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Because of the low throughput of current first-generation sequencing and the shortread length of second-generation sequencing, a new technology that overcomes the above shortcomings has emerged. The third-generation sequencing based on nanopore does not rely on the chain reaction of DNA polymerases and distinguishes bases by identifying electrical signals. It has broad application prospects and also faces more challenges. At present, it has many applications in detection of infectious pathogens, infectious disease prevention and control, genetic variation, and tumor diagnosis.
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Objective:To summarize the clinical characteristics and risk factors of combined pulmonary fibrosis and emphysema syndrome(CPFE)in the elderly.Methods:42 patients with CPFE and 83 patients with idiopathic pulmonary fibrosis(IPF)admitted to Beijing Hospital from January 2015 to January 2020 were included for this retrospective study, and their clinical data, laboratory test results, imaging, pulmonary function and treatment outcomes were compared.The correlations of diffusing capacity of the lungs for carbon monoxide(DLCO)with lung volume and other ventilation-related parameters were analyzed.Multivariate Logistic analysis was used to screen for risk factors.Results:Compared with the IPF group, the proportions of patients who were male(78.6% or 33/42 vs.50.6% or 42/83), were smokers(78.6% or 33/42 vs.45.8% or 38/83)and had allergies(23.8% or 10/42 vs.4.8% or 4/83)were significantly higher in the CPFE group( χ2=9.090, 12.219, 8.293, P=0.003, 0.000, 0.004, respectively). Eosinophil counts were significantly higher in the CPFE group than in the other group[0.17×10 9/L with a(0.12-0.25)×10 9/L range vs.0.10×10 9/L with a(0.03-0.21)×10 9/L range]. In terms of pulmonary function tests, patients with CPFE had higher levels of vital capacity(VC)[2.60 L, range: (2.18-3.08)L vs.1.99 L, range: (1.48-2.63)L], total lung capacity(TLC)[4.54 L, range: (3.89-5.45)L vs.3.74 L, range: (2.92-4.70)L], forced vital capacity(FVC)[2.46 L, range: (2.12-3.08)L vs.1.95 L, range: (1.43-2.58)L], and forced expiratory volume in 1 second(FEV1)/FVC%[84.18%, range: (75.59-88.83)% vs.80.94%, range: (69.07-83.08)%], with significant differences from patients in the IPF group( Z=2.032, 2.248, 2.357, 2.421, 3.102, P=0.042, 0.025, 0.018, 0.015, 0.002). Positive correlations of DLCO were found with residual volume of the predicted(RV%pred), vital capacity of the predicted(VC%pred), alveolar ventilation of the predicted(VA%pred), total lung capacity of the predicted(TLC%pred), forced vital capacity of the predicted(FVC%pred), and percentage of forced expiratory volume in first second as predicted(FEV1%pred)in the IPF group( r=0.422, 0.370, 0.473, 0.520, 0.356, 0.267, P=0.000, 0.002, 0.000, 0.000, 0.003, 0.029), but not in the CPFE group.According to multivariate Logistic regression analysis, smoking( OR=5.421, 95% CI: 1.458-20.154, P=0.012)and allergies( OR=7.458, 95% CI: 1.795-30.979, P=0.006)were independent predictors of CPFE. Conclusions:The eosinophil count and lung volume in elderly CPFE patients are higher than those in IPF patients, and the significant feature is the decrease of DLCO, which is not correlated with changes in lung ventilation parameters and lung volume.Smoking and allergies are risk factors for CPFE in the elderly.
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Objective:To study the value of ventilation/perfusion single-photon emission computed tomography(SPECT)in combination with a low-dose CT scan(SPECT/CT)in diagnosing pulmonary embolism(PE)in elderly patients.Methods:In this retrospective study, data were collected from 279 patients with suspected PE and undergone SPECT/CT between January 2015 and December 2019 at Beijing Hospital, with 163 aged ≥65(the elderly group)and 116 aged <65(the control group). Based on diagnosis confirmed during follow-up as the final diagnosis, the diagnostic efficacy of ventilation/perfusion SPECT/CT in the two age groups was examined.The diagnostic efficacy of ventilation/perfusion SPECT/CT and age-adjusted D-dimer in the elderly group was also compared.The diagnostic efficacy of ventilation/perfusion SPECT/CT and CT pulmonary angiography(CTPA)was compared in 43 elderly patients who had undergone both ventilation/perfusion SPECT/CT and CTPA.Results:The sensitivity, specificity and accuracy of ventilation/perfusion SPECT/CT in the elderly group were 96.10%(74/77), 91.86%(79/86)and 93.87%(153/163)in the elderly group and 96.43%(27/28), 94.31%(83/88)and 94.83%(110/116)in the control group, respectively, with no statistically significant difference between the two groups( χ2=0.000, 0.409, 0.116, P=1.000, 0.522, 0.733). The sensitivity, specificity and accuracy of age-adjusted D-dimer were 84.42%(65/77), 63.95%(55/86)and 73.62%(120/163), and were significantly different from those of ventilation/perfusion SPECT/CT(all P<0.05). Among 43 elderly patients undergone ventilation/perfusion SPECT/CT and CTPA, 1 was excluded because the diagnosis based on CTPA was uncertain.The diagnostic sensitivity, specificity and accuracy of ventilation/perfusion SPECT/CT were 96.55%(28/29), 92.31%(12/13)and 95.24%(40/42)and those of CTPA were 65.52%(19/29), 92.31%(12/13)and 73.81%(31/42). They had the same specificity, but there were significant differences in sensitivity and accuracy( P=0.012, 0.022). Conclusions:Ventilation/perfusion SPECT/CT has higher accuracy in the diagnosis of PE in elderly patients, compared with CTPA and age-adjusted D-dimer.
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Objective:To investigate the changes in clinical signs and laboratory testing results and their risk-tiring diagnostic effectiveness in elderly patients with pulmonary embolization (PE) with different risk levels.Methods:A retrospective analysis was conducted on the clinical data of elderly hospitalized PE patients in Beijing Hospital and other coordinated hospital from 2012 to 2020.Differences in 43 clinical signs and detection indicators between patients with four different risk levels were compared.The univariate and multivariate regression models were used to analyze differences between high-risk and non-high-risk PE and between intermediate-risk and low-risk PE with ROC analysis.Results:In the multi-group comparison, there are 33 clinical tests having significant differences between four risk groups, 29 clinical tests having significant differences between three risk groups(high, intermediate and low groups), and 21 clinical tests having significant differences between two groups(high and non-high groups). In the ROC analysis of risk stratification in high-risk and non-high-risk groups, it was found that the range of area under the curves(AUC)of 14 significantly changed clinical tests were 0.611 to 0.802 in the univariate regression analysis.The AUC of the model of systolic blood pressure(SBP)combined with white blood cell count(WBC)and aspartate aminotransferase(AST)was 0.8593(95% CI: 0.795-0.924)in the multivariate regression analysis.While in the ROC analysis between intermediate-risk and low-risk, the range of AUC of 12 significantly changed clinical tests were 0.592 to 0.835 in the univariate regression analysis.The B-type natriuretic peptide(BNP)and N-terminal B-type natriuretic peptide(NT-proBNP)can assist the risk stratification in intermediate-risk and low-risk PE groups.No efficient combined diagnosis model was found. Conclusions:The basic vital signs and multiple clinical laboratory tests were significantly different among four risk levels of elderly PE patients, such as blood gas analysis, coagulative function, liver and kidney function and myocardial markers.The combination of SBP, WBC, and AST can effectively assist the risk stratification in high-risk and non-high-risk PE groups.
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Objective:To establish the method for detecting lower respiratory infections (LRIs) bacterialpathogens using nanopore sequencing, and evaluate the feasibility of this method.Methods:Bronchoalveolar lavage fluid (BALF) samples from 33 patients with LRIs who visited the Department of Respiratory and Critical Care Medicine of Beijing Hospital from July 2019 to September 2020 were collected.Nanopore 16S amplicon sequencing were performed on these samples. In order to evaluate the clinical value of the nanopore sequencing, χ 2 test was used to analyze the pathogen differences between the detection rate and pathogen types results found with using the nanopore 16S sequencing and the results found with bacterial culture. Results:The process and method of nanopore sequencing used in the detection of the LRIs pathogens were established. The pathogen detection rate of the 16S sequencing was higher than that of the traditional bacterial culture (75.8% [25/33], 45.5% [15/33], χ2=5.140, P<0.05). From the 25 positive samples found with nanopore 16S sequencing, 16 pathogens were detected, including Haemophilus parainfluenzae, Haemophilus influenzae, Streptococcus pneumoniae, Streptomonas maltophilia, Acinetobacter baumannii, and Acinetobacter junii, Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecalis, Enterococcus gallinarum, Corynebacterium striatum, Mycobacterium paraintracellulare, Serratia marcescens, Achromobacter insuavis, Citrobacter murliniae and Mycoplasma pneumoniae. More than 6 pathogens were tested in clinical culture, including Haemophilus parainfluenzae, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae and Streptomonas maltophilia (χ2=7.949, P<0.05). 16S sequencing aligned to species level sequences accounted for 80.0 (60.0, 86.0)% of the genus level. The results obtained by using16S sequencing and bacterial culture were consistent in 11 (33.3%) samples. Conclusions:Nanopore 16S amplicon sequencing can quickly identify pathogenic bacteria from BALF in LRIs patients. Nanopore 16S amplicon sequencing has a high detection rate, it can detect more pathogens than traditional bacterial culture, and it can also identify most bacteria to the species level. This technology is a very promising platform with broad application prospects.
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Objective:To analyze the clinical features and prognosis of elderly patients with malignant tumors complicated with venous thromboembolism(VTE).Methods:The clinical data of 280 patients with malignant tumors and VTE hospitalized in Beijing Hospital from January 2003 to January 2013 were retrospectively analyzed.The clinical features and prognosis were analyzed and compared between the elderly and non-elderly groups.Results:Of the 280 patients with VTE, 167(59.6%)were elderly and 113(40.4%)were non-elderly, with an average age of(75.2±6.1)years and(53.9±8.2)years, respectively.Patients in the elderly group were associated with higher incidences of hypertension, coronary heart disease, cardiac insufficiency and chronic obstructive pulmonary disease, lower rate of liver disease, higher proportions of urinary system tumors, braking for more than 3 d, trauma history and surgery history(>3 months), lower proportions of chemotherapy history and surgery history(<1 month), increased occurrences of fever and lower extremity edema( χ2=6.043, P=0.014; χ2=3.862, P=0.049), a higher score of pulmonary embolism severity index( t=3.339, P=0.001), a lower platelet level in the elderly group( Z=-2.383, P=0.017), and a higher D-dimer level( Z=-3.150, P=0.002)compared with those in the non-elderly group(all P<0.05). Up to the follow-up time, 89 elderly patients in the elderly group died, with an average survival time of (29.3±2.8)months.However, 41 patients died in the non-elderly group with an average survival time of (49.7±4.1)months.The proportion of death in the elderly group(89/167, 53.3%)was higher than that in the non-elderly group(41/113, 36.3%)( χ2=8.394, P=0.004). Log-rank test showed that the difference in survival time between the two groups was statistically significant( χ2=8.878, P=0.003). The binary Logistic regression analysis showed that elderly men(≥65 years)( OR=3.263, 95% CI: 1.600~6.654)and urinary system tumors( OR=4.875, 95% CI: 1.526~15.571)were predictive factors of death in the elderly with malignant tumor and VTE. Conclusions:Patients with malignant tumors and VTE are more common in elderly patients.Elder patients have more comorbidities, greater disease severity and a higher rate of mortality.And male and urinary system tumors are predictors of death in elderly patients.
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Objective To systematically review the efficacy and safety of aspirin in prevention of venous thromboembolism (VTE) compared to LMWH,warfarin,rivaroxaban and placebo.Methods Randomized controlled trials (RCT) and cohort studies comparing aspirin to LMWH,warfarin,rivaroxaban and placebo for prevention of VTE were retrieved from PubMed,Embase,Cochrane Library,Scopus,Ovid,CINAHL and Wanfang Data.Meta-analysis was performed by using Rev Man 5.3 software after data extraction and quality evaluation.Results Totally 40 studies were included.There were no significant differences in overall rate of VTE(RR=1.08,95％CI:0.97-1.20,P=0.15),major bleeding incidence(RR=0.97,95％CI:0.81-1.16,P=0.73) and death (RR=0.86,95％CI:0.71-1.03,P=0.10)between aspirin and LMWH groups.Aspirin was associated with a lower risk of VTE(RR=0.49,95％CI:0.43-0.57,P＜0.05),major bleeding(RR=0.62,95％CI:0.46-0.84,P＜0.01)and death(RR=0.32,95％CI:0.15-0.64,P＜0.01)compared with warfarin.Rivaroxaban was associated with a significantly lower risk of deep-vein thrombosis (DVT) (RR=2.55,95％CI:1.41-4.62,P＜0.01),while no significant differences in pulmonary embolism (PE)(RR=1.86,95％CI:0.69-5.04,P=0.22),major bleeding(RR=0.90,95％CI:0.44-1.87,P=0.79)and death(RR=1.50,95％CI:0.60-3.74,P=0.39)compared with aspirin.Compared to placebo group aspirin significantly reduced the risk for VTE(RR=0.81,95％CI:0.72-0.90,P＜0.01),increased the frequency of major bleeding(RR=1.17,95％CI:1.06-1.30,P＜0.01),while there was no significant difference in death between aspirin and placebo (RR=0.97,95％CI:0.89-1.04,P=0.38).Conclusion Aspirin is not inferior to LMWH,warfarin,and rivaroxaban in safety and efficiency for preventing VTE,and can be used for VTE prevention for patients after total joint arthroplasty.
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Objective To investigate clinical features and prognosis of patients with cancerrelated isolated distal deep vein thrombosis(IDDVT).Methods Data of 64 patients with malignant tumor complicated with IDDVT at our hospital from January 2003 to January 2013 were retrospectively analyzed for the clinical features and prognosis.Results Among the 64 patients,32 male and 32 female cases were involved,aged 37 to 87 years,average(66.0 ± 12.6) years.There were 42 cases aged 65 years and older and 22 cases aged under 65 years.The IDDVT involved veins of lower extremity in 64 patients,unilaterally (47/64)or bilaterally (17/64).The intermuscular veins were involved by IDDVT in 46 cases(71.9％).Posterior tibial veins were involved in 17 cases(26.6％),peroneal veins were involved in 14 cases(21.9％),anterior tibial veins were involved in 2 cases (3.1 ％).Common symptoms were swollen lower extremity and pain (53.1％).Bleeding occurred in 2 (3.6 ％) of the 55 patients(55/64,85.9 ％) who underwent anticoagulant therapy,and no major bleeding occurred.The cumulative incidence of IDDVT at 3,6,and 12 months after tumor diagnosis was 64.0％ (41/64 cases),75.0 ％ (48/64 cases) and 85.9 ％ (55/64 cases),respectively.The cumulative incidences of IDDVT at 3 and 6 months were higher after diagnosis of lung cancer than after diagnosis of digestive tract tumors(P =0.005 and 0.035).By the end of follow-up(a median follow-up of 13.0 months),30 patients(46.9 ％)died.The mortality rate was lower in the non-elderly group than in the elderly group (22.7％ vs.59.5％,x2 =7.850,P=0.005).The mortality rate was lower in patients with stage Ⅰ-Ⅲa than in patients with stage Ⅲb-Ⅳ(24.0％ vs.68.8％,x2=11.246,P=0.001).The mortality rate was lower in patients with gynecologic tumors(10.0％) than in patients with lung cancer(55.6％),digestive tract tumors (40.0％) and hematologic tumors (71.4％) (P =0.041,0.037 and 0.035,respectively).TNM Ⅲ b-Ⅳ (OR =8.42,95 ％ CI:1.93-30.00,P =0.004) and age ≥ 65 years (OR =6.28,95％CI:1.50-27.76,P=0.012)were independent risk factors for death.Conclusions Cancerassociated IDDVT most commonly involves the intermuscular veins.The incidence of hemorrhage after anticoagulant therapy is low.For patients without anticoagulation contraindications,active anticoagulant therapy should be recommended.The advanced cancer and old age are independent risk factors for cancer-related IDDVT death.
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Objective To evaluate the diagnostic efficacy of the pulmonary perfusion tomography combined with low dose CT scan (Q SPECT/ CT) in detecting acute pulmonary embolism (PE) by compa-ring with pulmonary ventilation/ perfusion (V/ Q) SPECT imaging. Methods A total of 203 patients sus-pected with acute PE (88 males, 115 females, age range 19-94 years) from January 2013 to December 2015 were enrolled in this retrospective study. All patients underwent V/ Q SPECT and low dose CT scan. Final clinical diagnosis was regarded as the gold standard. The diagnostic consistency and diagnostic efficacy of Q SPECT/ CT were compared with those of V/ Q SPECT. χ2 test was used to compare the differences be-tween the two methods. Kappa analysis was used to analyze the agreement of them. Results The coinci-dence rate of Q SPECT/ CT and V/ Q SPECT was 94.09％(191/ 203), Kappa= 0.882, P<0.001. Among the 12 cases with inconsistent diagnosis, 9 were finally diagnosed as chronic obstructive pulmonary disease (COPD). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Q SPECT / CT in the diagnosis of PE were 95. 12％(78/ 82), 80.99％(98/ 121), 77.23％(78/ 101), 96.08％(98/ 102), 86. 70％ ( 176/ 203). The counterpart parameters of V/ Q SPECT were 95. 12％ ( 78/ 82), 90. 91％(110/ 121), 87.64％ (78/ 89), 96.49％ (110/ 114), 92.61％ (188/ 203). Compared with V/ Q SPECT, Q SPECT/ CT had the same sensitivity but lower specificity (χ2 = 4.928, P = 0.026). The positive predictive value, negative predictive value and accuracy of Q SPECT/ CT were lower than those of V/ Q SPECT, but there was no significant difference (χ2 values: 3.491, 0.000, 3.824, all P>0.05). Conclusion In the majority of patients with suspected acute PE, V/ Q SPECT scan can be replaced by Q SPECT/ CT, but it must be careful to select Q SPECT/ CT for patients with COPD history.
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Objective To explore the clinical characteristics and prognosis of patients with malignant tumor of digestive system combined with venous thromboembolism(VTE).Methods The clinical data of 77 patients admitted in Beijing Hospital from January 2003 to April 2013 with digestive system malignant tumor complicated with VTE were retrospectively analyzed.The incidence,clinical features and prognosis of the patients with digestive system cancer were analyzed.Results Among 77 patients,57 cases of male and 20 cases of female were involved,with an average age of(68.7 ± 12.4)years,including 60 cases(77.9 ％)of adenocarcinoma.The pathological results showed that differentiated tumors accounted for 61.0％ (47/77).Among the 77 patients,pulmonary thromboembolism (PTE) accounted for 33.8 ％ (26 cases) and deep vein thrombosis(DVT)in the low extremities accounted for 66.2 ％ (51 cases).Among all the patients,the most common symptoms were dyspnea and swelling or pain in the extremities.The incidence of VTE was 24.7％ (19/77),13.0％(10/77),19.5％(15/77),5.2％(4/77),5.2％ (4/77),32.5％ (25/77) at 1,3,6,9,12,＞ 12 months after diagnosis of digestive system malignancies,respectively.By April 2013,the 54.5 ％ (42/77) patients died,among which 73.8 ％ (31/42) died of digestive system malignancies,11.9 ％ (5/42) died of PTE,14.3 ％ (6/42) died of other causes.The mortality rates at 1,3,6,9,12,＞ 12 months after the diagnosis of VTE were 20.8％ (16/77),6.5 ％ (5/77),13.0 ％ (10/77),5.2 ％ (4/77),2.6 ％ (2/77),6.5 ％ (5/77),respectively.The difference in VTE incidence between the group aged ≥65 years and group aged ＜65 years at 1,3,6,9 and 12 months after the diagnosis of tumors was not statistically significant(P =0.309).The differences in mortality(P =0.357) and in the median survival time(x2 =0.290,P =0.591) between the two groups were not statistically significant at 1,3,6,9 and 12 months after the diagnosis of VTE.Conclusions The risks for VTE are high in patients with digestive tract malignant tumor,advanced malignant tumor,poor histologic grade(poorly or moderately differentiation),and chemotherapy or surgery,which mostly occurs within 3-6 months after diagnosis.Most deaths occur within the 1st year after the diagnosis of VTE.
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Objective To investigate the evolution of nonspecific manifestations of pulmonary function in elderly people.Methods Retrospective analysis of the data of nonspecific pulmonary function(NSPF) on the initial PF testing in elderly people from the same PFT apparatus in Beijing Hospital were collected from January 2004 to December 2012.All the patients with complete clinical data and reexamination at least one time were enrolled into this analysis.NSPF was defined as normal FEV1/FVC and TLC combined with a decreased FEV1 or FVC or both.All the patients with complete clinical data were divided into blocking group,restricted group,NFSP group and normal group according to their PF.The comparison was performed among these groups.Kaplan-Meier was used for analysis of the turnover and outcome of elderly NSPF patients,log-rank test was used for comparing the difference of turnover and outcome and COX regression was used for analyzing single and multiple factors of different turnover and outcome.Results Overall 59 patients were diagnosed as NSPF,with male:female ratio of 52:7,the average age of(71.8 ± 8.8)years and at a median follow-up of 4 years.The statistically significant differences in age,sex,body mass index(BMI),smoking status,both the clinical manifestations and chest CT performance at first visit and during the following-up were not found among the groups(all P ＞0.05).The pulmonary functions of NSPF patients were transformed into an obstructive pattern(19.6 ％),into a restrictive pattern(7.6 ％)and into a normal pattern(8.8 ％) in 4 years cumulative incidence rate,with statistically significant in differences(x2 =7.411,P =0.024).An invariant pulmonary function in NSPF patients accounted for 64.0％ in the most,and the second was obstructive ventilation function disability.Monomial and multinomial Cox regression analysis showed that emphysema and bulla in the initial CT scan was the predictor of the change to the obstructive pattern from NSPF during follow-up(HR=4.325,P=0.045),age was the predictor of the change to the restrictive pattern(HR=1.143,P=0.020).And pleural thickening and disappearing of pleural effusion were the predictor of change to the normal pattern (HR =8.889,P =0.018) respectively.Conclusions Most NSPF in elderly people could exist consistently.Obstructive pattern is the maximal likelihood of NSPF changing to the other pattern.Emphysema and bulla in the initial CT scan is the predictor of the obstructive pattern.The change is related with emphysema and bulla in the initial CT scan.
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Objective To explore the clinical characteristics and prognosis of patients with malignant tumor of digestive system combined with venous thromboembolism(VTE).Methods The clinical data of 77 patients admitted in Beijing Hospital from January 2003 to April 2013 with digestive system malignant tumor complicated with VTE were retrospectively analyzed.The incidence,clinical features and prognosis of the patients with digestive system cancer were analyzed.Results Among 77 patients,57 cases of male and 20 cases of female were involved,with an average age of(68.7 ± 12.4)years,including 60 cases(77.9 ％)of adenocarcinoma.The pathological results showed that differentiated tumors accounted for 61.0％ (47/77).Among the 77 patients,pulmonary thromboembolism (PTE) accounted for 33.8 ％ (26 cases) and deep vein thrombosis(DVT)in the low extremities accounted for 66.2 ％ (51 cases).Among all the patients,the most common symptoms were dyspnea and swelling or pain in the extremities.The incidence of VTE was 24.7％ (19/77),13.0％(10/77),19.5％(15/77),5.2％(4/77),5.2％ (4/77),32.5％ (25/77) at 1,3,6,9,12,＞ 12 months after diagnosis of digestive system malignancies,respectively.By April 2013,the 54.5 ％ (42/77) patients died,among which 73.8 ％ (31/42) died of digestive system malignancies,11.9 ％ (5/42) died of PTE,14.3 ％ (6/42) died of other causes.The mortality rates at 1,3,6,9,12,＞ 12 months after the diagnosis of VTE were 20.8％ (16/77),6.5 ％ (5/77),13.0 ％ (10/77),5.2 ％ (4/77),2.6 ％ (2/77),6.5 ％ (5/77),respectively.The difference in VTE incidence between the group aged ≥65 years and group aged ＜65 years at 1,3,6,9 and 12 months after the diagnosis of tumors was not statistically significant(P =0.309).The differences in mortality(P =0.357) and in the median survival time(x2 =0.290,P =0.591) between the two groups were not statistically significant at 1,3,6,9 and 12 months after the diagnosis of VTE.Conclusions The risks for VTE are high in patients with digestive tract malignant tumor,advanced malignant tumor,poor histologic grade(poorly or moderately differentiation),and chemotherapy or surgery,which mostly occurs within 3-6 months after diagnosis.Most deaths occur within the 1st year after the diagnosis of VTE.
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Objective To obtain a novel tool-enzyme for genetic engineering with good solubility,strong specificity of enzyme digestion and maintaining the enzyme activity at low temperature by using E.coli expression system to express self-processed re-combinant MBP-HRV 3C fusion protease.Methods The cDNA encoding HRV 3C protease was cloned into pRSF-Duet vector.The recombinant plasmid was transferred into E.coli BL21 (DE3)for expression.HRV 3C protease was obtained through Nichol col-umn affinity purification.The cleavage activity of HRV 3C protease was determined by in vivo experiment.Results HRV 3C prote-ase was highly expressed in E.coli expression system,and the obtained HRV 3C protease could recognize and digest HRV 3C site. Conclusion A novel tool-enzyme for genetic engineering is obtained.
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Objective To explore the clinical characteristics,relationship between treatment and prognosis of sarcoidosis and relationship of relapse to prednisone.Methods The clinical data of 165 patients with sarcoidosis were collected.The clinical characteristics,treatment process and prognosis,relationship of relapse with prednisone maintenance dose and course of treatment were retrospective analyzed.Results Among them,the most common involved systems were lung and lymph nodes.The involvement rates of lung,extra-thorax lymph nodes,cutaneous,ocular,salivary glands,liver & spleen,kidney and nervous system was 87.3％,51.5％,6.7％,6.1％,6.1％,4.2％,1.2％ and 1.2％ respectively.Unilateral tonsil,breast,ovary and bone involvement was seen in only 1 patient respectively with an involvement rate of 0.6％.A retrospective analysis was made for 114 cases with complete follow-up data.The mean follow-up period was (11.7 ± 5.7) (5-32) years.And 46 cases had no symptom on routine medical examinations.The most common consulted departments were respiratory,dermatological and general surgery departments.Among 74 patients on prednisone,48 patients (64.9％) were cured while 13 patients (17.6％) relapsed.Whereas in the observation group,25/38 patients (65.8％) remitted spontaneously and only 1 patient (2.6％) had recurrence.Relapse occurred more often in prednisone therapy group than in observation group (P ＜ 0.05).Longer prednisone 10-15 mg daily maintenance and a longer total course of treatment were associated with fewer recurrence(P ＜ 0.05).Conclusions The clinical manifestations of sarcoidosis vary and many patients have a self-limiting course.The most common involved systems are lung and lymph nodes.Stage Ⅰ / Ⅱ disease should be observed before prednisone therapy.Prednisone 10-15 mg daily for at least 6 months and a total course of treatment over 18 months may prevent relapse.
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Objective To compare clinical features,pulmonary functions,chest imaging and prognosis between combined pulmonary fibrosis and emphysema syndrome (CPFE) and idiopathic pulmonary fibrosis(IPF) without emphysematous changes in elderly patients.Methods 88 elderly IPF patients in Beijing hospital from January 2000 to October 2012 were divided into CPFE (n=30) and IPF (n =58) groups according to the CT imaging.Clinical features,blood gas analysis,pulmonary function,chest CT and survival time were compared between the two groups.Results 30 CPFE patients with the mean age of(75.5 ±7.6) years and 58 IPF patients without emphysema with the mean age of(73.7±6.8) years were enrolled.The proportions of male patients,smoking history and mortality were higher in CPFE patients than in IPF group(86.7％ vs.63.8％,28 vs.36,76.7％ vs.43.1％,x2 =5.09,9.74,8.98,P＜0.05 or 0.01).CPFE patients had a higher force vital capacity(FVC) and total lung capacity(TLC) as compared with IPF group [(2.6±0.9) L vs.(2.1± 0.5) L,(5.4±1.9) L vs.(4.4±1.1) L,t=2.69,2.35,P＜0.01 or 0.05].There were no significant differences in forced expiratory volume in one second(FEV1) and the diffusion capacity for carbon monoxide(DLCO) between the two groups.The main type of emphysema by HRCT scan were centrilobular emphysema in CPFE patients.There were lower median survival time in CPFE group than in IPF group [(3.0±0.2) years vs.(4.0±1.0) years,x2=4.50,P＜0.05].Conclusions The majority of elderly CPFE patients are males and smokers.The lung volume is increased in elderly CPFE patients as compared with IPF patients.Centrilobular emphysema is the primary type in CPFE patients.The prognosis is worse in elderly CPFE patients than in IPF patients.
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0. 05) . (3) The symptoms were ameliorated and the physically active ability was improved after 6 months exercise training. Conclusions Although the pulmonary function is not significantly improved, but the symptoms and the exercise endurance are improved after 6 months exercise training in the elderly outpatients with COPD.