[Progress in platelets and tuberculosis].

Platelets are important cells in hemostatic and coagulative reactions. Interestingly, platelets-related immunopathological mechanism and clinical research have become one of the hot research topics in tuberculosis at home and abroad in recent years. Platelets get involved in host chronic inflammation and pulmonary immune response, thus playing a negative regulatory role in tuberculosis. This is achieved through direct internalization of Mycobacterium tuberculosis and indirect interaction with immune cells. In addition, patients with tuberculosis often have thrombocytosis, and there is increasing evidence that anti-platelet therapy as a host-directed therapy has demonstrable clinical benefit in tuberculosis control. Platelet inhibition may be an emerging therapeutic strategy for tuberculosis. This review aims to highlight the research progress in platelets and tuberculosis.

[Cryotherapy combined with local spraying of isoniazid for the treatment of nasopharyngeal tuberculosis: a case report].

Nasopharyngeal tuberculosis refers to the tuberculosis in the nasopharynx, which is mainly treated with systemic chemotherapy with anti-tuberculosis drugs. Here, we reported a case of nasopharyngeal tuberculosis treated by cryosurgery combined with local spraying of isoniazid on the basis of systemic chemotherapy with anti-tuberculosis drugs. By reviewing the case data and relevant literature, we understood the clinical manifestations, diagnosis and differential diagnosis of the disease, improved everyone's understanding of the disease, and proposed a new method of cryosurgery combined with local spraying of isoniazid for the treatment of nasopharyngeal tuberculosis for clinical discussion.

[Effects of surgical procedures and general anesthesia exposure within 2 hours in early childhood on neurodevelopmental outcomes in school-age].

Objective: To observe the effect of surgical procedures and general anesthesia exposure (<2 h) in early childhood on neurodevelopmental outcomes in school-age. Methods: A total of 147 children aged 6-12 years old, who received surgery under general anesthesia (<2 h) at the age of 0-2 years in Children's Hospital of Nanjing Medical Universityfrom June 2009 to December 2012 were retrospectively enrolled in this study (from June 2018 to December 2021) as exposure group, including 76 males and 71 females, with a mean age of (8.8±1.6) years. All the cases were divided into single-exposure group (n=65) and multiple-exposure group (≥2 times, n=82) according to different times of anesthesia exposure. According to the cohort of exposure group, 160 healthy children of the same age with no history of surgery under general anesthesia were recruited from the community from June 2018 to December 2021 as the control group, including 87 males and 73 females, and aged (8.6±1.9) years. A variety of standardized neurological tests including Wechsler intelligence scale for children fourth edition (WSC-Ⅳ), integrated visual and auditory continuous performance test (IVA-CPT), Swanson Nolan and Pelham, version Ⅳ (SNAP-Ⅳ), children sensory integration capacity development rating scale (CSIC), and social living ability scale were performed in all subjects by a child health specialist who failed to know the details. The primary outcome was the full-scale IQ (FSIQ) in WISC-Ⅳ, and the secondary outcomes were IVA-CPT, SNAP-Ⅳ, CSIC, and social living ability scale. Results: The FSIQ of single-exposure, multiple-exposure and control groups was 105.4±14.1, 100.9±10.2 and 103.6±13.5, respectively, with no statistically significant difference (F=2.37, P=0.095). The FSIQ of different first age exposure groups (aged 0-6 months, 7-12 months and 1-2 years) was 99.8±10.2, 104.5±10.5 and 104.4±14.5, respectively, with no statistically significant difference (F=2.39, P=0.095). The FSIQ of different exposure duration groups (0-59 min, 60-119 min and control group) was 102.8±11.3, 103.0±13.7 and 103.6±13.5, respectively, with no statistically significant difference (F=0.13, P=0.882). As for the secondary outcomes, the scores of visual persistence quotient in single-exposure, multiple-exposure and control groups were 94.8±10.5, 94.0±10.9 and 100.6±17.7, with a statistically significant difference (F=6.96, P=0.001). In terms of locomotion in social living ability scale, the score of the three groups was 10.0±0.2, 10.2±0.6 and 10.4±0.7, respectively, with a statistically significant difference (F=10.61, P<0.001), but all were within the standard range. Conclusions: The surgical procedures and general anesthesia exposure within 2 hours in early childhood has no effect on the overall FSIQ in school age, but has a slight impacts on the visual persistence quotient of IVA-CPT and the locomotion score of social living ability scale.

[Reference values for carotid artery intima-media thickness among community adult dwellers in Shenzhen City].

Objective: To establish reference values for carotid intima-media thickness (CIMT) of adult dwellers in Shenzhen City. Methods: The study was conducted based on the Shenzhen heart failure epidemiological survey from 2021 to 2022. In this survey, residents aged 18 years and above in Shenzhen were selected by using a multi-stage stratified random sampling method. General information, cardiovascular disease (CVD) related behavior and carotid ultrasound examination and etc. were collected from the participants. People with CVD factors, a history of atherosclerotic cardiovascular disease, carotid plaque or having no carotid ultrasound examination results were excluded. The parameter regression model based on fractional polynomial was used to establish the reference values of CIMT by age and sex. Results: A total of 2 163 healthy individuals were enrolled in the final analysis, including 576 males (26.6%) and 1 587 females (73.4%). The fractional polynomial regression of the CIMT mean and standard deviation was obtained. For men, the regression was meanCIMT=0.324 7+0.006 9×age and SDCIMT=0.076 9+0.001 2×age. For women, the regression was meanCIMT=0.354 9+0.005 4×age and SDCIMT=0.041 6+0.002 0×age. Conclusion: The age and sex reference values for CIMT of adult people in Shenzhen established in this study could provide the latest reference standards for early screening of subclinical CVD.

[Bronchial tuberculosis complicated with massive hemorrhage after Dieulafoy's disease biopsy: a case report].

Compared with simple bronchial Dieulafoy's disease, bronchial tuberculosis with Dieulafoy's disease is rarer and more complex, with non-specific clinical manifestations. In this article, we reported a case of right lateral basal segment bronchial tuberculosis complicated with Dieulafoy's disease. The clinical manifestations, microscopic features, and rescue procedures in the event of massive hemorrhage in this case were described in detail, and the shortcomings in the clinical diagnosis and treatment of this case were analyzed. The aim of this study was to improve clinicians' understanding of bronchial tuberculosis combined with Dieulafoy's disease.

[A real-world study of the effects of endocrine therapy on liver function in breast cancer].

Objective: To compare the effect of different endocrine therapy drugs on liver function in patients with early breast cancer. Methods: A retrospective cohort study was conducted to include 4 318 patients with early breast cancer who received adjuvant endocrine therapy in Department of Breast Surgery, Peking Union Medical College Hospital from January 1, 2013 to December 31, 2021. All the patients were female, aged (51.2±11.3) years (range: 20 to 87 years), including 1 182 patients in the anastrozole group, 592 patients in the letrozole group, 332 patients in the exemestane group, and 2 212 patients in the toremifene group. The mixed effect model was used to analyze and compare the liver function levels of patients at baseline, 6, 12, 18, 24, 36, 48, 60 months of medication, and 1 year after drug withdrawal among the three aromatase inhibitors (anastrozole, letrozole, exemestane) and toremifene. Results: ALT and AST of the 4 groups were significantly higher than the baseline level at 6 months (all P<0.01), and there were no significant differences in total bilirubin, direct bilirubin and AST levels among all groups one year after drug withdrawal (P: 0.538, 0.718, 0.061, respectively). There was no significant difference in the effect of all groups on AST levels (F=2.474, P=0.061), and in the effect of three aromatase inhibitors (anastrozole, letrozole, and exemestane) on ALT levels (anastrozole vs. letrozole, P=0.182; anastrozole vs. exemestane, P=0.535; letrozole vs. exemestane, P=0.862). Anastrozole and letrozole had significantly higher effects on ALT levels than toremifene (P<0.01, P=0.009). The proportion of abnormal liver function in each group increased significantly at 6 months compared with baseline, and then the proportion showed a decreasing trend over time. Conclusions: Three aromatase inhibitors (anastrozole, letrozole, and exemestane) and toremifene can significantly increase the level of ALT and AST in patients with breast cancer, and the levels can gradually recover to the baseline after 1 year of drug withdrawal. The effect of non-steroidal aromatase inhibitors (anastrozole, letrozole) on ALT levels is greater than toremifene.

[One-stage revision using intra-articular vancomycin infusion effectively treats chronic prosthetic joint infection caused by Enterococcal].

Objective: To investigate the clinical effects of one-stage revision combined with intra-articular infusion of vancomycin in the treatment of chronic prosthetic joint infection (PJI) caused by Enterococcal. Methods: From May 2013 to June 2020,the clinical data of 9 patients (2 males and 7 females) with chronic Enterococcal PJI treated with one-stage revision using intra-articular infusion of vancomycin at Department of Orthopaedics,First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed,including 8 hips and 1 knee.A total of 9 patients with age of (63.9±11.7)years (range:43 to 76 years) were included, and the body mass index was (23.6±4.3)kg/m2 (range:18 to 30 kg/m2).There were 6 cases with antibiotic history and 5 cases with sinus tract.The joint fluid,infected tissue around the prosthesis and ultrasonic shock fluid of the prosthesis were collected during operation for microbial culture identification and drug sensitivity test.After thorough debridement of the infected site and removal of the infected prosthesis,a new prosthesis was implanted,then the drainage tube in the operation area was placed.After surgery,vancomycin(1.0 g,q12 h) was combined with intra-articular vancomycin(0.5 g,qd) in monomicrobial PJI,and vancomycin(1.0 g,q12 h) was combined with intra-articular vancomycin (0.5 g,qd) and imipenem/meropenem (0.5 g,qd),and the interval between the two drugs was 12 hours in polymicrobial PJI.Hip and knee functions were evaluated by Harris Hip Score or Knee Society Score(KSS),respectively.The comparison of hip function scores before and after operation was performed by paired t-test. Results: All patients were followed up for (60±39)months(range:24 to 110 months).Two cases were infected with Enterococcus faecium and 7 cases were infected with Enterococcus faecalis.There were 7 cases of monomicrobial infection and 2 cases of polymicrobial infection.Erythromycin(5/9),tetracycline(4/9),ciprofloxacin and ß-lactam antibiotics(3/9) were the top three antibiotics in Enterococci resistance rate.The sensitive antibiotics for Enterococcal were vancomycin,linezolid and tigecycline.The average duration of intravenous antibiotics was (14±1)days (range:13 to 17 days),and the average duration of antibiotics in articular cavity was (15±2)days(range:11 to 20 days).Mean duration of oral antibiotic use after discharge was (2±1)months(range:1 to 3 months).One case of polymicrobial PJI treatment failed,with a failure rate of 1/9.At last follow-up,the Harris score of patients with hip PJI increased from (43±6)points to (84±6)points(t=-11.899, P<0.01). KSS score of knee function was improved from 33 point pre-operatively to 85 point post-operatively;overall function score was improved from 35 point pre-operatively to 80 point post-operatively.During the treatment,no formation of sinus tract of the hip joint caused by a catheter,skin necrosis at the knee puncture site or leakage of joint fluid;no complications such as deep vein thrombosis and pulmonary embolism occurred. Conclusions: One-stage revision combined with intra-articular infusion of vancomycin can achieve acceptable infection control rate and joint function in patients with chronic Enterococcus PJI.However,the treatment of polymicrobial PJI still needs to be further verified.

[A multicenter study on the tolerance of intravenous low-dose cyclophosphamide in systemic lupus erythematosus].

OBJECTIVE: To compare the safety of low-dose cyclophosphamide and high-dose cyclophosphamide in the treatment of systemic lupus erythematosus (SLE). METHODS: A total of 1 022 patients with systemic lupus erythematosus from 24 hospitals in China between March 2017 to July 2018 were enrolled. Their clinical manifestations, laboratory tests, adverse events, reasons for stopping receiving intravenous cyclophosphamide and comorbidities were collected. Among them, 506 SLE patients received short-interval low-dose intravenous cyclophosphamide therapy (SILD IV-CYC, 400 mg every two weeks), and 256 patients underwent high-dose cyclophosphamide therapy (HD IV-CYC, 500 mg/m2 of body surface area every month), the side effects between the two groups were compared, the remaining 260 SLE patients were treated with IV-CYC irregularly. Moreover, a total of 377 patients in SILD IV-CYC group and 214 patients in HD IV-CYC group had medical records of the reasons for stopping recei-ving IV-CYC. The reasons for stopping receiving IV-CYC in these two groups were analyzed. RESULTS: In this study, only 40.27%(238/591)of the SLE patients stopped receiving intravenous cyclophosphamide for the causes of disease improvement, however, up to 33.67% (199/591) of the patients for the reason of drug-related side effects. There were 83 patients out of 214 (38.79%) with high-dose intravenous cyclophosphamide treatment who stopped receiving IV-CYC for the drug-related side effects, which was significantly higher than that in the low-dose cyclophosphamide group (30.77%, 116/337, P=0.048). Of theses 506 patients in SILD IV-CYC group, 88 (17.39%) patients experienced gastrointestinal reactions, 66 (13.04%) suffered from infections, 49 (9.68%) had myelosuppression and 68 (13.44%) had alopecia, respectively. Among the 256 patients in the HD IV-CYC group, 80 (31.25%) experienced gastrointestinal reactions, 57 (22.27%) suffered from infections, 51 (19.92%) had myelosuppression and 49 (19.14%) had alopecia. Moreover, 71 (25.18%) of 282 female patients with age between 16 to 45 years in SILD IV-CYC group had abnormal menstruation, while menstrual disorder occurred in 39.72% (56/141) patients of HD IV-CYC group. There was no difference of drug-induced hepatic injury, hemorrhagic cystitis and fatigue between the two groups. CONCLUSION: Low-dose cyclophosphamide showed a lower prevalence of adverse events than high-dose cyclophosphamide in systemic lupus erythematosus patients.

[The prognostic value of dynamic minimal residual disease after autologous hematopoietic stem cell transplantation in patients with multiple myeloma in novel-agent era].

Objective: To investigate the clinical prognostic value of dynamic minimal residual disease (MRD) after autologous hematopoietic stem cell transplantation (AHSCT) in patients with multiple myeloma (MM). Methods: Patients with MM who underwent AHSCT in Beijing Chao-Yang Hospital from February 2016 to December 2019 were enrolled in this study. All the patients in the study had complete baseline data at the diagnosis. AHSCT was performed after induction chemotherapy. Response evaluation was performed after induction therapy. All the patients were assessed at approximately 100 days after AHSCT. Bone marrow MRD by NGF was performed every three months and dynamically monitored for at least 12 months. All the patients were divided into different groups according to cytogenetics and MRD status. Survivals in different groups were analyzed by IBM SPSS 22.0 statistical software. Results: A total of 150 patients with MM were enrolled in this study at last, including 66 patients in the cytogenetic standard risk group and 84 patients in the cytogenetic high-risk group. The median age was 54 years (range 30-68 years) and 87 male patients (58.0%) was in the study. The median follow-up was 36 months (range 16-72 months). Patients in the standard-risk group had better clinical prognosis than those in the high-risk group [median PFS in the standard-risk group was not achieved, and median PFS in the high-risk group was 45 months (P<0.001); median OS of both groups was not reached, and the estimated 3-year OS rate of the standard-risk group and the high-risk group was 95.2% and 78.9%, respectively (P=0.001)]. According to MRD status of patients, patients in each group were divided into three subgroups: persistent positive (Ppos), transient negative (Tneg) and persistent negative (Pneg). The median OS and median PFS of all subgroups in the standard-risk group was not reached (P=0.324 and P=0.086). In high-risk group, the median OS of MRD Pneg subgroup was not reached, and the estimated 3-year OS rate was 100%; The median OS of MRD Ppos subgroup was 52 months, and MRD Tneg subgroup only 31 months (P=0.002); the median PFS of MRD Pneg group was not reached, and the estimated 3-year PFS rate was 85.4%; median PFS of MRD Ppos subgroup was 40 months, and MRD Tneg subgroup only 17 months (P=0.001). Conclusions: MRD Pneg might overcome the adverse prognosis of MM patients with high-risk cytogenetics. However, MRD Tneg might be a poor prognostic factor for the patients with cytogenetic high-risk MM.

[Association between short-term exposure to ambient nitrogen dioxide and the risk of heart failure hospitalization].

Objective: To assess the association between short-term exposure level of nitrogen dioxide and the hospitalization risk of heart failure. Methods: Based on China-PEACE Retrospective Heart Failure Study, 117 364 hospitalized patients with heart failure were recruited from 92 hospitals in 62 cities throughout China between January 1, 2015 and December 31, 2015. The daily exposure level of nitrogen dioxide, temperature, and humidity in the same cities during the same period were also collected. We applied the generalized additive model and Bayesian hierarchical model to quantify the lagged effect and cumulative effect of short-term (0-3 days) exposure to ambient nitrogen dioxide on the hospitalization risk of heart failure. We further conducted stratified analyses by age, region, and season to identify any difference in the associations between short-term nitrogen dioxide exposure and heart failure among subgroups. Results: The mean age for participants in the analysis was (70.32±12.22) years. The median, minimum and maximum of daily nitrogen dioxide concentration in 62 cities from January 1, 2015 to December 31, 2015 was 26.4 µg/m3, 2.33 µg/m3 and 150.25 µg/m3, respectively. The exposure level of nitrogen dioxide at the same day was associated with the hospitalization risk of heart failure (OR=1.022, 95%CI: 1.012, 1.031). Significant effects were also observed in the moving average concentrations from lag 0-1 to lag 0-3 day (OR=1.020, 95%CI: 1.009, 1.030; OR=1.016, 95%CI: 1.004, 1.028; OR=1.013, 95%CI: 1.001, 1.026). Moreover, all of the associations between short-term exposure to nitrogen dioxide and the risk of heart failure hospitalization were statistically significant, with no significant difference in all subgroups stratified by age, region, and season. Conclusion: A higher level of short-term exposure to nitrogen dioxide could trigger more hospitalizations with heart failure.

Linc-ROR promotes mesenchymal stem cells chondrogenesis and cartilage formation via regulating SOX9 expression.

OBJECTIVE: The present study is to characterize the role of long intergenic non-coding RNA, regulator of reprogramming (linc-ROR) in bone marrow mesenchymal stem cell (BMSCs) chondrogenesis, cartilage formation and OA development. METHODS: Linc-ROR expression pattern in articular cartilage tissue sample from OA patients were studied by real-time PCR. Linc-ROR lentivirus mediated BMSCs were constructed. In vitro micromass cultured BMSCs chondrogenesis or in vivo MeHA hydrogel encapsulated BMSCs cartilage formation activity were studied. Linc-ROR associating miRNAs which repressed SOX9 expression were characterized by luciferase assay, real-time PCR and Western blot. Linc-ROR was co-transfected with miRNAs into BMSCs to study its rescue effect on SOX9 expression and chondrogenesis activity. RESULTS: Linc-ROR was down-regulated in articular cartilage tissue from OA patients and was positively correlated with the expression level of SOX9 (R2 = 0.43). Linc-ROR expression was upregulated during BMSCs chondrogenesis. Linc-ROR ectopic expression significantly promoted in vitro BMSCs chondrogenesis and in vivo cartilage formation activities as revealed by safranin O, alcian blue and COL II staining. The mRNA expression level of chondrogenesis markers including COL II, SOX9 and ACAN were increased, and the hypertrophy markers MMP13 and COL X were decreased upon linc-ROR overexpression in BMSCs. Linc-ROR functioned as a miRNA sponge for miR-138 and miR-145. Both miR-138 and miR-145 suppressed BMSCs chondrogenesis activity and SOX9 expression, while co-expression of linc-ROR displayed a rescuing effect. CONCLUSIONS: Taken together, linc-ROR modulated BMSCs chondrogenesis differentiation and cartilage formation by acting as a competing endogenous RNA for miR-138 and miR-145 and activating SOX9 expression. Linc-ROR could be considered as a new diagnostic and therapeutic target for OA treatment.

[Comparison of acquired immure deficiency syndrome-related knowledge and behavior between persons with and without human immunodeficiency virus- infection among young male students who have sex with men].

OBJECTIVE: To understand the differences between young male students who have sex with men (MSM) with and without human immunodeficiency virus (HIV)-infection in acquired immure deficiency syndrome (AIDS)-related knowledge and behavior, and to provide a scientific reference to make targeted and effective measures in AIDS prevention. METHODS: Using snow balling sampling combined with participants' referral, we conducted a questionnaire survey among 548 young MSM students (in whom there were both HIV-positive and HIV-negative) in Harbin, Tianjin, Xi'an, and Chongqing cities from April 2017 to March 2018. The chi-square test and binary Logistic regression were used to compare the differences in AIDS-related knowledge and behavior between males with and without HIV-infection. RESULTS: A total of 583 questionnaires were obtained, of which 548 were valid, with an effective rate of 94.0%. Having a junior college education or below (P=0.002), a monthly consumption level of less than 2 000 RMB (P=0.021), and living off campus (P=0.004) were associated with being tested positive for HIV. In any period of schooling, receiving AIDS prevention education was a protective factor for HIV infection [Primary school OR=0.203 (0.073－0.561), junior high school OR=0.287 (0.142－0.581), senior high school OR=0.271 (0.142－0.518), and university OR=0.322 (0.168－0.616)]. There was no statistical difference between HIV positive and negative young MSM students in the cognition of "AIDS-related Knowledge for Public"(P=0.907) and "AIDS-related Knowledge for Youth"(P=0.782), with the awareness rate all about 90%. There was a statistical difference in the need for some specific knowledge (For "AIDS prevention and treatment policy", P=0.012, for "Ways to identify and prevent high-risk sexual behavior", P < 0.001). HIV-positive males had a younger age of first sexual activity (P=0.006), had more sexual partners in the early (P < 0.001) and had lower frequency of condom use (P < 0.001). However, there was no statistical difference in the later number of sexual partners (P=0.247) and the frequency of condom use (For regular sex partners, P=0.735, and for casual sex partners, P=0.765), which might be related to the change of sexual behavior characteristics caused by HIV infection (For regular sex partners, P < 0.001, and for casual sex partners, P=0.006). CONCLUSION: There was no statistical difference between HIV positive and negative young MSM students in the cognition of "AIDS-related Knowledge for Public" and "AIDS-related Knowledge for Youth", which were both lower than 95% required by the state. However, the specificity in the knowledge needs was certainly shown. There was no significant difference in the recent sexual behavior between the two groups, but HIV positive students were more likely to have high-risk sexual behaviors in the early stage, so we should strengthen and move forward the sex education and AIDS prevention education with adjusted contents, and prevent high-risk sexual behaviors within young MSM students in the early stage.

Sleep and hypertension.

PURPOSE: Hypertension is a global public issue, and sleep status was regarded as its risk factor; however, the results were inconsistent. This study aims to deeply investigate the correlation between sleep status and hypertension. METHODS: The electronic databases Cochrane Library, Pubmed, and Embase updated to May 31, 2019, were retrieved. Studies were selected according to the predefined screening criteria, and their qualities were assessed by using quality check scales. Based on Stata 15.1 software, the associations between sleep status and hypertension were analyzed by meta-analyses, using odds ratio and 95% confidence interval as effect indexes. Furthermore, publication bias and small study bias were evaluated using Begg and Egger's test. In addition, sensitivity analysis was conducted through ignoring one study per time and then observing its influences on the pooled results. RESULTS: A total of 54 studies (involving 1,074,207 subjects) were eligible for this meta-analysis. Six factors were included in this study. Raised blood pressure was associated with obstructive sleep apnea (OSA), oxygen desaturation index (ODI), short sleep duration, and long sleep duration. The differences in ≤ 5 h, 6 h, ≥ 9 h, and 10 h groups had statistical significances, while there was no significant difference in ≥ 8 h group. Snoring is a risk factor of hypertension (OR = 1.94, 95%CI 1.41-2.67). Subgroup analysis was conducted and results were varied. CONCLUSIONS: The hypertension risk might be reduced by treated OSA, ODI, and snoring, as well as appropriate sleep duration. More studies with large sample sizes and high qualities should be included to support the findings further.

Chronic Obstructive Pulmonary Disease (COPD) management in the community: how could primary care team contribute?

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease commonly encountered in primary care. This study aimed to audit COPD care at primary care clinics of Hong Kong and to work out improvement strategies. METHOD: All COPD patients aged 40 or above who had been followed up at 13 public primary care clinics of Kowloon Central Cluster (KCC) under the Hospital Authority of Hong Kong (HAHK) were included in this clinic audit. Evidence-based audit criteria and performance standards were established after thorough literature review. Phase 1 was from 1st April 2016 to 31st March 2017, with deficiencies of care identified. It was followed by a one-year implementation phase through which a series of improvement strategies were executed. Outcome of the enhancement was reviewed during Phase 2 from 1st April 2018 to 31st March 2019. Chi-square test and student's t test were used to detect statistically significant changes between Phase 1 and Phase 2. RESULTS: A total of 2358 COPD cases were identified in Phase 1 where 658 of them were smokers. Of those smokers, 332 (50.5%) had been referred to Smoking Counselling and Cessation Service (SCCS) and 289 (43.9%) actually attended it. 991 cases (42%) received Seasonal Influenza Vaccine (SIV) and 938 cases (39.8%) received Pneumococcal Vaccine (PCV). 698 patients (29.6%) had spirometry done before and 423 patients (17.9%) had been admitted to hospital due to acute exacerbation of COPD (AECOPD). With the concerted effort taken during the implementation phase, Phase 2 data showed significant improvement in nearly all criteria. There was a marked increase in the SIV and PCV uptake rate, spirometry performance rate and most importantly, a significant reduction in AECOPD rate leading to hospital admission (13.5%, P = 0.000043). However, the referral rate and attendance rate of SCCS among smokers remained stagnant (P > 0.05). CONCLUSION: Via a systematic team approach, COPD care at primary care clinics of KCC under HAHK had been significantly improved for most of the audit criteria, which in turn reduced the burden of the healthcare system.

Proton pump inhibitors and risk of hip fracture: a meta-analysis of observational studies.

We performed a meta-analysis of relevant studies to quantify the magnitude of the association between proton pump inhibitors (PPIs) and risk of hip fracture. Patients with PPIs had a greater risk of hip fracture than those without PPI therapy (RR 1.20, 95% CI 1.14-1.28, p < 0.0001). These results could be taken into consideration with caution, and patients should also be concerned about the inappropriate use of PPIs. INTRODUCTION: Proton pump inhibitors (PPIs) are generally considered as first-line medicine with great safety profile, commonly prescribed for gastroesophageal reflux disease (GERD) and peptic ulcer disease. However, several epidemiological studies documented that long-term use of PPIs may be associated with an increased risk of hip fracture. Although, the optimal magnitude of the hip fracture risk is still undetermined. We, therefore, performed a meta-analysis of relevant studies to quantify the magnitude of the association between PPIs and risk of hip fracture. METHODS: We collected relevant articles using MEDLINE, EMBASE, Google Scholar, and Web of Science from January 1, 1990, to March 31, 2018. We included only the large (n ≥ 500) observational studies with a follow-up duration of at least one year in which the hip fracture patients were identified by a standard procedure. Two of the authors extracted data from each included study independently according to a standardized protocol. RESULTS: A total of 24 observational studies with 2,103,800 participants (319,568 hip fracture patients) met all the eligibility criteria. Patients with PPIs had a greater risk of hip fracture than those without PPI therapy (RR 1.20, 95% CI 1.14-1.28, p < 0.0001). An increased association was also observed in both low and medium doses of PPI taken and hip fracture risk (RR 1.17, 95% CI 1.05-1.29, p = 0.002; RR 1.28, 95% CI 1.14-1.44, p < 0.0001), but it appeared to be even greater among the patients with higher dose (RR 1.30, 95% CI 1.20-1.40, p < 0.0001). Moreover, the overall pooled risk ratios were 1.20 (95% CI 1.15-1.25, p < 0.0001) and 1.24 (95% CI 1.10-1.40, p < 0.0001) for the patients with short- and long-term PPI therapy, respectively, compared with PPI non-users. CONCLUSION: Our results suggest that PPI use is significantly associated with an increased risk of hip fracture development, which is not observed in H2RA exposure. Physicians should, therefore, exercise caution when considering a long-term PPI treatment to their patients who already have an elevated risk of hip fracture. In addition, patients should be concerned about the inappropriate use of PPIs; if necessary, then, they should continue to receive it with a clear indication.

Are we mis-estimating chemotherapy-induced peripheral neuropathy? Analysis of assessment methodologies from a prospective, multinational, longitudinal cohort study of patients receiving neurotoxic chemotherapy.

BACKGROUND: There are inconsistencies in the literature regarding the prevalence and assessment of chemotherapy-induced peripheral neuropathy (CIPN). This study explored CIPN natural history and its characteristics in patients receiving taxane- and platinum-based chemotherapy. PATIENTS AND METHODS: Multi-country multisite prospective longitudinal observational study. Patients were assessed before commencing and three weekly during chemotherapy for up to six cycles, and at 6,9, and 12 months using clinician-based scales (NCI-CTCAE; WHO-CIPN criterion), objective assessments (cotton wool test;10 g monofilament); patient-reported outcome measures (FACT/GOG-Ntx; EORTC-CIPN20), and Nerve Conduction Studies. RESULTS: In total, 343 patients were recruited in the cohort, providing 2399 observations. There was wide variation in CIPN prevalence rates using different assessments (14.2-53.4%). Prevalence of sensory neuropathy (and associated symptom profile) was also different in each type of chemotherapy, with paclitaxel (up to 63%) and oxaliplatin (up to 71.4%) showing the highest CIPN rates in most assessments and a more complex symptom profile. Peak prevalence was around the 6-month assessment (up to 71.4%). Motor neurotoxicity was common, particularly in the docetaxel subgroup (up to 22.1%; detected by NCI-CTCAE). There were relatively moderately-to-low correlations between scales (rs = 0.15,p < 0.05-rs = 0.48 p < 0.001), suggesting that they measure different neurotoxicity aspects from each other. Cumulative chemotherapy dose was not associated with onset and course of CIPN. CONCLUSION: The historical variation reported in CIPN incidence and prevalence is possibly confounded by disagreement between assessment modalities. Clinical practice should consider assessment of motor neuropathy for neurotoxic chemotherapy. Current scales may not be all appropriate to measure CIPN in a valid way, and a combination of scales are needed.

[Biomechanical changes of sheep cervical spine after unilateral hemilaminectomy and different degrees of facetectomy].

OBJECTIVE: To establish animal models and investigate the impact of unilateral hemilaminectomy (ULHL) and different degrees of facetectomy (FT) on the cervical spinal biomechanics. METHODS: Twenty sheep were randomly and evenly divided into 4 groups. No operation was performed for group A, right C4-C6 ULHL was performed for group B, right C4-C6 ULHL and 50% ipsilateral C4-C5 FT was performed for group C, right C4-C6 ULHL and 100% ipsilateral C4-C5 FT was performed for group D. Animals of group A, B, C and D were sacrificed 24 weeks after operating and fresh cervical spine specimens were acquired, biomechanically tested and these data were compared to determine whether ULHL and different degrees of FT led to long-term differences in range of motion. RESULTS: (1) Changes of the total range of motion of cervical spine 24 weeks after surgery: the total range of motion of group D (60.2°±8.6°) was significantly greater than group A (40.7°±6.4°) and group B (41.2°±13.1°) under flexion-extension station, the total range of motion of group D (81.5°±15.7°) was significantly greater than that of group A (56.7°±12.2°) and group B (57.7°±12.8°) under lateral bending station, and the total range of motion of group D (38.5°±17.5°) had no obvious increase compared with group A (26.4°±9.9°) and group B (27.1°±10.9°) under axial rotation station. The total range of motion of group C had no obvious increase compared with group A and group B under flexion-extension station (44.1°±11.7°), lateral bending station (73.6°±11.4°) and axial rotation station (31.3°±11.5°). (2) Changes of the intersegmental motion 24 weeks after surgery: the intersegmental motion of group D (20.3°±4.6°) at C4-C5 was significantly greater than that of group A (11.7°±3.4°) and group B (11.9°±2.1°) under flexion-extension station, the intersegmental motion of group D (26.8°±3.5°) at C4-C5 was significantly greater than that of group A (15.2°±3.1°) and group B (16.2°±3.2°) under lateral bending station, the intersegmental motion of group D (15.2°±3.5°) at C4-C5 was significantly greater than that of group A (6.6°±2.3°) and group B (7.1°±1.9°) under axial rotation station. The intersegmental motion of group C (21.2°±4.1°) at C4-C5 was significantly greater than that of group A and group B under lateral bending station, the intersegmental motion of group C at C4-C5 had no obvious increase compared with group A and group B under flexion-extension station (15.7°±3.7°) and axial rotation station (10.3°±3.1°). CONCLUSION: ULHL does not affect cervical stability, ULHL and 50% ipsilateral FT does not affect the long-term cervical stability, ULHL and 100% ipsilateral FT can lead to long-term instability under lateral bending and flexion-extension station.

[Effects of short-term intervention of walking on body mass index, waist circumference, and related indicators of working population].

Objective: To quantify the effects of short-term walking intervention on body mass index (BMI), waist circumference, and related indicators of working population. Methods: The China Motivational Healthy Walking Program in 2016 recruited 29 224 individuals from 139 demonstration areas for comprehensive prevention and control of chronic and non-communicable diseases at the national level and 70 areas at the provincial level. All subjects volunteered to participate into this program. The intervention lasted 100 days from June to September 2016. The walking behavior, height, weight and waist circumference of subjects were measured using a uniform pedometer, body composition tester, height tester and waist-to-hip caliper before and after the intervention. Daily average steps, daily average effective steps, and the percent of fulfilling continuous walking per day were used as main indicators in this study. Self-administered questionnaires were used to collect demographic characteristics, behaviors and chronic diseases. With the adjustment of potential confounding factors, multilevel regression was used to quantify the effect of walking on BMI and waist circumference, and multilevel logistic regression was used to quantify the effect on overweight or obesity and central obesity. Results: A total of 12 368 subjects completed walking interventions and all measurements included in this study. The mean±SD age of all subjects was (41.19±8.99) years, and 5 155 (59.17%) of them were women. After 100-day intervention, all outcome variables decreased significantly. For every additional 1 000 steps per day, subjects would have extra decrease in BMI of 0.023 kg/m(2) [ß (95%CI): -0.023 (-0.030, -0.017)], in waist circumference of 0.046 cm [ß (95%CI): -0.046 (-0.071, -0.020)], and the likelihood for becoming overweight or obesity was 0.97 times [OR (95%CI): 0.97 (0.95, 0.98)] that of before intervention. With additional 1 000 effective steps per day, the difference between baseline and endpoint increased by 0.028 kg/m(2) [ß (95%CI): -0.028 (-0.035, -0.020)] in BMI and 0.062 cm [ß (95%CI): -0.062 (-0.091, -0.033)] in waist circumference. The likelihood of progressing into overweight or obesity was 0.97 times [OR (95%CI): 0.97(0.95, 0.98)] that of before-intervention, and the likelihood of becoming central obesity was 0.98 times [OR (95%CI): 0.98(0.96, 0.99)] that of before-intervention. Compared to subjects with low level percent of fulfilling continuous walking per day, those with high level would have an extra decrease in BMI by 0.150 kg/m(2) [ß (95%CI): -0.150 (-0.22, -0.079)], in waist circumference by 0.340 cm [ß (95%CI): -0.340 (-0.620, -0.064)], and the likelihood of becoming overweight or obesity decreased to 0.74 times that of the low level group [OR (95%CI): 0.74(0.62, 0.89)] and the likelihood of becoming central obesity decreased to 0.78 times that of the low level group [OR (95%CI): 0.78 (0.68, 0.91)]. Conclusion: Strengthening walking exercise in the short term has a positive effect on promoting working population to reduce BMI and waist circumference, and prevent overweight, obesity and central obesity.