Pneumocystis jirovecii Pneumonia in Patients with Lung Cancer: A Review / 中国肺癌杂志

In recent years, with the widespread use of immunodepressant agents, Pneumocystis jirovecii pneumonia (PJP) has been significantly found in non-human immunodeficiency virus (HIV) patients, such as those with malignancies, post-transplantation and autoimmune diseases. Although the risk factors and management of PJP have been extensively studied in the hematologic tumor and post-transplant populations, the research on real tumor cases is insufficient. Lung cancer has been the most common tumor with the highest number of incidence and death worldwide, and the prognosis of lung cancer patients infected with PJP is poor in clinical practice. By reviewing the previous studies, this paper summarized the epidemiology and clinical manifestations of PJP in lung cancer patients, the risk factors and possible mechanisms of PJP infection in lung cancer patients, diagnosis and prevention, and other research progresses to provide reference for clinical application.
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Overview of Multiplex Immunohistochemistry and Immunofluorescence Techniques in the Lung Cancer Immunotherapy / 中国肺癌杂志

Lung cancer is the most common malignancy and is a major public health problem worldwide. Programmed cell death receptor 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors provide a new treatment strategy for non-small cell lung cancer (NSCLC). The existing biomarkers all have advantages and defects in selecting patients who benefit from immunotherapy. The multiplex immunohistochemistry/immunofluorescence (mIHC/IF) provides multiplex staining, allows comprehensive studies of cellular composition, cellular functions and cell-cell interactions. A number of studies have used mIHC/IF to explore specific immune cells in tumor immune microenvironment (TIME) and found that it is helpful for clinical prognosis and efficacy prediction in patients with lung cancer. In the era of immunotherapy for lung cancer, this technique has a bright future in translational research and clinical practice. The research progress of mIHC/IF detection in lung cancer immunotherapy is summarized in this review.
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Hospitalization Due to Asthma Exacerbation: A China Asthma Research Network (CARN) Retrospective Study in 29 Provinces Across Mainland China

PURPOSE: Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS: A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS: There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.

Management of corona virus disease-19 (COVID-19): the Zhejiang experience / 浙江大学学报·医学版

The current epidemic situation of corona virus disease-19 (COVID-19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID-19 inZhejiang Province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance"strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinarypersonalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in10% patients'blood samples at acute periodand 50% of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifyingcytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance"strategyeffectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviraleffects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favoredthe balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short periods of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis should be prescribed rationally and was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned.Some patients with COVID-19 showed intestinal microbialdysbiosis with decreasedprobiotics such as and . Nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore, we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the SARS-CoV-2 infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience above and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19.

Clinical experience of high-flow nasal cannula oxygen therapy in severe corona virus disease 2019 (COVID-19) patients / 浙江大学学报·医学版

Acute respiratory failure due to acute hypoxemia is the major manifestation in severe coronavirus disease 2019 (COVID-19) induced by severe acute respiratory syndrome coronavirus 2 infection. Rational and effective respiratory support is crucial in the management of COVID-19 patients. High-flow nasal cannula (HFNC) has been utilized widely due to its superiority over other non-invasive respiratory support techniques. To avoid HFNC failure and intubation delay, the key issues are proper patients, timely application and improving compliance. It should be noted that elder patients are vulnerable for failed HFNC. We applied HFNC for oxygen therapy in severe and critical COVID-19 patients and summarized the following experiences. Firstly, to select the proper size of nasal catheter, to locate it at suitable place, and to confirm the nose and the upper respiratory airway unobstructed. Secondly, an initial flow of 60 L/min and 37℃ should be given immediately for patients with obvious respiratory distress or weak cough ability; otherwise, low-level support should be given first and the level gradually increased. Thirdly, to avoid hypoxia or hypoxemia, the treatment goal of HFNC should be maintained the oxygen saturation (SpO) above 95% for patients without chronic pulmonary disease. Finally, patients should wear a surgical mask during HFNC treatment to reduce the risk of virus transmission through droplets or aerosols.

Management of COVID-19: the Zhejiang experience / 浙江大学学报·医学版

The current epidemic situation of coronavirus disease 2019 (COVID-19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID-19 in Zhejiang province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance" strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinary personalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in 10%patients' blood samples at acute period and 50%of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifying cytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance" strategy effectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviral effects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favored the balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short period of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned.Some patients with COVID-19 showed intestinal microbial dysbiosis with decreased probiotics such as and , so nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore,we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19.

Pharmaceutical care for severe and critically ill patients with COVID-19 / 浙江大学学报·医学版

Severe and critically ill patients with coronavirus disease 2019 (COVID-19) were usually with underlying diseases, which led to the problems of complicated drug use, potential drug-drug interactions and medication errors in special patients. Based on ( 6), and -19: , we summarized the experience in the use of antiviral drugs, corticosteroids, vascular active drugs, antibacterial, probiotics, nutrition support schemes in severe and critically ill COVID-19 patients. It is also suggested to focus on medication management for evaluation of drug efficacy and duration of treatment, prevention and treatment of adverse drug reactions, identification of potential drug-drug interactions, individualized medication monitoring based on biosafety protection, and medication administration for special patients.

Clinical experience of high-flow nasal cannula oxygen therapy in severe COVID-19 patients / 浙江大学学报·医学版

Acute respiratory failure due to acute hypoxemia is the major manifestation in severe coronavirus disease 2019 (COVID-19). Rational and effective respiratory support is crucial in the management of COVID-19 patients. High-flow nasal cannula (HFNC) has been utilized widely due to its superiority over other non-invasive respiratory support techniques. To avoid HFNC failure and intubation delay, the key issues are proper patients, timely application and improving compliance. It should be noted that elder patients are vulnerable for failed HFNC. We applied HFNC for oxygen therapy in severe and critical ill COVID-19 patients and summarized the following experiences. Firstly, to select the proper size of nasal catheter, to locate it at suitable place, and to confirm the nose and the upper respiratory airway unobstructed. Secondly, an initial ow of 60 L/min and 37℃ should be given immediately for patients with obvious respiratory distress or weak cough ability; otherwise, low-level support should be given first and the level gradually increased. Thirdly, to avoid hypoxia or hypoxemia, the treatment goal of HFNC should be maintained the oxygen saturation (SpO) above 95% for patients without chronic pulmonary disease. Finally, patients should wear a surgical mask during HFNC treatment to reduce the risk of virus transmission through droplets or aerosols.

Progress on the Study of PD-L1 Detection Methods in Non-small Cell Lung Cancer / 中国肺癌杂志

PD-1/PD-L1 inhibitors play an important role in the first-line and second-line treatment of non-small cell lung cancer (NSCLC), indicating a new treatment strategy of NSCLC. Completed clinical trials have shown that effective detection of PD-L1 expression is the key to the use of immunosuppressive agents. However, the gold standard for PD-L1 detection has still lacked. In recent years, immunohistochemistry (IHC) and enzyme-linked immunosorbent assay (ELISA) have been continuously innovated, which accounts for good prospect in PD-L1 detection. The research progress of PD-L1 detection methods in NSCLC is summarized in this review.
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Prognostic Analysis of EGFR-TKIs Combined with Gamma Knife in EGFR-mutant Lung Adenocarcinoma with Brain Metastasis / 中国肺癌杂志

BACKGROUND@#Advanced epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma had a high overall incidence of brain metastasis during the full course, and local brain radiotherapy combined with systemic targeted therapy may be a better strategy. This study aimed to identify the prognostic factors of EGFR-mutant brain-metastatic lung adenocarcinoma patients who received EGFR-tyrosine kinase inhibitors (EGFR-TKIs) in combination with gamma knife radiosurgery.@*METHODS@#Retrospective analysis of EGFR-mutant lung adenocarcinoma patients with brain metastases which developed at initial diagnosis or during EGFR-TKIs treatment period were performed. Intracranial progression free survival (PFS) was statistically analyzed between different subgroups to find out the prognostic factors including gender, age, smoking history, extracranial metastasis, EGFR mutation type, size and number of intracranial lesions, carcino-embryonic antigen (CEA) level, lung-molGPA score and so on.@*RESULTS@#A total of 74 EGFR-mutant brain-metastatic lung adenocarcinoma patients were enrolled in this study, with median intracranial PFS of 14.7 months. One-year intracranial-progression-free rate was 58.5%, and two-year rate was 22.2%. Univariate survival analysis showed that patients with lower CEA level at initial diagnosis (3)(15 months vs 12.6 months, P=0.041) were prone to have a superior intracranial PFS. Multivariate analysis showed that CEA≥10 ng/mL and intracranial lesion≥2 cm were the independent risk factors of intracranial PFS.@*CONCLUSIONS@#EGFR-TKIs in combination with gamma knife radiosurgery was an efficient treatment option to control the cranial tumor lesion. CEA≥10 μg/L at initial diagnosis and intracranial lesion≥2 cm were the risk factors of EGFR-mutant brain-metastatic lung adenocarcinoma patients receiving EGFR-TKIs in combination with gamma knife radiosurgery.

The efficacy and safety of different antimicrobial regimens in carbapenem-resistant Klebsiella pneumoniae bloodstream infections / 中华内科杂志

Objective To evaluate the efficacy and safety of different antimicrobial regimens in patients with bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP).Methods The clinical date of patients with CRKP bloodstream infections were retrospectively analyzed at the First Affiliated Hospital of Zhejiang University Medical College between January 2017 and January 2018.All subjects were separated into three groups based on antibiotics regimens over 72 hours,including meropenem 2.0 g every 8 hours,tigecycline 200 mg as initial dose and 100 mg every 12 hours,and polymyxin B 1.25 mg/kg every 12 hours as salvage treatment of tigecycline.Results A total of 86 patients were finally recruited,including 14,52 and 20 patients in groups of meropenem,tigecycline and polymyxin B salvage,respectively.All of the strains were resistant to meropenem and susceptible to tigecycline and polymyxin B initially,while 2 of them became resistant to tigecycline during treatment.The 28-day mortality was significantly higher in meropenem group (13/14) than that in tigecycline group and polymyxin B salvage group (61.5％,32/52) and (12/20),respectively (P＜0.01),while as no significant difference was seen in the last two groups (x2=0.014,P＞0.05).The incidences of hepatic impairment [3.8％(2/52) vs.1/20] and renal dysfunction (0 vs.1/20) between tigecycline group and polymyxin B salvage group were both comparable (P＞0.05).Conclusion The meropenem-based therapy is not recommended for CRKP-related bloodstream infections.Tigecycline-based therapy is still disappointing despite salvage use of polymyxin B after 72 hours.Hepatic and nephretic toxicities caused by additional polymyxin B are acceptable.

Characteristics and Influencing Factors of Pathogenic Bacteria in Lung Cancer Chemotherapy Combined with Nosocomial Pulmonary Infection / 中国肺癌杂志

BACKGROUND@#The aim of this study is to explore the pathogenic bacteria type, distribution, drug resistance and influencing factors of nosocomial pulmonary infection in patients with lung cancer during chemotherapy.@*METHODS@#This study retrospectively analyzed the clinical data of 411 patients with lung cancer who were hospitalized in the First Affiliated Hospital of Zhejiang University Medical College from January 2017 to December 2018, and counted the incidence of nosocomial lung infection, pathogens, drug resistance and influencing factors.@*RESULTS@#There were 184 cases of nosocomial pulmonary infection in 411 lung cancer patients during chemotherapy, the infection rate was 44.77%. The isolated pathogens included Gram-negative bacteria, Gram-positive bacteria, viruses, fungi and tuberculosis, among which Gram-negative bacteria accounted for 37.25%, followed by virus infection, accounting for 15.69%. Pseudomonas aeruginosa and Klebsiella pneumoniae are the main Gram-negative bacteria, Staphylococcus aureus and Streptococcus pneumoniae are the common gram-positive bacteria, influenza B virus is the main virus, Candida and Aspergillus are the most common fungi. The resistance rate of Pseudomonas aeruginosa to imipenem was 26.67%, while that of Klebsiella pneumoniae to imipenem was 12.50%, and that of the main Gram-positive bacteria to vancomycin was 0.00%. Hypoproteinemia, long chemotherapy cycle, high-intensity chemotherapy, chronic obstructive pulmonary disease and basic bronchiectasis were the high risk factors of lung cancer patients with nosocomial pulmonary infection during chemotherapy (P<0.05).@*CONCLUSIONS@#During the chemotherapy of lung cancer patients with nosocomial pulmonary infection, the distribution and drug resistance of pathogenic bacteria have certain characteristics. Clinicians should strengthen the detection of pathogenic bacteria and their drug resistance. On the basis of symptomatic treatment, to achieve the purpose of ensuring the treatment effect and prolonging the survival period of patients, preventive measures should be taken for high-risk patients to reduce the chemotherapy cycle and intensity as much as possible to reduce the incidence of infection life.

Seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China / 中华流行病学杂志

Objective To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China.Methods This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast,north,central,east,south,northwest and southwest).The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded.The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared.Results During the study period,6 480 patients were admitted for asthma exacerbation,accounting for 3.14％ of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals.The ratio of asthmatic patients to total inpatients in the northeast area (5.61％) was highest,and the ratio in east area was lowest (1.97％).Statistical analysis showed that the difference among different areas was significant (P＜0.000 1).In most areas,both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October).In the northeast area,east area and south area,the peaks in spring were more obvious,while in the north area and southwest area,the peaks in autumn were more obvious.In the northwest area the peaks occurred in winter (December-January) and summer (June-August),respectively.The differences in hospitalization due to asthma among different months were significant in the northeast,north,and southwest areas (P＜0.005).Conclusion The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China.In most areas,more asthmatic patients were admitted to hospitals in spring and autumn.

Independent predictors and prediction model of malignant micro-sized solitary pulmonary nodules / 中国肿瘤临床

Objective:To evaluate the clinical factors affecting the probability of malignant micro-sized (≤10 mm) solitary pulmonary nodules (≤10 mm, micro-sized SPN), and established a clinical prediction model. Methods:Medical records from 102 patients with a pathological diagnosis of micro-sized SPN (Group A), established between June 2012 and March 2014, were reviewed. Clinical data were collected to evaluate the independent predictors of malignant micro-sized SPN using single factor analysis and Logistic regression analysis. A clinical prediction model was subsequently created. Receiver-operating characteristic (ROC) curves were constructed using the prediction model. Between January 2015 and August 2017, data from an additional 10 patients enrolled from January 2015 to August 2017 from Jinhua Guangfu Hospital (Group B) with a pathological y diagnosed micro-sized SPN were used to validate this clinical prediction model. The model was also compared with the Mayo Clinic Model. Results:Median age of 102 patients (Group A) was 55.31±10.77 years old. There were 75.5％malignant nodules and 24.5％benign ones. Logistic regression analysis identified six clinical characteristics (no symptoms, upper lobe, diameter>5 mm, no clear border, not irregular round, no calcification) as independent predictors of malignancy in patients with micro-sized SPN. The area under the ROC curve for our model was 0.922 (95％CI:0.857-0.986). In our model, the diagnosis sensitivity and specificity were 88.3％and 84.0％, respectively. The test power of the model was better compared with the Mayo Clinic Model. Conclusions:In this study, we had found the independent predictors of malignant micro-sized SPN, and developed a prediction model that could accurately identify malignant micro-sized SPN in patients.

Evaluation of asthma management from the surveys in 30 provinces of China in 2015-2016 / 中华内科杂志

Objective To evaluate the general level of asthma management in urban areas of China and further promote the national asthma management plan. Methods A multi-center, cross-sectional survey was carried out in 30 provinces of China (except for Tibet) during Oct 2015 to May 2016. It's a questionnaire-based face-to-face survey which included asthma management using peak flow meter (PFM) and pulmonary function test,medication choice of maintenance therapy and asthma education.Results A total of 3 875 asthmatic outpatients were recruited including 2 347(60.6%)females and 1 528(39.4%)males. The mean age was(50.7±16.7)years ranging from 14 to 99.Only 10.1%(388/3 837)patients used PFM as monitoring, whereas 62.1%(2 405/3 874) patients underwent pulmonary function test during the past year. There were 57.4%(2 226/3 875) patients treated with inhaled cortical steroid plus long-acting β2-agonist combinations (ICS+LABA) as daily medication. 43.3%(1 661/3 836) patients were followed up by physicians. Among this population, 1 362 asthmatic outpatients were recruited, who also took part in the asthma control survey in 2007-2008 in 10 cities.In this subgroup,17.9%(244/1 360)were tested by PFM and 66.6%(907/1 362)by pulmonary function test during last year.As to the medication,63.1%(860/1 362) selected ICS+LABA for daily control. There were 50.4%(685/1 359) patients in the follow-up cohort by physicians.Compared to the similar survey conducted in 2007-2008,the proportion of patients with ICS+LABA regimen and follow-up by physicians were markedly higher,while the rate of PFM use did not have significant improvement. Conclusion Although the present level of asthma management in China is still far from ideal, asthma management has improved compared to 8 years ago. Yet the use of PFM does not significantly improve.Asthma action plan and application of PFM should be further promoted to improve the level of asthma management.

Seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China / 中华流行病学杂志

Objective To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China.Methods This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast,north,central,east,south,northwest and southwest).The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded.The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared.Results During the study period,6 480 patients were admitted for asthma exacerbation,accounting for 3.14％ of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals.The ratio of asthmatic patients to total inpatients in the northeast area (5.61％) was highest,and the ratio in east area was lowest (1.97％).Statistical analysis showed that the difference among different areas was significant (P＜0.000 1).In most areas,both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October).In the northeast area,east area and south area,the peaks in spring were more obvious,while in the north area and southwest area,the peaks in autumn were more obvious.In the northwest area the peaks occurred in winter (December-January) and summer (June-August),respectively.The differences in hospitalization due to asthma among different months were significant in the northeast,north,and southwest areas (P＜0.005).Conclusion The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China.In most areas,more asthmatic patients were admitted to hospitals in spring and autumn.

The influences of sucrose, citric acid and sodium bicarbonate on the adhesion of 3 kinds of adhesives / 实用口腔医学杂志

Objective:To study the influences of sucrose,citric acid and sodium bicarbonate on the adhesion of 3 kinds of adhesives.Methods:60 extracted tooth and 60 zirconia blocks (3 mm × 3 mm × 3 mm) were randomly divided into 3 groups (n =20),namely PULPDENT group,3M ESPE RelyxTM Veneer group and RelyxTM Luting group.Then,the samples of each group fell into 4 subgroups(n=5),namely subgroup A for artificial saliva,subgroup B for 10％ sucrose,subgroup C for 0.2％ citric acid,and subgroup D for 0.03 ％ sodium bicarbonate.After completing the adhesion of the specimens with corresponding adhesives,the specimens of subgroups A,B,C and D were submerged into artificial saliva(the control),sucrose,citric acid and sodium bicarbonate solutions for 2 times/day and 5 min/time,respectively.For the rest of time,all the specimens were submerged in artificial saliva.3 months later,shear bond strength of the specimens was tested,the fracture surface was observed under SEM,20 × microscope,and the fracture model was observed by stereoscopic microscope.SPSS 17.0 software was adopted for statistical analysis of the data.Results:The bond strength of PULPDENT,3M ESPE RelyxTM Veneer groups were higher than that of RelyxTM Luting group(P ＜ 0.05);the bond strength of subgroups B,C and D was lower than that of subgroup A(P ＜0.05);and the difference between the remaining groups was not statistically significant(P ＞0.05).SEM observation displayed that in group RelyxTM Luting,subgroups B,C and D showed increased crack depth,width and length when compared with subgroup A;there was no obvious difference between the remaining groups and the control group;in groups PULPENT,3M ESPE RelyxTM Veneer and RelyxTM Luting,all samples in their subgroups showed interface failure.Conclusion:Compared with PULPDENT and 3M ESPE RelyxTM Veneer adhesive,RelyxTM Luting is more susceptible to the influence of sucrose,citric acid and sodium bicarbonate,so it is not suitable for bonding zirconia blocks.

The influence of disposing the shoulder by the dental pneumatic ultrasonic hand-piece on the edge sealing prop-erty of the zirconium dioxide crown / 实用口腔医学杂志

15 extracted premolars were selected and randomly divided into 3 groups, with 5 in each group. MANI TF-13 bur、TR13-EF bur and the dental pneumatic ultrasonic hand-piece were respectively used to dispose the shoulder. 15 Zirconium dioxide full crowns were made. The shoulder marginal microleakage was observed by staining method. Dental pneumatic ultrasonic hand-piece showed the best anti-mic-roleakage effect in shoulder refinement.

Analysis of clinical manifestations and risk factors of mortality in Acinetobacter baumannii bloodstream infection / 中华内科杂志

Objective To explore the clinical manifestations,antimicrobial therapy,and risk factors of mortality in patients with Acinetobacter baumannii bloodstream infection.Methods Clinical data of 153 patients with Acinetobacter baumannii bloodstream infection hospitalized in First Affiliated Hospital of Zhejiang University from January 2013 to September 2014 were analyzed retrospectively.According to the 28-day survival after diagnosis,the patients were divided into death group (n =76) and survival group (n =77).Data related to demographic and clinical characteristics,underlying diseases,treatment,invasive procedures,bacterial resistance to antibiotics,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)scores at onset,and antimicrobial therapy were collected.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.Results This study included 153 patients with Acinetobacter baumannii bloodstream infection.The 28-day mortality was 49.7％.The independent risk factors of mortality were APACHE Ⅱ score ≥22 at onset (OR =15.7,95％ CI 5.1-48.1,P ＜ 0.001),septic shock (OR =6.3,95 ％ CI 1.9-21.3,P =0.003),and administration of steroids (OR =3.6,95％ CI 1.0-12.3,P =0.043).Compared with subjects treated with non-cefoperazone-sulbactam-based regimen,those treated with cefoperazone-sulbactam for multidrug-resistant Acinetobacter baumannii (MDR-AB) had significantly lower mortality on day7,day14 and day28 (8.9％ vs 59.2％,31.1％ vs 65.8％,44.4％ vs 72.4％ respectively).Conclusions The patients with Acinetobacter baumannii bloodstream infection have high mortality within one month.Administration of steroids and septic shock are associated with poor prognosis.APACHE Ⅱ score ≥ 22 at onset predicts adverse outcome.Cefoperazone-sulbactam-based antimicrobial therapy improves patients' survival.

In vitro culture and migration assay of mouse smooth muscle progenitor cells / 中国药理学通报

Aim To establish a reliable method for the culture of mouse smooth muscle progenitor cells and in-vestigate their migration ability .Methods Mesenchy-mal stem cells from compact bones were obtained from C57 BL/6 mice and stimulated with PDGF-BB to in-duce these cells to differentiate into smooth muscle pro-genitor cells. Morphological analysis , immunocyto-chemical and flow cytometric analysis were used to i-dentify the cell type and the migration ability was in-vestigated by the transwell system and flow cytometry . Result After PDGF-BB stimulation for 7 days, the cells showed spindle shape and started to express α-SMA as demonstrated by immunocytochemistry .After 21 days induction , Flow cytometric analysis revealed that over 70%of the cells expressed both CD 34 andα-SMA and 58.5%of the cells expressed SM-MHC.Mi-gration assay showed that the smooth muscle progenitor cells from culture could migrate in vivo and in vitro. Conclusions The culture of smooth muscle progenitor cells from compact bone-derived mesenchymal stem cells is easily operated with high yield rate and shorten culture period . Obtained smooth muscle progenitor cells from culture could migrate in vivo and in vitro, which is suitable for the mechanism studies .