Objective:To explore the early prognosis on patient of idiopathic pulmonary fibrosis (IPF) combined with different degrees of pulmonary arterial hypertension (PAH) undertake lung transplantation (LTx).Methods:From January 2017 to December 2020, the clinical data of 134 patients with IPF who underwent LTx in Wuxi People's Hospital were analyzed retrospectively. According to the average pulmonary artery pressure detected by right cardiac catheter before operation, the patients were divided into mild PAH group (63 cases), moderate PAH group (47 cases) and severe PAH group (24 cases). The donor data and the recipient's preoperative, intraoperative and postoperative data were collected; the postoperative survival curve to analyze early survival among the three patient groups.Results:With the increase of pulmonary artery pressure, the rate of abnormal right ventricular function increased, the end diastolic diameter of left ventricle decreased before operation, and the rate of using veno-arterial extracorporeal membrane oxygenation (V-A ECMO) increased during the surgery ( P<0.05). Multivariate analysis found that combined severe PAH had significant effects on primary graft dysfunction (Primary graft dysfunction, PGD), retracheal intubation or tracheotomy, hypovolemic shock within 72 h, and 6-month survival after LTx. The survival surve showed that 30-day survival rates of patients with IPF complicated with mild, moderate and severe PAH were 85.7%, 80.8% and 66.7% respectively, and the 6-month survival rates were 80.9%, 74.0% and 62.2%, respectively. Conclusion:Patient of IPF combined with different degrees of PAH had a significant impact on cardiac function and intraoperative ECMO selection of LTx, and severe PAH could significantly reduce the early survival rate after LTx.

Objective:To explore the safety and nosocomial infection control measures of COVID-19 patients of end-stage respiratory failure after lung transplantation.Methods:Lung transplantation was performed for a COVID-19 patient with end-stage respiratory failure after a negative conversion of 2019-nCoV nucleic acid. Before operation, all medical staff received simulated training on nosocomial infection. The procedures were performed in an operation room with a negative pressure environment. The three-grade preventive strategy was implemented and wearing positive pressure protective mask of electric air supply required. During operation, the patient was managed according to the in-hospital protection process. The environment and medical instruments were disinfected after operation.Results:The operation was completed successfully. The 2019-nCoV nucleic acid test was negative for many times after operation. Participants were placed in medical isolation for 14 days after surgery. During the period, nucleic acid test was negative twice.Conclusions:As an exploratory treatment, lung transplantation is a safe option for end-stage respiratory failure in COVID-19 in operation room with a negative pressure environment and implementations of three-grade preventive strategy.

Objective:To explore the effect of dose adjustment based on doxofylline blood concentration monitoring on safety of combination of doxofylline and terbutaline for respiratory diseases.Methods:The subjects were selected from patients who received doxofylline injection, terbutaline sulphate solution for nebulizationor, and the combination of the two drugs and hospitalized in Department of Respiratory Medicine of Zhengzhou Second People′s Hospital from January 1, 2014 to December 31, 2018. Patients who met the inclusion criteria were divided into 3 groups: doxofylline group, terbutaline group, and combination of doxofylline and terbutaline group (combination group). All patients in the 3 groups were given conventional treatments and symptomatic treatments. Doxofylline 300 mg once daily was given by an IV infusion and terbutaline 2 ml (5 mg) thrice daily was given by atomized inhalation for 7-14 days. Adverse reactions in the 3 groups were compared. The dosage of doxofylline in patients with adverse reactions of grade 1 was adjusted to 250 mg once daily, 200 mg once daily for patients with adverse reactions of grade 2, and doxofylline was stopped in patients with adverse reactions of more than grade 3. The blood concentration of doxofylline, the proportion of the patients whose adverse reactions were alleviated or disappeared, the length of hospital stay, and the efficiency of treatment before and after dose adjustment of doxofylline in patients in the doxofylline group and the combination group were compared.Results:A total of 6 582 patients were entered in the study. Of them, 1 438 patients were in the doxofylline group, including 793 males and 645 females with age of (61±11) years; 2 217 patients were in the terbutaline group, including 1 281 males and 936 females with age of (60±15) years; 2 927 patients were in the combination group, including 1 644 males and 1 283 females with age of (63±12) years. The differences in gender, age distribution, basic disease, combined disease, and combination medication among the 3 groups were not statistically significant ( P>0.05). The overall incidences of adverse reactions in the 3 groups were 13.1% (189/1 438), 8.9% (197/2 217), and 21.2% (620/2 927), respectively, which was higher in the combination group than that in the doxofylline group ( χ 2=41.271, P<0.001) and the terbutaline group ( χ 2=142.766, P<0.001) and higher in the doxofylline group than that in the terbutaline group ( χ 2=16.738, P<0.001). The incidences of tremor and headache in the combination group were higher than those in the other 2 groups( P<0.001), the incidence of hyperglycemia was higher than that in the doxofylline group( P=0.003), the incidence of insomnia was higher than that in the terbutaline group( P<0.001), the incidence of tachycardia was higher than that in the terbutaline group( P<0.001), the incidence of nausea was lower than that in the doxofylline group( P<0.001) and higher than that in the terbutaline group( P<0.001), the incidence of mood disorders was higher than that in terbutaline group ( P=0.017). No adverse reactions of more than grade 3 occurred in the 3 groups, the difference in proportions of patients with adverse reactions of grade 1 and grade 2 was not statistically significant( χ 2=1.097, P=0.578). The difference in blood concentration of doxofylline in patients with adverse reactions between the combination group and the doxofylline group was not statistically significant before dose adjustment ( P>0.05), but all decreased after dose adjustment (all P<0.001) and the blood concentration of doxofylline in the combination group was lower than that in the doxofyllin group [(8.38±2.19) μg/ml) vs. (10.64±2.55) μg/ml, P<0.001]; the proportion of patients whose adverse reactions were alleviated or disappeared in the combination group was higher than that in the doxofylline group [40.81% (253/620) vs. 30.16% (57/189), P=0.008], the hospitalization time was shorter than that in the doxofylline group [(10±2) d vs. (15±3) d, P<0.001], the treatment efficiency was higher than that in the doxofylline group [531 (85.65%) vs. 136 (71.96%), P<0.001]. Conclusion:When doxofylline injection is combined with terbutaline solution for nebulizationor, the blood concentration of doxofylline can be controlled at (8.38±2.19) μg/ml by monitoring the blood concentration of doxofylline, which can not only improve the treatment efficacy, but also improve the medication safety.

Objective:To explore the effect of dose adjustment based on doxofylline blood concentration monitoring on safety of combination of doxofylline and terbutaline for respiratory diseases.Methods:The subjects were selected from patients who received doxofylline injection, terbutaline sulphate solution for nebulizationor, and the combination of the two drugs and hospitalized in Department of Respiratory Medicine of Zhengzhou Second People′s Hospital from January 1, 2014 to December 31, 2018. Patients who met the inclusion criteria were divided into 3 groups: doxofylline group, terbutaline group, and combination of doxofylline and terbutaline group (combination group). All patients in the 3 groups were given conventional treatments and symptomatic treatments. Doxofylline 300 mg once daily was given by an IV infusion and terbutaline 2 ml (5 mg) thrice daily was given by atomized inhalation for 7-14 days. Adverse reactions in the 3 groups were compared. The dosage of doxofylline in patients with adverse reactions of grade 1 was adjusted to 250 mg once daily, 200 mg once daily for patients with adverse reactions of grade 2, and doxofylline was stopped in patients with adverse reactions of more than grade 3. The blood concentration of doxofylline, the proportion of the patients whose adverse reactions were alleviated or disappeared, the length of hospital stay, and the efficiency of treatment before and after dose adjustment of doxofylline in patients in the doxofylline group and the combination group were compared.Results:A total of 6 582 patients were entered in the study. Of them, 1 438 patients were in the doxofylline group, including 793 males and 645 females with age of (61±11) years; 2 217 patients were in the terbutaline group, including 1 281 males and 936 females with age of (60±15) years; 2 927 patients were in the combination group, including 1 644 males and 1 283 females with age of (63±12) years. The differences in gender, age distribution, basic disease, combined disease, and combination medication among the 3 groups were not statistically significant ( P>0.05). The overall incidences of adverse reactions in the 3 groups were 13.1% (189/1 438), 8.9% (197/2 217), and 21.2% (620/2 927), respectively, which was higher in the combination group than that in the doxofylline group ( χ 2=41.271, P<0.001) and the terbutaline group ( χ 2=142.766, P<0.001) and higher in the doxofylline group than that in the terbutaline group ( χ 2=16.738, P<0.001). The incidences of tremor and headache in the combination group were higher than those in the other 2 groups( P<0.001), the incidence of hyperglycemia was higher than that in the doxofylline group( P=0.003), the incidence of insomnia was higher than that in the terbutaline group( P<0.001), the incidence of tachycardia was higher than that in the terbutaline group( P<0.001), the incidence of nausea was lower than that in the doxofylline group( P<0.001) and higher than that in the terbutaline group( P<0.001), the incidence of mood disorders was higher than that in terbutaline group ( P=0.017). No adverse reactions of more than grade 3 occurred in the 3 groups, the difference in proportions of patients with adverse reactions of grade 1 and grade 2 was not statistically significant( χ 2=1.097, P=0.578). The difference in blood concentration of doxofylline in patients with adverse reactions between the combination group and the doxofylline group was not statistically significant before dose adjustment ( P>0.05), but all decreased after dose adjustment (all P<0.001) and the blood concentration of doxofylline in the combination group was lower than that in the doxofyllin group [(8.38±2.19) μg/ml) vs. (10.64±2.55) μg/ml, P<0.001]; the proportion of patients whose adverse reactions were alleviated or disappeared in the combination group was higher than that in the doxofylline group [40.81% (253/620) vs. 30.16% (57/189), P=0.008], the hospitalization time was shorter than that in the doxofylline group [(10±2) d vs. (15±3) d, P<0.001], the treatment efficiency was higher than that in the doxofylline group [531 (85.65%) vs. 136 (71.96%), P<0.001]. Conclusion:When doxofylline injection is combined with terbutaline solution for nebulizationor, the blood concentration of doxofylline can be controlled at (8.38±2.19) μg/ml by monitoring the blood concentration of doxofylline, which can not only improve the treatment efficacy, but also improve the medication safety.

Objective To investigate whether γH2AX could be a useful biomarker for evaluating the DNA double‐stranded . Methods Semem samples in case group were from 27 infertile males who were diagnosed in Andriatrics department or reproductive centre in the First Affiliated Hospital of Guangxi Medical University .The other semen samples were from 23 healthy donors with fertility as comparison .The levels of γH2AX were detected by flow cytometry .Single cell gel electropherosis(SCGE)was applied to assess the level of DSBs of sperm .Density gradient centrifugation(DGC) was applied to optimized spermatozoa .Results TheγH2AX levels and the DSBs of the sperm of the infertile subjects were significantly higher than those of healthy males(P<0 .01) , and the levels of γH2AX and the DSBs of sperm significantly decreased in two groups by DGC(P<0 .01) .Conclusion The level of spermatozoaγH2AX is higher in male infertility patients than in healthy donors with fertility ,which might be a useful biomarker for evaluating DSBs of sperm .