus systemic treatment, palliative surgery plus systemic treatment and systemic treatment alone were 68.3%, 63.1%, 30.6%, and the 3-year overall survival rates were 41.1%, 29.9%, 11.9%, showing a significant difference in overall survival rate among the three groups of patients ( χ2=19.46, P<0.05). Results of further analysis showed that there was a significant difference in overall survival rate between patients undergoing radical surgery plus systemic treatment and patients undergoing systemic treatment alone ( hazard ratio=0.40, 95% confidence interval as 0.26-0.61, P<0.05), between patients undergoing palliative surgery plus systemic treatment and patients under-going systemic treatment alone ( hazard ratio=0.47, 95% confidence interval as 0.32-0.71, P<0.05). (3) Analysis of influencing factors for prognosis of patients with initially resectable GCLM. Results of multivariate analysis showed that the larger primary gastric tumor, poorly differentiated tumor, larger liver metastasis, multiple hepatic metastases were independent risk factors for prognosis of patients with initially resectable GCLM ( hazard ratio=1.20, 1.70, 1.20, 2.06, 95% confidence interval as 1.14-1.27, 1.25-2.31, 1.04-1.42, 1.45-2.92, P<0.05) and immunotherapy or targeted therapy, the treatment modality of radical or palliative surgery plus systemic therapy were independent protective factors for prognosis of patients with initially resectable GCLM ( hazard ratio=0.60, 0.39, 0.46, 95% confidence interval as 0.42-0.87, 0.25-0.60, 0.30-0.70, P<0.05). (4) Screening of potentinal beneficiaries in patients who were treated by radical surgery plus systemic treatment and patients who were treated by palliative surgery plus systemic treatment. Results of forest plots analysis showed that for patients with high-moderate differentiated GCLM and patients with liver metastasis located in the left liver, the overall survival rate of patients undergoing radical surgery plus systemic treatment was better than patients undergoing palliative surgery plus systemic treatment ( hazard ratio=0.21, 0.42, 95% confidence interval as 0.09-0.48, 0.23-0.78, P<0.05). Conclusions:Compared to systemic therapy alone, both radical and palliative surgery plus systemic therapy can improve the pro-gnosis of patients with initially resectable GCLM. The larger primary gastric tumor, poorly differen-tiated tumor, larger liver metastasis, multiple hepatic metastases are independent risk factors for prognosis of patients with initial resectable GCLM and immunotherapy or targeted therapy, the treatment modality of radical or palliative surgery plus systemic therapy are independent protective factors for prognosis of patients with initially resectable GCLM.

Objective:To compared the positive rate of anal swab nucleic acid test and clinical characteristics of critical and general coronavirus disease 2019 (COVID-19) patients.Methods:Clinical data of 18 patients with COVID-19 admitted to the First People's Hospital of Lianyungang City from February to March 2020 were retrospectively analyzed. The patients were divided into general group ( n = 11) and critical ill group ( n = 7) according to the severity of the disease. The differences of gender, age, epidemiological characteristics, fever duration after admission, underlaying disease, positive rate of anal swab nucleic acid test at admission and two times of negative pharyngeal swab test were compared between the two groups. Results:There were no significant differences in gender, age, fever duration after admission or underlaying disease between the two groups. The number of anorectal swab positive cases in critically ill group was significantly higher than that in general group (cases: 4 vs. 1, P = 0.047). After two negative pharyngeal swab nucleic acid test, the number of anal swab positive cases in critical illness group was still higher than that in general group (cases: 2 vs. 0), but the difference was not statistically significant ( P = 0.137). The number of non-local infection in critical ill group was significantly higher than that in general group (cases: 4 vs. 0, P = 0.047). All of the 4 non-local infected patients had a history of living in Wuhan. Conclusions:The patients with anorectal swab nucleic acid positive may have a more serious condition. It may be a risk to transfer ill patients out of the isolation ward by the criteria of only two times of negative pharyngeal swab nucleic acid test. Patients returning to our city after infection in Wuhan may be more serious.

Objective To investigate the causes of disease condition changes after the patients' transfer from intensive care unit (ICU) into the general wards. Methods From January 2013 to December 2018, the patients with improvement of disease condition in comprehensive ICU were transferred into the general wards of the First People's Hospital of Lianyungang and their clinical data were retrospectively analyzed. The general information of patients was collected, such as gender, age, underlying diseases, heavy smoking, acute physiology and chronic health evaluationⅡ(APACHEⅡ) and Glasgow coma score (GCS) in 24 hours, length of stay in ICU, average levels of oxygenation index and respiratory rates during the stay in ICU and on the day transfer from ICU, GCS score on the day of transfer from ICU, presence or absence of invasive ventilation,the time of invasive ventilation, sepsis or its absence, the situation of community or hospital acquired pneumonia, etc, and the classification of the disease changes after transfer. The patients were divided into a disease situation change group (change group) and a disease situation stable group (stable group) according to whether there was any change in the disease situation in the general ward or not, the patients were divided into respiratory complications group and non-respiratory complications group. The risk factors that may influence the change of the disease condition were analyzed by multiple-factor Logistic regression. Results From January 2013 to December 2018, there were 2 451 patients treated in comprehensive ICU, of that 1 293 were transferred into the general wards for further treatment. Among the patients transferred to the general ward, 628 cases' conditions were changed.① The respiratory complications were the most common changes (345 cases, 54.9%) in patients after the transfer from ICU, followed by cardiovascular complications (118 cases, 18.8%) and surgery-related complications (96 cases, 15.3%).② The proportions of underlying diseases and heavy smoking in the change group were significantly higher than those in the stable group [24.4% (153/628) vs. 7.8% (52/665), 40.3% (253/628) vs. 24.2% (161/665), all P < 0.05]. Compared with the stable group, the average oxygenation index [mmHg (1 mmHg = 0.133 kPa): 238.91±71.14 vs. 291.74±63.64], and the turn-out day oxygenation index (mmHg: 261.23±58.11 vs. 301.00 ±58.25) were lower in the change group, while the proportion of applying invasive ventilation [64.2% (403/628) vs. 47.4% (315/665)], and the duration of invasive ventilation [days: 5 (2-9) vs. 3 (2-7)] were higher in the change group, the differences being all statistical significant (all P < 0.05). ③ Compared with the non-respiratory complications group, the average oxygenation index in the respiratory complications group was lower (mmHg: 216.43±67.17 vs. 264.85±78.46), the turn-out day oxygenation index was lower (mmHg: 250.72±74.93 vs. 274.87±81.79), and invasive ventilation ratio was higher [77.4% (267/345) vs. 48.1% (136/283)], the differences being statistically significant (all P < 0.05).④ Logistic regression analysis showed that the underlying diseases [odds ratio (OR) = 1.522], heavy smoking (OR = 2.314), and average oxygenation index (OR = 1.821) were the independent risk factors for patients in the general wards occurring disease situation changes after transfer from ICU (all P < 0.05). Conclusions The patients with following factors: underlying diseases, heavy smoking, low average oxygenation index during ICU stay, low oxygenation level on the day of transfer, application of invasive ventilation and long ventilation time are more easily to occur complications of respiratory system in the general wards after transfer from ICU; among the above related factors, the underlying diseases, heavy smoking and average oxygenation index are the independent risk factors for patients' occurrence of disease situation changes after transfer from ICU. Therefore, the patients with these risk factors, the evaluation and monitoring of the disease situation should be strengthened before and after patients' transfer from ICU. and the changes of patients' condition are mostly respiratory complications. Among them, combined underlying diseases, severe smoking and average oxygenation index are the independent risk factors for patients who have condition changes transferred from ICU. For patients with these risk factors, evaluation and monitoring should be strengthened before and after patients are transferred from ICU.

Objective To explore the long-term compliance of continuous positive airway pressure ventilation in patients with obstructive sleep apnea hypopnea syndrome.Methods The clinical data of 62 patients with obstructive sleep apnea hypopnea syndrome were retrospectively analyzed. According to the patients'compliance of continuous positive airway pressure ventilation in 12 months,the patients were divided into 2 groups: good compliance group (34 cases) and poor compliance group (28 cases).The cause of poor compliance and the long-term risk factors of poor compliance with continuous positive airway pressure ventilation in patients with persistent positive airway pressure were analyzed. Results In 28 cases of poor compliance,the main reasons were inadaptation machine during pressure titration of continuous positive pressure ventilation(9 cases),complex operations(6 cases)and unwanted complex treatment(4 cases).The Logistic multiplicity analysis result showed that male(OR=1.737,95% CI 2.397-4.184),rural residence(OR=3.522,95% CI 2.025-3.987),low educational level(OR=3.673,95% CI 2.017-4.812),short time flow monitoring(OR=2.301,95% CI 2.485-4.128),short pressure titration time (OR = 2.012,95% CI 2.783 - 3.573) and many times pressure titration (OR =1.993, 95% CI 2.593 - 3.717) were the independent risk factors of poor compliance of continuous positive airway pressure ventilation in patients with obstructive sleep apnea hypopnea syndrome(P<0.05 or<0.01).Conclusions The long term compliance of continuous positive airway pressure ventilation in patients with obstructive sleep apnea hypopnea syndrome is poor. Health education should be strengthened in patients of male,rural residence,low educational level,short time flow monitoring,short pressure titration time and many times pressure titration,in order to improve the treatment compliance.

Objective To explore the role of ethyl pyruvate (EP) on E-cadherin of airway epithelium and airway inflammation in a TDI-induced mouse asthma model. Methods 30 male BALB/c mice were randomly divided into control group , asthma group and EP group. On day 1 and 8 , mice in asthma group and EP group were treated with 0.3%TDI on the dorsum of both ears for sensitization. And on day 15 , 18 and 21 the mice underwent an aerosol inhalation of 3% TDI, and saline (100 mg/kg) was injected intraperitoneally 1 hour before inhalation. The control group underwent acetone and olive oil (AOO) sensitization on day 1 and 8, AOO challenge on day 15, 18 and 21. Saline (100 mg/kg) was injected intraperitoneally 1 hour before challenge. One hour before each challenge, mice were given EP (100mg/kg) or vehicle via intraperitoneal injection. On day 22, airway reactivity, IL-4 , IFN-γand IgE in the serum were detected , immunohistochemistry and WB were used to assess E-cadherin levels. Results Airway reactivity, IL-4, IFN-γin and IgE in the serum in asthma group are significantly higher than that in control group (P<0.05). Treatment with EP dramatically decreased airway hyperresponsiveness in TDI-challenged mice, as well as IL-4, IFN-γ and IgE (P < 0.05). E-cadherin in control group was distributed evenly at the connection of epithelial cells. E-cadherinin distribution was chaotic and its expression was decreased in asthma group. EP intervention can ameliorate the damage of E-cadherinin. Conclusions EP can ameliorate the destruction of E-cadherin in airway epithilum by TDI.

OBJECTIVETo test the effect of high-mobility group box protein 1 (HMGB1) alone or in synergy with interleukin-1β (IL-1β) on the expression of IL-8 in human airway epithelial cells in vitro.

METHODSHuman airway epithelial 16HBE and A549 cell lines were incubated with HMGB1 (100 ng/ml) in the absence or presence of IL-1β (10 ng/ml) for 24 h, and the changes of IL-8 mRNA and protein expressions were assessed using quantitative PCR and enzyme-linked immunosorbent assay (ELISA).

RESULTSIn the two human airway epithelial cell lines, HMGB1 alone did not produce obvious effect on the expression of IL-8, but in the presence of IL-1β, HMGB1 caused a significant increase of IL-8 expressions at both the mRNA and protein levels.

CONCLUSIONHMGB1 in synergy with IL-1β increases the expression of IL-8 in human airway epithelial cells, which provides new evidence that HMGB1 contributes to neutrophilic airway inflammation by regulating IL-8 expression.

Bronchi ; cytology ; drug effects ; Cell Line ; Epithelial Cells ; drug effects ; metabolism ; HMGB1 Protein ; pharmacology ; Humans ; Inflammation ; Interleukin-1beta ; pharmacology ; Interleukin-8 ; metabolism ; RNA, Messenger

AIM: To investigate the effects of insulin on aortic constriction caused by endothelin-1(ET-1) in normal and hyperglycemic rats. METHODS: Hyperglycemic rat models were prepared. Two aortic rings were immersed in the Krebs-Hensleit fluid with and without insulin (40 mIU/L) and the responses of rings to 10 -9 mol/L ET-1 were observed. RESULTS:ET-1 induced more obvious aortic ring constriction in normal rats than those in hyperglycemic rats ( P

To provide necessary evidence for studying the pharmacological and clinical effectiveness of Styela clava,the quantities of 21 chemical elements in Styela clava were analysised.It was found that the quantities of several mineral elements in it were higher than that in sea water,which indicated Styela clava had a relatively high ability to concentrate mineral elements.