Pemetrexed long-term maintenance therapy for advanced severe lung cancer with long-term progression-free survival: a case report.

It is relatively rare to achieve a median progression-free survival (PFS) of 40 months with pemetrexed monotherapy maintenance, especially in patients with advanced and severe lung cancer. Here, we reported a case of advanced severe lung adenocarcinoma treated with pemetrexed monotherapy maintenance achieving long survival with a median PFS of 46 months. A 52-year-old female diagnosed with stage IV lung adenocarcinoma was tested for no targeted drug benefit in the driver gene. The patient was financially disadvantaged and could not afford and refused immune checkpoint inhibitor drugs but was in the favor of platinum-based double-drug chemotherapy. After six cycles of effective administration of cisplatin in combination with pemetrexed, pemetrexed monotherapy was given for long-term maintenance treatment to date, with a median PFS of 46 months, with a treatment effect close to complete response and tolerable side effects.

Exposure duration of ambient fine particulate matter determines the polarization of macrophages.

Ambient fine particulate matter (FPM) promotes airway inflammation and aggravates respiratory and cardiovascular diseases. Macrophage polarization plays an essential role in FPM-induced inflammation and tissue repair. The balance of pro-inflammatory M1-type and anti-inflammatory M2-type macrophages determines the fate of tissues and is involved in the pathogenesis of various FPM-induced diseases. The mechanism of macrophage polarization induced by FPM is still not fully understood. Here, we explored the effect of ambient FPM exposure duration on the polarization of peritoneal macrophages. Mice were exposed to concentrated ambient FPM for different duration. Markers of M1-type macrophage and M2-type macrophage in peritoneal macrophages were detected. We found that macrophage polarization was affected by FPM both in vitro and in vivo. Acute FPM stimulation in vitro and short-term concentrated ambient FPM exposure in vivo promoted the expression of NLRP3 and NOS2 and inhibited the expression of ARG1 and CD206. With the extension of concentrated ambient FPM exposure time, ARG1 was gradually up-regulated, and NLRP3 was gradually down-regulated. These results indicate that FPM exposure duration interferes with macrophage polarization. This may provide new insight into the treatment of patients exposed to FPM.

Early aEEG can predict neurodevelopmental outcomes at 12 to 18 month of age in VLBWI with necrotizing enterocolitis: a cohort study.

BACKGROUND: Studies have shown that neurological damage is common in necrotizing enterocolitis (NEC) survivors. The purpose of the study was to investigate the predictive value of amplitude-integrated electroencephalogram (aEEG) for neurodevelopmental outcomes in preterm infants with NEC. METHODS: Infants with NEC were selected, and the control group was selected based on 1:1-2 pairing by gestational age. We performed single-channel (P3-P4) aEEG in the two groups. The Burdjalov scores were compared between the two groups. Cranial magnetic resonance imaging (MRI) was performed several months after birth. The neurological outcomes at 12 to 18 months of age were compared with the Gesell Developmental Schedules (GDS). The predictive value of aEEG scores for neurodevelopmental delay was calculated. RESULTS: There was good consistency between the two groups regarding general conditions. In the 1st aEEG examination, the patients in NEC group had lower Co (1.0 (0.0, 2.0) vs. 2.0 (2.0, 2.0), P = 0.001), Cy (1.0 (0.0, 2.0) vs. 3.0 (3.0, 4.0), P < 0.001), LB (1.0 (0.0, 2.0) vs. 2.0 (2.0, 2.0), P < 0.001), B (1.0 (1.0, 2.0) vs. 3.0 (3.0, 3.5), P < 0.001) and T (3.0 (2.0, 8.0) vs. 10.0 (10.0, 11.5), P < 0.001), than the control group. Cranial MRI in NEC group revealed a widened interparenchymal space with decreased myelination. The abnormality rate of cranial MRI in the NEC group was higher than that in the control group (P = 0.001). The GDS assessment indicated that NEC children had inferior performance and lower mean scores than the control group in the subdomains of gross motor (71 (SD = 6.41) vs. 92 (SD = 11.37), P < 0.001), fine motor (67 (SD = 9.34) vs. 96 (SD = 13.69), adaptive behavior (76 (SD = 9.85) vs. 95 (SD = 14.38), P = 0.001), language (68 (SD = 12.65) vs. 95 (SD = 11.41), P < 0.001), personal-social responses (80 (SD = 15.15) vs. 93(SD = 14.75), P = 0.037) and in overall DQ (72 (SD = 8.66) vs. 95 (SD = 11.07), P < 0.001). The logistic binary regression analysis revealed that the NEC patients had a significantly greater risk of neurodevelopmental delay than the control group (aOR = 27.00, 95% CI = 2.561-284.696, P = 0.006). Confirmed by Spearman's rank correlation analysis, neurodevelopmental outcomes were significantly predicted by the 1st aEEG Burdjalov score (r = 0.603, P = 0.001). An abnormal 1st Burdjalov score has predictive value for neurodevelopmental delay with high specificity (84.62%) and positive predictive value (80.00%). CONCLUSIONS: Children with NEC are more likely to develop neurodevelopmental delay. There is high specificity and PPV of early aEEG in predicting neurodevelopmental delay.

Clinical analysis of a case of neonatal exfoliative esophagitis in an 18-day-old neonate.

BACKGROUND: This study aims to provide guidance for clinical work through analysis of the clinical characteristics, endoscopic and pathological manifestations, diagnosis, and treatment of an 18-day-old neonate with exfoliative esophagitis. CASE PRESENTATION: The patient presented with vomiting but the parents did not pay too much attention. The pathological report revealed numerous fibrinous exudative necrotic, and inflammatory cells, as well as a small amount of squamous epithelium. Furthermore, milk allergy factors were considered. Conservative treatments, such as fasting, acid suppression, mucosal protection, parenteral nutrition, and the replacement of anti-allergic milk powder were given. Thereafter, endoscopic examination revealed that the patient returned to normal, and was discharged after 21 days. CONCLUSIONS: Exfoliative esophagitis has multiple causes; and has characteristic clinical and endoscopic manifestations. Endoscopic examination after 18 days presentation and conservative therapy revealed that the esophagus had returned to a normal appearance and the patient was discharged. Following discharge, the parents were advised to feed the patient ALFERE powder. Attention should be given to the timely detection of complications and corresponding treatment.

Effect of proton pump inhibitors versus histamine-2 receptor antagonists on acute kidney injury in septic patients at high risk for developing stress ulcers.

BACKGROUND: To compare the effects of proton pump inhibitor (PPI) and histamine-2 receptor antagonist (H2RA) use on the occurrence of acute kidney injury (AKI) in septic patients at high risk for developing stress ulcers. METHODS: Using the Medical Information Mart for Intensive Care IV version 2.2 database, septic patients with high-risk factors for stress ulcers (i.e., shock, coagulopathy, invasive mechanical ventilation, or chronic liver diseases) were included. Exposures included PPIs and H2RAs within 24 h of intensive care unit (ICU) admission or prior to ICU admission. The primary end point was severe sepsis-associated AKI as defined by the Kidney Disease Improving Global Outcomes criteria stage 3 (KDIGO-3). Propensity score matching (PSM) was performed to balance baseline characteristics. Multivariable Cox proportional hazards regression was used to estimate the effect size. RESULTS: 4731 PPI users and 4903 H2RA users were included. After PSM, there were 1785 pairs exposed to PPIs and H2RAs. In the PSM cohort, the cumulative incident KDIGO-3 rate was higher in the PPI group than in the H2RA group (log-rank test, p = 0.009). Regression analyses showed that PPI exposure [adjusted hazard ratio 1.32, 95% confidence interval (CI) 1.11-1.58, p = 0.002] was associated with incident KDIGO-3 compared with H2RA use. This association remained consistent in sensitivity analyses. Additionally, the PPI group had a higher need for kidney replacement therapy compared with the H2RA group (3.6% vs. 2.1%, P = 0.012). CONCLUSIONS: Among septic patients at high risk for developing stress ulcers, PPI exposure was associated with incident KDIGO-3 AKI compared with H2RA use.

Suspicious Plantar Lesion-A Case Report of Angiosarcoma.

Diabetic foot is one of the most common complications of diabetic mellitus (DM). This DM patient was admitted to our hospital presented with a 2-month history of plantar lesion. Shortly afterward, the patient appeared hemoptysis, respiratory failure, and multiple purpuric papules on his limbs. Biopsy of left plantar lesions demonstrated angiosarcoma. Therefore, it is suggested that tissue biopsy should be taken as early as possible for DM patients with prolonged nonhealing wounds.

Risk Factors Associated with Multi-Drug Resistance in Neonatal Sepsis Caused by Escherichia coli.

Background and Objective: An increasing number of cases of neonatal sepsis due to extended-spectrum beta-lactamase (ESBL)-producing multi-drug resistant (MDR) Escherichia coli (E. coli) have been reported worldwide. The aim of this study was to explore the risk factors associated with ESBL-producing MDR E. coli among neonates with culture-confirmed E. coli sepsis and thereby to help selection of appropriate empirical antibiotics. Patients and Methods: All newborn infants with a confirmed pathogen isolated from blood or cerebrospinal fluid (CSF) from 2016 to 2021 were identified and those with E. coli infection were included in this analysis. We compared a group of neonatal patients with ESBL-producing MDR E. coli sepsis (n=69) to a group with ESBL-negative E. coli (n=70) based on antimicrobial susceptibility reports. We used multivariable regression analysis to determine the risk factors associated with ESBL-producing MDR E. coli strains among the neonates with culture-confirmed E. coli sepsis. Results: ESBL-producing MDR E. coli sepsis was more common in premature infants and newborns with hospital-acquired late-onset sepsis (HALOS). The mortality rate of neonatal sepsis caused by ESBL-producing E. coli was about twice as that of sepsis caused by ESBL-negative E. coli. Antepartum exposure to cephalosporins (OR=25.191, 95% CI: 3.184-199.326, P<0.01) and parenteral nutrition for more than 1 week (OR=4.495, 95% CI: 2.009-10.055, P<0.01) were independent risk factors for neonatal infection with ESBL-producing stains among infants with E. coli sepsis. Conclusion: E. coli remains the most common Gram-negative bacterial pathogen causing neonatal sepsis. A higher proportion of ESBL-producing MDR E. coli is seen in premature infants and those newborns with HALOS and is associated with higher mortality. Antepartum use of cephalosporins and prolonged use of parenteral nutrition may be important factors to consider in the selection of empirical antibiotics for use in neonatal sepsis caused by gram-negative rods prior to the availability of the results of antimicrobial susceptibility.

[Changes of anti-Streptococcus pneumoniae status in rats with simulated weightlessness].

OBJECTIVE: To study the changes of anti-Streptococcus pneumonia (SP) status in rats with simulated weightlessness, and therefore to provide theoretical basis for the aerospace medicine. METHODS: Thirty-two healthy male Wistar rats were randomly allocated into 4 groups: group A, the tail-suspension and SP group; group B, the tail-suspension without SP group; group C, the unsuspended but SP group; group D, the unsuspended and no SP group, with 8 rats in each. The tail-suspension method, i.e. about 30° head-down tilt, was used for the model of simulated microgravity. On day 4, 0.4 ml of SP suspension [ATCC6303, serotype III(ATCC, bacteria concentration about 9.0×108 CFU/ml)] was instilled by tracheal intubation. Sterile saline was used for the control group. The experiment was ended after 7 days of tail-suspension. Lung pathology, blood test and C-reactive protein level were studied, and the CD(4)(+)/CD(8)(+) ratios were measured by flow cytometry. RESULTS: The lung pathological changes were much more severe in Group A as compared to those in Group B, C and D. The total number of WBC showed no significant difference among groups (F = 1.57, P = 0.22). But the neutrophil number was higher in Group A [(2.4 ± 0.53)×109/L], B [(2.0 ± 0.31)×109/L] and C [(1.7 ± 0.40)×109/L] as compared to Group D [(1.2 ± 0.15)×109/L], u = 0.0001, P = 0.001; u = 1.0, P = 0.001; u = 8.5, P = 0.013, respectively. The percentage of neutrophils showed a similar difference. The total number of lymphocytes showed no significant difference among groups (F = 0.720, P = 0.548). CRP levels in the SP infection groups were significantly higher than those in the uninfected groups. The ratio of CD(4)(+)/CD(8)(+) showed no difference among groups (F = 1.225, P = 0.319). Weight loss after the experiment was most severe in Group A (F = 122.067, P < 0.001). CONCLUSIONS: In rats with simulated weightlessness, the anti-infective ability to Streptococcus pneumoniae was reduced, and the inflammatory response was significantly increased, but the anti-infective immunity was compromised.

[Clinical analysis of 31 cases of neonatal purulent meningitis caused by Escherichia coli].

OBJECTIVE: Neonatal purulent meningitis is a severe infection responsible for high mortality and disabling sequelae. Escherichia coli is the main pathogen of neonatal purulent meningitis. This study explored the clinical characteristics and antibiotic resistance of Escherichia coli-induced neonatal meningitis. METHODS: A retrospective chart review was performed. A total of 31 cases of neonatal purulent meningitis caused by Escherichia coli were identified in the neonatal intensive care unit between January 1, 2001 and December 31, 2011. The clinical characteristics and antibiotic sensitivity test results were analyzed. RESULTS: Fever, poor feeding, lethargy and seizure were common clinical signs of neonatal purulent meningitis caused by Escherichia coli. Acute complications mainly included hyponatremia (17 cases), hydrocephalus (8 cases), subdural collection (2 cases), ventriculitis (2 cases) and cerebral infarction (1 case). Thirty neonates (97%) had increased CRP levels. Of the 31 patients, 14 cases were cured and 12 had adverse outcomes (5 patients died during hospitalization). Escherichia coli strains were resistant (>50%) to commonly used penicillins and cephalosporins between 2007 and 2011, presenting significantly higher resistance rates than between 2001 and 2006. The detection rate of extended spectrum ß-lactamases (ESBLs)-producing strains between 2007 and 2011 increased significantly compared with between 2001 and 2006 (57% vs 0). CONCLUSIONS: The clinical manifestations of neonatal purulent meningitis caused by Escherichia coli are non specific. The outcome is poor. Monitoring of CRP levels is valuable for the early diagnosis of neonatal purulent meningitis. The antimicrobial resistance rates of Escherichia coli are increasing, especially to cephalosporins. The percentage of ESBLs-producing strains is increasing over the years.

Exploring the Spatiotemporal Evolution and Socioeconomic Determinants of PM2.5 Distribution and Its Hierarchical Management Policies in 366 Chinese Cities.

From 2013 to 2017, progress has been made by implementing the Air Pollution Prevention and Control Action Plan. Under the background of the 3 Year Action Plan to Fight Air Pollution (2018-2020), the pollution status of PM2.5, a typical air pollutant, has been the focus of continuous attention. The spatiotemporal specificity of PM2.5 pollution in the Chinese urban atmospheric environment from 2018 to 2020 can be summarized to help conclude and evaluate the phased results of the battle against air pollution, and further, contemplate the governance measures during the period of the 14th Five-Year Plan (2021-2025). Based on PM2.5 data from 2018 to 2020 and taking 366 cities across China as research objects, this study found that PM2.5 pollution has improved year by year from 2018 to 2020, and that the heavily polluted areas were southwest Xinjiang and North China. The number of cities with a PM2.5 concentration in the range of 25-35 µg/m3 increased from 34 in 2018 to 86 in 2019 and 99 in 2020. Moreover, the spatial variation of the PM2.5 gravity center was not significant. Concretely, PM2.5 pollution in 2018 was more serious in the first and fourth quarters, and the shift of the pollution's gravity center from the first quarter to the fourth quarter was small. Global autocorrelation indicated that the space was positively correlated and had strong spatial aggregation. Local Moran's I and Local Geti's G were applied to identify hotspots with a high degree of aggregation. Integrating national population density, hotspots were classified into four areas: the Beijing-Tianjin-Hebei region, the Fenwei Plain, the Yangtze River Delta, and the surrounding areas were selected as the key hotspots for further geographic weighted regression analysis in 2018. The influence degree of each factor on the average annual PM2.5 concentration declined in the following order: (1) the proportion of secondary industry in the GDP, (2) the ownership of civilian vehicles, (3) the annual grain planting area, (4) the annual average population, (5) the urban construction land area, (6) the green space area, and (7) the per capita GDP. Finally, combined with the spatiotemporal distribution of PM2.5, specific suggestions were provided for the classified key hotspots (Areas A, B, and C), to provide preliminary ideas and countermeasures for PM2.5 control in deep-water areas in the 14th Five-Year Plan.

Escherichia coli Causing Neonatal Meningitis During 2001-2020: A Study in Eastern China.

BACKGROUND AND OBJECTIVE: Neonatal meningitis (NM) caused by Escherichia coli remains a major health problem in industrialized countries. Currently, information on the epidemiology and antimicrobial susceptibility patterns of NM in developing countries such as China is relatively scarce. Therefore, the present study investigated changes in the antimicrobial susceptibility of E. coli causing NM in a perinatal center in eastern China over the past 20 years. METHODS: This survey was conducted during three periods: 2001-2006, 2007-2012, and 2013-2020. NM was diagnosed according to the number of white blood cells in the cerebrospinal fluid (CSF) and the presence of a single potential pathogenic bacterium in the culture prepared from the blood or CSF of a newborn baby. Changes in the antimicrobial susceptibility of E. coli were analyzed. RESULTS: In total, 182 NM cases were identified. E. coli was identified in 69 of these cases, and in 21 of these cases, extended-spectrum beta-lactamase (ESBL) production was detected. E. coli was the main cause of NM identified in this study. The overall susceptibility of E. coli to third-generation cephalosporins such as cefotaxime decreased from 100% during 2001-2006 to 50% during 2007-2012 and, subsequently, increased to 71.0% during 2013-2020. This pattern of change is correlated with bacterial ESBL production. Only 8.3% of E. coli found in samples collected from infants with early onset meningitis (EOM) produced ESBL, while 37.3% of E. coli isolated from children with late-onset meningitis (LOM) produced ESBL. CONCLUSION: E. coli remains the primary pathogen of NM. Compared with that isolated from infants with LOM, the percentage of ESBL-producing multidrug-resistant E. coli isolated from infants with EOM is significantly lower. Clinicians should consider this trend when determining appropriate and effective antibiotics as empirical treatment for NM.

Clinical Analysis of Severe Radiation Pneumonia.

OBJECTIVE: The present study aims to discuss the clinical characteristics, factors, and treatment methods affecting the prognosis in patients with severe radiation pneumonia (RP). METHODS: The radiotherapy status, clinical features, imaging characteristics, laboratory examination results, treatment methods, and prognoses of 34 patients with severe RP treated in our department between January 2011 and July 2017 were retrospectively analyzed. The severe RP grading was based on the Common Terminology Criteria for Adverse Events version 4.0; patients who scored Grade ≥3 were considered to have a severe case of RP. RESULTS: The results of the present study showed that 22 patients had lung cancer, 6 had esophageal cancer, 5 had breast cancer, and 1 had colon cancer with lung metastasis. The total radiation dose was 37.5-66 Gy, and the overall average dose was 53 Gy; the average dose in the patients who died was 52.9 Gy. A total of 28 patients presented with a cough and sputum as the initial symptom, and 24 presented with wheezing as an accompanying symptom; of the 24 patients, 8 experienced fever, 2 experienced wheezing as the only symptom, 1 had chest pain, and 1 had chest tightness. In 26 patients, the changes were in the radiation field, and in 8 cases, the changes appeared both inside and outside the radiation field. After the use of glucocorticoid methylprednisolone, respiratory support, and anti-infection treatment, 18 patients were cured, 8 showed a condition improvement, and 8 died. CONCLUSION: The prognosis of severe RP was not significantly correlated with the administered radiation dose; however, lung cancer, a high Acute Physiology and Chronic Health Evaluation score, and delayed diagnosis were risk factors for patient death. However, a combination of antibiotic therapy, ventilator-assisted respiration, and steroid therapy could improve patient prognosis.

Soluble Triggering Receptors Expressed on Myeloid Cells-1 as a Neonatal Ventilator-Associated Pneumonia Biomarker.

BACKGROUND: Neonatal ventilator-associated pneumonia (NVAP) is one of the main infections acquired in hospitals, and soluble triggering receptors expressed on myeloid cells-1 (sTREM-1) are a TREM-1 subtype that can be released into the blood or bodily fluids during an infection. METHODS: The patients included in the present study were divided into three groups: the NVAP group, the first control group, and the second control group (n = 20, each). Children requiring respiratory treatment were assigned to the NVAP group, newborns who received mechanical ventilation and had neonatal respiratory distress syndrome were assigned to the first control group, and newborns with normal X-ray and electrocardiogram results but no non-pulmonary infection was assigned to the second control group. The blood and bronchoalveolar lavage fluid (BALF) sTREM-1 levels in all newborns were analyzed. RESULTS: The acute-phase blood and BALF sTREM-1 levels were significantly higher in the NVAP group than in the first control group, and the blood sTREM-1 expression level was lower in the second control group than in the NVAP group. CONCLUSION: The present results suggest that sTREM-1 might be a useful biomarker for NVAP prediction in the Department of Pediatrics.

[The clinical characteristics and treatment of community outbreaks of the new influenza A (H1N1) infection].

OBJECTIVE: To describe the clinical characteristics of 3 community outbreaks of the novel influenza A (H1N1), and to compare the treatment effects of the traditional Chinese medicine with or without Oseltamivir. METHOD: The clinical records of 234 patients in 3 community outbreaks of the novel influenza A (H1N1) infection in June (n = 56), August (n = 96) and October (n = 82) of 2009 were analyzed, and the treatment effects of the traditional Chinese medicine with or without Oseltamivir were evaluated. RESULTS: The baseline characteristics, including age, temperature, indices of blood tests, hepatic and renal functions were distributed evenly between the 2 treatment groups. The overall analysis suggested that there was no significant difference between the 2 treatment groups in the duration of clinical symptoms (P > 0.05), the duration of fever (P > 0.05), and the hospitalization days (P > 0.05). However, an analysis stratified by the temperature (≥ 39°C or < 39°C) suggested that patients treated by the traditional Chinese medicine with Oseltamivir tended to suffer a shorter duration of fever [40.5 (37.3, 42.0) vs 22.0 (10.5, 30.8) hr, P < 0.01) ] in the higher temperature group. CONCLUSIONS: The traditional Chinese medicine was equivalent to oseltamivir in treating patients with the novel influenza A (H1N1) infection with lower temperature (< 39°C). Oseltamivir was effective in shortening the duration of fever in patients with temperature higher than 39°C.

[Clinical characteristics of neonatal Klebsiella pneumoniae sepsis and the antibiotic sensitivity pattern of strains].

OBJECTIVE: To study the clinical characteristics of neonatal sepsis caused by Klebsiella pneumoniae and the antibiotic sensitivity pattern of Klebsiella pneumoniae strains. METHODS: The clinical data of 42 cases of neonatal sepsis caused by Klebsiella pneumoniae from January, 2000 to August, 2009 were retrospectively studied. RESULTS: The clinical presentations were non-specific, including fever or hypothermia, tachypnea, apnea and feeding intolerance. C-reactive protein (CRP) level increased in 95% of the cases. The mortality was 21%. In neonates with early onset sepsis, Klebsiella pneumoniae strains were sensitive to amoxicillin/clavulanic-acid, piperacillin/tazobactam, cefoxitin, imipenem, cefoperazone/and sulbactam. In neonates with late onset sepsis, the sensitive antibiotics of Klebsiella pneumoniae strains were less, including cefoxitin, piperacillin/tazobactam and imipenem. Klebsiella pneumoniae strains were not sensitive to penicillins and cephalosporins in either neonates with early onset sepsis or late onset sepsis. The extended spectrum ß-lactamases (ESBLs)-producing strains were found in 92% of the cases. The neonates with late onset sepsis presented a higher prevalence of ESBLs-producing strains than those with early onset sepsis (100% vs 70%; P<0.05). CONCLUSIONS: The clinical manifestations of neonatal sepsis caused by Klebsiella pneumoniae are usually non-specific. CRP detection is valuable for early diagnosis of sepsis. There are differences in the antibiotic sensitivity of strains between the neonates with early onset and late onset Klebsiella pneumoniae sepsis.

Cavitation and fatal hemoptysis after immunotherapy for advanced lung adenocarcinoma: A case report.

Immune checkpoint inhibitor (ICI)-related massive hemoptysis with cavitation has rarely been identified. Here, we report a case of advanced lung adenocarcinoma with lethal bleeding after eight cycles of pembrolizumab. A 55-year-old male was diagnosed with stage IV non-small cell lung cancer (NSCLC). Following confirmation of high programmed death-ligand 1 (PD-L1) expression of 60% cancer cells, he subsequently received pembrolizumab monotherapy. His symptoms and chest images significantly improved after four cycles of therapy. However, after eight cycles of immunotherapy, he presented with recurrence of bloody sputum and shortness of breath. Pembrolizumab was discontinued and a diagnosis of checkpoint inhibitor-associated pneumonitis (CIP) was made. When the CIP was absorbed after glucocorticoid therapy, the patient died of sudden massive hemoptysis with cavitation in the lesion. KEY POINTS: Although checkpoint inhibitor associated pneumonitis was the leading cause of ICI-related death, clinicians should be alerted to the finding that more attention should be given to hemoptysis attributed to ICI therapy in advanced lung cancer.

[Exposure of acute severe air pollution promotes inflammatory cell infiltration and increases the levels of proinflammatory cytokines and chemokines in lung tissues of rats].

Objective To observe the effect of acute severe air pollution exposure on cytokines and chemokines in lung tissues of rats and explore its significance. Methods During the period of severe air pollution in Beijing from December 17 to 22, 2016, rats were exposed to air pollution for 6 days, and then sacrificed on the 7th day. Lung tissues were taken and their histological changes were observed by HE staining. The levels of 22 cytokines/chemokines in the lung tissue homogenate supernatant were detected by liquid chip method. Results Compared with the control group, the lung tissues of the rats in the air pollution exposure group were characterized by widened alveolar septum, inflammatory cell infiltration and vascular bleeding. Chemokines eotaxin, monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-2 (MIP-2), regulated on activation, normal T cell expressed and secreted factor (RANTES), and proinflammatory cytokines interleukin 1ß (IL-1ß), IL-17, IL-18, tumor necrosis factor α (TNF-α) in the supernatant of lung homogenate of rats in the air pollution exposure group significantly increased. But anti-inflammatory IL-10 significantly decreased. Th1 cytokines IL-2 and interferon-γ (IFN-γ) did not change, and Th2 cytokines IL-5 increased by 1.65 times and IL-10 decreased by 0.82 times. Conclusion Acute severe air pollution exposure can lead to inflammatory response in lung tissues of rats. The secretion of chemokines eotaxin, MCP-1, MIP-2, RANTES and proinflammatory cytokines IL-1ß, IL-17, IL-18, TNF-α are promoted in this process. The infiltrated T cells in lung tissues are dominated by Th2 cells.

Hyperosmotic Infusion and Oxidized Surfaces Are Essential for Biofilm Formation of Staphylococcus capitis From the Neonatal Intensive Care Unit.

Staphylococcus capitis is an opportunistic pathogen often implicated in bloodstream infections in the neonatal intensive care unit (NICU). This is assisted by its ability to form biofilms on indwelling central venous catheters (CVC), which are highly resistant to antibiotics and the immune system. We sought to understand the fundamentals of biofilm formation by S. capitis in the NICU, using seventeen clinical isolates including the endemic NRCS-A clone and assessing nine commercial and two modified polystyrene surfaces. S. capitis clinical isolates from the NICU initiated biofilm formation only in response to hyperosmotic conditions, followed by a developmental progression driven by icaADBC expression to establish mature biofilms, with polysaccharide being their major extracellular polymer substance (EPS) matrix component. Physicochemical features of the biomaterial surface, and in particular the level of the element oxygen present on the surface, significantly influenced biofilm development of S. capitis. A lack of highly oxidized carbon species on the surface prevented the immobilization of S. capitis EPS and the formation of mature biofilms. This information provides guidance in regard to the preparation of hyperosmolar total parenteral nutrition and the engineering of CVC surfaces that can minimize the risk of catheter-related bloodstream infections caused by S. capitis in the NICU.

[Costs of the last hospitalization for patients with acute exacerbation of chronic obstructive pulmonary disease and patients with lung cancer].

OBJECTIVE: To examine the cost for patients who died in hospital with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) compared with those died with lung cancer, and to examine their variations. METHODS: A retrospective cohort study was performed. The patients who died in hospital between January in 2003 and December in 2007 were enrolled. Statistical analysis was performed using the SPSS 13.0. RESULTS: Totally 416 patients were enrolled, with 86 COPD patients and 330 lung cancer patients. Patients with COPD were older than those with lung cancer. The incidences of co-morbidities such as coronary artery disease, hypertension, cerebrovascular disease, respiratory failure and lung infection in AECOPD patients were higher than those in lung cancer patients. Second malignant neoplasm of important organs was found in 211 patients (63.94%) with lung cancer. In the last hospitalization, the total amount of direct medical costs was higher for patients with AECOPD than for patients with lung cancer [74 143 (102 608) RMB vs 37 810 (51 374) RMB], z = 2.48, P < 0.05, especially for the treatment cost [(19 324 (61 843) vs 5876 (9764), z = 4.55, P < 0.01] and the laboratory cost [7976 (18 397) vs 3397 (4096), z = 5.97, P < 0.01]. There was no significant difference in the constituents of the cost between COPD and lung cancer patients (chi(2) = 8.23, P > 0.05). The percentage of the drug cost to the total cost was the highest, followed by the treatment cost and the auxiliary examination cost. The ratio of the drug cost to the total cost was lower in COPD patients (37.2 +/- 12.6)% vs (53.8 +/- 17.6)%, t = 7.34, P < 0.01, while the constituent ratio of treatment cost was higher in COPD than in lung cancer patients CONCLUSIONS: There was significant variability in healthcare resource utilization between COPD and lung cancer patients in their last hospitalization of life, the main reason of which was the increased costs of maintenance of life.

Multi-Drug Resistant Escherichia coli Causing Early-Onset Neonatal Sepsis - a Single Center Experience from China.

BACKGROUND AND OBJECTIVE: Infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) have raised public-health concerns and are becoming a global health challenge. This study aimed to investigate changes in antimicrobial resistance of E. coli responsible for early-onset sepsis (EOS) in a perinatal center in eastern China. METHODS: Two periods, 2002 to 2008 and 2012 to 2018, were investigated. EOS was defined as the presence of a single potentially pathogenic bacterium grown from blood or cerebrospinal fluid in cultures drawn in any newborn infant within 72 hrs of birth. The changes in antimicrobial resistance of E. coli were analyzed. RESULTS: A total of 163 cases of EOS were identified, and E. coli continued to be the leading pathogen in our neonatal intensive care unit (NICU). Overall resistance of E. coli to third-generation cephalosporins increased from 14.3% in 2002-2008 to 46.7% in 2012-2018 (p<0.05). This resistance pattern closely parallels ESBL production. Compared to that from term infants, E. coli isolated from preterm infants had a significantly higher rate of resistance to ampicillin (93.3% vs 48.4%, p<0.01) and gentamicin (60.0% vs 9.4%, p<0.01), as well as a higher rate of ESBL production (66.7% vs 15.6%, p<0.01). CONCLUSION: We conclude that ESBL-producing multi-drug resistant E. coli has emerged as the major pathogen responsible for early-onset neonatal sepsis, particularly in preterm infants. Clinicians should consider this trend and attempt to select proper effective antibiotics as the empirical treatment for early-onset neonatal sepsis.