“闪电小生”马樟花

越剧舞台六十年, 故人往事近万千, 多少奇才常怀念, 边忆边谈写成篇。

长期家庭氧疗联合雾化吸入治疗COPD的疗效观察

目的 观察评价长期家庭氧疗联合布地奈德雾化吸入治疗慢性阻塞性肺病（COPD）的临床效果.方法 将86例稳定期COPD患者随机对照试验分为两组,对照组43例给予常规对症疗法治疗,观察组43例在常规对症疗法基础上给予长期家庭氧疗联合布地奈德雾化吸入治疗,并比较两组的临床效果.结果 观察组总有效率为93.02％,明显高于对照组的76.74％（P＜0.05）;治疗后,观察组与对照组FEV1较治疗前均明显升高（均P＜0.05）,观察组FEV1明显高于对照组（P＜0.05）;治疗后,观察组与对照组FVC较治疗前均显著升高（均P＜0.05）,观察组FVC显著高于对照组（P＜0.05）;治疗后,观察组与对照组FEV1/FVC较治疗前均显著升高（均P＜0.05）,观察组FEV1/FVC显著高于对照组（P＜0.05）;治疗后,观察组气促消失时间、咳嗽消失时间、肺部啰音消失时间均显著低于对照组（均P＜ 0.05）.结论 长期家庭氧疗联合布地奈德雾化吸入治疗COPD能够提高临床疗效,增加组织供氧,改善患者的呼吸功能,延缓病情发展,并提高患者的生活质量.

Antiviral Activity of the Effective Monomers from Folium Isatidis Against Influenza Virus in Vivo

In order to evaluate the anti-influenza virus activity of the effective monomer from Folium Isatidis (FI) in vivo,we established mice model with viral pneumonia and divided them into 3 different dose groups,then observed their lung indexes,pulmonary pathological changes,pulmonary virus hemagglitination titers,living time and death rates.The results showed that the monomer could reduce the pulmonary index from 2.64 to 1.93,1.63 and 1.40 (P<0.01) and decrease the hemagglitination titer from 1.15 to 0.84,0.70 and 0.59 (P<0.01).In addition,different groups of FI could significantly lessen the mortality rate from 100% to 30%,25% and 15%,and prolong the living time from 5.1d to 6.5d,8.4d and 8.9d respectively(P<0.01).The high dose (75 mg/kg/d) has the similar effect with 100 mg/kg/d dose of virazole(P>0.05),and more effective than 200 mg/kg/d dose of antiviral liquor (P<0.05).

MUC5AC EXPRESSION UP-REGULATION GOBLET CELL HYPERPLASIA IN THE AIRWAY OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Objective To determine the number of goblet cells, the change of MUC5AC expression in chronic obstructive pul- monary disease (COPD) patients and the relationship of smoking with goblet cell, MUC5AC, and lung function. Methods Eighteen patients undergoing lung resections for a solitary peripheral carcinoma were classified by lung function as having COPD. Twenty patients with normal lung function served as the control group. Normal lobe bronchioles far away from the lesion site were taken for paraffin section. Goblet cells were identified by AB/PAS staining and the ex- pression of MUC5AC in the paraffin’s section was tested by immunohistochemistry. Results Goblet cell hyperplasia was observed in the COPD group. The positive rate of goblet cell in COPD group (0.20% ± 0.10%) was significantly higher than that in the normal lung function group (0.13% ± 0.06%, P < 0.05). The posi- tive rate of MUC5AC expression in the COPD group (0.27% ± 0.09%) was higher than that in the normal lung function group (0.20% ± 0.10%, P < 0.05). The positive rate of goblet cell in smokers (27.93% ± 9.00%) of the COPD group and normal lung function group was higher than that in non-smokers (17.70% ± 9.37%, P < 0.05), while MUC5AC expression had no significant difference between smokers and non-smokers (17.88% ± 6.44% and 10.88% ± 7.10%, respectively). Conclusion For COPD patients with declined lung function, there were goblet cell hyperplasia and increased expres- sion of MUC5AC. MUC5AC expression up-regulation may due to goblet cell hyperplasia. Smoking may be an important factor for goblet cell hyperplasia.

Bronchopulmonary infection with lophomonas blattarum:two cases report and literature review

Objective： To improve the recognition and diagnosis on the bronchopulmonary infection with Lophomonas blattarum （L. blattarum）. Methods： The clinical characteristics of 2 patients diagnosed and treated in our hospital were reported, and 42 cases that had been reported from years 1993 to 2007 are analyzed. Results： In our report, the first patient attacked serious asthma time after time, the second patient suffered from bronchiectasis with a protracted infection course. Forty-four cases all have pathogen examination and parasitic expertise. The most common symptoms are fever, cough and expectoration. 1/3 of the patients have increased acidophilic granulocyte in peripheral blood. Chest X film and CT scanning suggest changes were similar to pneumonia. Chronic cases are manifested with bronchial asthma, bronchiectasis and pulmonary abscess. L. blattarum found in phlegm or specimen collected by bronchoscopy provides the most reliable evidence for the diagnosis of this disease. Conclusion： Bronchopulmonary L. blattarum infection is a new kind of diseases. The clinical manifestations are similar to pneumonia, asthma, bronchiectasis infection or pulmonary abscess. L. blattarum found in sputum smear, bronchoscopic brush smear, bronchoscopic biopsy smear, or hronchoalceolar lavage under microscope is the foundation of the diagnosis. The pathogen species has not been finally confirmed. It is still unclear how the pathogen exists in the natural environment, how to transmit to persons and what kind of people would suffer from the disease more easily. Treatment only with antibiotics is not effective to this disease. Metronidazole with dosage of 0.5 g per time and twice per day was effective to most patients, the period of treatment need to last 14-38 d, but multidrug resistance case had been reoorted.

Comparative study of induction chemotherapy and chemoradiotherapy in the treatment of limited-disease small cell lung cancer with ipsilateral pleural effusion

Objective:The aim of the study was to explore the effects and side effects of induction chemotherapy followed by chemoradiotherapy for limited-disease small cell lung cancer (LD-SCLC) patients with ipsilateral pleural effusion.Methods:From January 2005 to May 2009,52 LD-SCLC patients with ipsilateral pleural effusion were treated with induction chemotherapy first.The regimen was taken as follows:etoposide 100 mg iv,d1-d5,cisplatin 25 mg/m2 iv,d1-d3 or CBP AUC 4 iv,d1.Three-week therapy was a cycle.According to pleural effusion status after 2-4 cycles induction chemotherapy,patients got disappearance of pleural effusion after chemotherapy were underwent thoracic radiotherapy (TRT;50 Gy/25 fraction) or same chemotherapy regimen;patients without disappearance or with increasing of pleural effusion after chemotherapy were given same chemotherapy regimen.Therapeutic effect was evaluated every two cycles according to RECIST 1.0 and side-effects were evaluated every cycle according to NCI-CTC AE Grades.All patients were followed up,and the median follow-up time was 26 months.Results:The response rate of patients was 80.7% (42/52) after induction chemotherapy and 34 patients got disappearance of pleural effusion.The median survival time,1-and 2-year survival rates were 15.4 months,76.9% (40 /52) and 38.5% (20 /52) respectively.The median survival time,1-and 2-year survival rates of patients with pleural effusion remission received chest radiotherapy (A group,n=20),patients with pleural effusion remission received chemotherapy (B group,n=14) and patients without pleural effusion remission received chemotherapy (C group,n=18) were 21.5 months,14.4 months,12.5 months,80.0%,64.3%,55.6% and 35%,21.4%,11.1%,respectively.Main side effects were grades 1-2,including myelosuppression,fatigue,nausea and vomiting.No therapeutic related death was occurred.Conclusion:Induction chemotherapy plus chemoradiotherapy has shown better effect in prolonging survival of small cell lung cancer (SCLC) patients with ipsilateral pleural effusion than chemotherapy alone.The patients with decreased ipsilateral pleural effusion may receive benefit from subsequent TRT.

Lung Cancer Survival Improvement through Surgical Intervention in PUMCH Hospital

Objective： To investigate and evaluate improvement of lung cancer survival after surgical intervention in PUMC hospital during the last 15 years. Methods： From January 1989 to December 2003, 1574 lung cancer cases underwent surgical treatment and followed up. All cases in this series were divided into two groups according to time period： group A （1999-2003） and group B （1989-1998）. The difference in the survival rate between groups A and B was compared. Results： The morbidity and mortality in group A was decreased significantly in comparison to group B （11.2% vs. 19.2%, 1.06% vs. 1.93%, respectively）. However, the 3-year and 5-year survival rate was increased from 42.35% to 56.07%, and from 28.46% to 38.99%, respectively. A significant improvement in survival was observed in patients with stage Ⅰ, Ⅱ and ⅢA, but not in those with stage ⅢB and Ⅳ. Also, patients with lobectomy had more satisfactory results than those receiving exploratory thoracotomy, limited resection, pneumonectomy and sleeve resection. Conclusion： Lobectomy plus systematic mediastinal lymph nodes dissection has become the standard mode for resectable lung cancer. Combination of complete resection along with lymph nodal dissection, and postoperative adjuvant chemotherapy based on platinum/3^rd generation chemotherapy medicine, has preliminarily been justified, proving an important approach for effective improvement in long-term survival of non-small cell lung carcinoma.

Reliability and validity of Chinese version of a tool to assess the quality of life in idiopathic pulmonary fibrosis in patients with interstitial lung disease

Objective:This paper aims to determine the reliability and validity of the Chinese version of a tool that assesses the quality of life in idiopathic pulmonary fibrosis(cATAQ-IPF)in patients with interstitial lung disease(ILD).Methods:We used the process of scale introduction to establish cATAQ-IPF.The content validity of the scale was evaluated by six experts.A total of 92 patients with ILD completed the cATAQ-IPF,St.George's respiratory questionnaire(SGRQ),and The Medical Research Council dyspnoea scale at the baseline,and 15 patients completed cATAQ-IPF at the follow-up period 2 weeks later.Thus,yielding data were used to assess various psychometric properties of cATAQ-IPE Intraclass correlation coefficient(ICC),Cronbach'sαcoefficient,content validity index(CVI),item-level CVI(I-CVI),Pearson's coefficients,criterion-relation validity,and known-group validity were used for data analysis.Results:The cATAQ-IPF showed excellent test-retest reliability(ICC=0.95),except for the therapy domain(Cronbach'sα=0.60)and acceptable internal consistency(Cronbach'sα=0.96 for the total).The scale-level CVI was 0.80,and the I-CVI was in the range of 0.78-1.00.The total cATAQ-IPF score was strongly correlated with the SGRQ total score(r=0.71,P<0.01).The cATAQ-IPF score of patients with ILD was 250.74±47.39,and that of patients with IPF was 287.90±22.56.Patients with IPF possessed considerable impairments in health-related quality of life according to the cATAQ-IPF score(t=4.94,P<0.01).Conclusions:The cATAQ-IPF is a reliable and valid instrument for the evaluation of quality of life of Chinese patients with various forms of ILD.

Understanding the pregnant women’s experiences during the COVID-19 pandemic:A qualitative study

Objective To explore and interpret the experiences of pregnant women in Macao region,China during the COVID-19 pandemic.Methods Recruitment advertisements were published through multiple social platforms in Macao region,China.A purposive snowball sampling method was adopted to select interviewees.Eighteen women who were confirmed as pregnant from January to May 2020 participated in this qualitative study.Data was collected from November to December 2020 using in-depth personal interviews.One-to-one interviews were conducted by telephone to avoid personal contact.Thematic analysis was used to perform the data analysis and identify emergent themes.Results Five themes emerged from the data analysis:changes in daily life,psychological distress,unique experiences of pregnancy follow-up,trying to pay attention to health information but also feeling overwhelmed,and change in hygiene behaviors due to fear of infection.Six sub-themes were identified:being confined at home but understanding the reasons,financial pressures and timely support from the government,perceived risk of catching the infection,retaining optimism with various help and support,adequate personal protections,and obsessive hygiene behaviors.Conclusion During a pandemic,there is a risk of greater individual isolation,particularly for vulnerable groups such as women in pregnancy.The humanized attention to and support for the residents from the government buffered the adverse impact on the study participants.Preplanning for such events is needed to focus on psychological distress,financial constraints,and prenatal health services.Alternative service delivery,such as telemedicine,online counseling,and virtual reality(VR)technology,should be applied to offer pregnant women timely support and avoid a crisis.

Epidemiology of pulmonary hypertension in the elderly

1 Introduction Pulmonary hypertension （PH） is a haemodynamic and pathophysiological condition defined as increase in mean pulmonary arterial pressure≥ 25 mmHg at rest as assessed by right heart catheterization （RHC）.

Role of social distancing in tackling COVID-19 during the first wave of pandemic in Nordic region:Evidence from daily deaths,infections and needed hospital resources

Objectives:To measure the effect of social distancing on reducing daily deaths,infections and hospital resources needed for coronavirus disease 2019(COVID-19)patients during the first wave of the pandemic in Nordic countries.Methods:The observations of social distancing,daily deaths,infections along with the needed hospital resources for COVID-19 patient hospitalizations including the numbers of all hospital beds,beds needed in ICUs and infection wards,nursing staffs needed in ICUs and infection wards were collected from the Institute for Health Metrics and Evaluation(IHME)by the University of Washington.The observations of social distancing were based on the reduction in human contact relative to background levels for each location quantified by cell phone mobility data collected from IHME.The weighted data per 100,000 population gathered in a 40-day period of the first wave of the pandemic in Denmark,Finland,Iceland,Norway and Sweden.Statistical technique of panel data analysis is used to measure the associations between social distancing and COVID-19 indicators in long-run.Results:Results of dynamic long-run models confirm that a 1%rise in social distancing by reducing human contacts may decline daily deaths,daily infections,all hospital beds needed,beds/nurses needed in ICUs and beds/nurses needed in infection wards due COVID-19 pandemic by 1.13%,15.26%,1.10%,1.17%and 1.89%,respectively.Moreover,results of error correction models verify that if the equilibriums between these series are disrupted by a sudden change in social distancing,the lengths of restoring back to equilibrium are 67,62,40,22 and 49 days for daily deaths,daily infections,all hospital beds needed,nurses/beds needed in ICUs and nurses/beds needed in infection wards,respectively.Conclusion:Proper social distancing was a successful policy for tackling COVID-19 with falling mortality and infection rates as well as the needed hospital resources for patient hospitalizations in Nordic countries.The results alert governments of the need for continuously implementing social distancing policies while using vaccines to prevent national lockdowns and reduce the burden of patient hospitalizations.

FACTORS ASSOCIATED WITH QUALITY OF LIFE IN ACUTE EXACERBATION OF COPD

Objective To measure the QOL in patients with AECOPD and the frequency of potential risk factors, and to evaluate the association of risk factors with poor QOL in patients with AECOPD. Methods A study sample of 196 patients with moderate to severe COPD admitted for acute exacerbations to two large general hospitals were studied. The St George QOL (SGQOL) scale, socio-demographic, clinical and patient care characteristics, including depression and spirometry were ascertained in the stable state before discharge and at one-month post discharge. Results There was a high prevalence of current or ex-heavy smokers, depression and consumption of psychotropic drugs, and low prevalence of care giver support, pulmonary rehabilitation and vaccination. The mean scores for the different domains were 55.9 for Symptoms; 65.1 for Activity; 32.9 for Impact; and the mean of overall Total scores was 46.5. Multiple regression analysis showed that CMH, male, depression, previous frequent hospital readmissions and poor therapy compliance were independently related to worse Symptoms Scores. Previous frequent readmissions, depression, severe dyspnea and older age (>72 years) were related to worse Activity Scores of SGQOL. Depression, previous frequent readmissions, severe dyspnea, long COPD duration(≥5years) and severe smoking were related to worse Impact Scores of SGQOL. Depression, previous frequent readmissions, severe dyspnea and long COPD duration(≥5years) were independently related to worse Total Scores of SGQOL. Conclusion Poor QOL in patients with COPD exacerbation was associated with disease severity, psychosocial and health care factors which are modifiable.

Value of video-assisted thoracoscopic surgery in the diagnosis and treatment of pulmonary tuberculoma:53 cases analysis and review of literature

Tuberculoma of the lung is one of manifestations in tuberculosis and usually presents as a solitary pulmonary nodule(SPN).It is difficult to differentiate tuberculoma from SPN by other benign or malignant diseases.At present,the crucial role of video-assisted thoracoscopic surgery(VATS) in diagnosis and treatment of pulmonary diseases has been well acknowledged.Here,we reported 53 patients undergoing VATS resection for tuberculomas in our series.No postoperative mortality was found and only two patients experienced prolonged air-leakage(>7 d) and two had minor wound infections that were recovered after anti-tuber-culosis or antibiotic treatment.Anti-tuberculosis chemotherapy from 6 to 12 months was routinely used postoperatively.We conclude that VATS is a satisfactory tool for the diagnosis and treatment of tuberculoma and can also establish a reliable diagnosis for all patients with SPNs.

Correlation between lower gastrointestinal tract symptoms and quality of life in patients with stable chronic obstructive pulmonary disease

OBJECTIVE:To explore correlations between the symptoms of constipation and abdominal distention and severity of chronic obstructive pulmonary disease(COPD)in patients with stable disease.METHODS:We studied 191 patients with stable COPD(according to defined criteria)in this cross-sectional study from four three-level class A Chinese medicine hospitals in China.We built an Epidata 3.0 database and performed statistical analysis with SPSS,version 17.0.We analyzed correlations between the frequency of lower gastrointestinal tract symptoms(constipation and abdominal distention)and scores for major pulmonary symptoms(cough,sputum and wheezing)based on the St.George's Respiratory Questionnaire(SGRQ),6-minute walking distance(6MWD)and frequency of acute exacerbations of COPD(AECOPD).RESULTS:In addition to their pulmonary symptoms,39.79%and 40.31%of study patients withstable COPD reported constipation and abdominal distention,respectively.Scores for major pulmonary symptoms(cough,sputum and wheezing),AECOPD and SGRQ values in patients with constipation and abdominal distention were significantly greater,and the 6MWD markedly shorter,than in those without them.According to Pearson's correlation analysis,there were strong correlations between these lower gastrointestinal tract symptoms and scores for pulmonary symptoms,SGRQ,6MWD and AECOPD.CONCLUSION:Lower gastrointestinal tract symptoms such as constipation and abdominal distention can adversely affect pulmonary symptoms,frequency of acute exacerbations and quality of life in patients with stable COPD.

The effects of Chinese Yam-Epimedium mixture on respiratory function and quality of life in patients with chronic obstructive pulmonary disease

OBJECTIVE:To examine the clinical effects of a mixture of Chinese Yam and Epimedium in patients with stable moderate or severe chronic obstructive pulmonary disease(COPD).METHODS:Forty-nine patients with COPD were randomly allocated to a group whose usual treatment was supplemented with oral Chinese Yam-Epimedium mixture,or a control group given placebo.For each patient,body mass index,airflow obstruction,dyspnea,and exercise capacity were measured and converted into the BODE index before treatment and at one and three months after initiation of treatment.Participants also completed the St George's Respiratory Questionnaire(SGRQ) at the same intervals.RESULTS:After one month,improvements were seen in the BODE index and SGRQ of participants taking Chinese Yam-Epimedium mixture compared to controls.There were statistically significant differences in the SGRQ:three of its components and the total SGRQ scores were significantly decreased(P<0.05),respiratory symptom scores had improved(P<0.01),and the dyspnea component of the BODE index had significantly decreased(P<0.05).Similar improvements were observed after three months of treatment,but exercise tolerance had also improved:the six-minute walking distance had significantly increased(P<0.05) in the treatment group when compared with controls.CONCLUSION:Chinese Yam-Epimedium mixture can significantly improve dyspnea,exercise capacity,and the quality of life of patients with stable moderate or severe COPD.