Effects of insurance status on long-term survival among non-small cell lung cancer(NSCLC) patients in Beijing,China: A population-based study

Objective: To evaluate the effects of health insurance status on long-term cancer-specific survival of non-small cell lung cancer(NSCLC) in Beijing, China, using a population-based cancer registry data.Methods: Information on NSCLC patients diagnosed in 2008 was derived from the Beijing Cancer Registry.The medical records of 1,134 cases were sampled and re-surveyed to obtain information on potential risk factors.Poorly-insured status was defined as Uninsured and New Rural Cooperative Medical Insurance Scheme(NRCMS),while well-insured included Urban Employees Basic Medical Insurance(UEBMI) and Free Medical Care(FMC).To estimate survival outcomes, individuals were followed-up until December 31, 2018. Cancer-specific survival probabilities at 5 and 10 years after diagnosis were estimated using the Kaplan-Meier method. Log-rank test was used to compare long-term survival with different characteristics. Multivariable Cox proportional hazard regression model was used to examine the relative effect of insurance status on cancer-specific mortality.Results: Well-insured NSCLC patients have longer cancer-specific survival than poorly-insured individuals[hazard ratio(HR)=0.81;95% confidence interval(95% CI): 0.67-0.97), even after adjusting for age, gender, cancer stage, smoking status, family history and residential area. Older age and rural residence were associated with a higher risk of cancer-specific mortality(HR=1.03;95% CI: 1.02-1.03 and HR=1.25;95% CI: 1.07-1.46,respectively). Smoking individuals had a 41% higher long-term cancer-specific mortality risk than non-smoking ones(HR=1.41;95% CI: 1.20-1.66).Conclusions: NSCLC patients with good insurance status had better survival rates than those with poor insurance. An association was significant even after 10 years. Large population-based studies are needed to validate that high reimbursement insurance status can lead to the improvement of long-term cancer prognosis in China.

Evaluation of a New Real-time PCR Assay for Detection of Mycoplasma Pneumoniae in Clinical Specimens

Objective To establish and evaluate a real-time PCR assay to detect Mycoplasma pneumoniae （M.pneumoniae） in clinical specimens. Methods By analysing the whole pl gene sequence of 60 M.pneurnoniae clinical isolates in Beijing of China, an optimized real-time PCR assay （MpP1） using pl gene conserved region was designed. The specificity and sensitivity of this assay were evaluated and compared with other two reported assays （RepMpl and Mp181） using 40 positive and 100 negative clinical specimens. Results The detection limit of the new assay was 8.1 fg （about 1-3CFU） M.pneumoniae DNA. The sensitivity of MpP1, RepMpl, and Mp181 assays appeared to be 100%, 100%, and 85%, respectively. Conclusion MpP1 assay is suitable for the detection of M.pneumoniae in Chinese clinical specimens.

Value of virtual bronchoscopic navigation and transbronchial ultrasound-guided sheath-guided exploration in diagnosis of peripheral lung cancer

BACKGROUND Peripheral lung cancer poses a substantial harm to human health,and it is easy to become exacerbated,potentially threatening the life and safety of patients AIM To assess the value of virtual bronchoscopic navigation(VBN)combined with transbronchial ultrasound-guided sheath-guided(EBUS-GS)exploration in the diagnosis of peripheral lung cancer.METHODS A total of 236 patients with peripheral lung cancer(nodule diameter range,8-30 mm;diagnosed using high-resolution computed tomography)were selected from three centers between October 2018 and December 2019.Patients who underwent EBUS-GS exploration alone were included in a control group,and those who received VBN in combination with EBUS-GS exploration were included in an observation group.The diagnostic rate and total operating time of differentsubgroups of the two groups were compared,and the time needed to determine the lesion was recorded.RESULTS There were no significant differences in diagnosis rate or total operation time between the two groups(P>0.05),and the time needed to determine the lesion in the observation group was less than that of the control group(P<0.05).CONCLUSION The combined use of VBN and EBUS-GS exploration technology has little effect on the diagnosis rate and total operation time of peripheral lung cancer,but it significantly shortens the time needed to determine the lesion and is a valuable diagnostic method.

Long-term effect of clopidogrel in patients with and without diabetes: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND Previous studies have shown that patients with diabetes mellitus(DM) respond poorly to clopidogrel treatment.AIM To systematically evaluate the efficacy of clopidogrel for the treatment of acute coronary syndromes or ischemic stroke in patients with or without DM.METHODS Pub Med,the Cochrane Central Register of Controlled Trials,and EMBASE were searched from 1980 on 27 June 2019 to identify relevant randomized controlled trials that compared the effect of a combination of clopidogrel and aspirin with aspirin alone.A random-effects meta-analysis was used to estimate the hazard ratio(HR) and its 95% confidence interval(CI).Sensitivity analysis was performed using a fixed-effect model.The I2 statistic was used to evaluate the heterogeneity of the study data.RESULTS Six randomized controlled trials,comprising 43352 participants(13491 with and 29861 without DM) who had received antiplatelet therapy for≥3 mo,were included in the meta-analysis.Compared with aspirin alone,a combination of clopidogrel and aspirin significantly reduced the risk of any cardiovascular event in patients without DM(HR=0.78,95%CI:0.71–0.86,P<0.001;I2=23%,P=0.26).Clopidogrel plus aspirin also significantly reduced cardiovascular risk in patients with DM,although the effect was smaller(HR=0.89,95%CI:0.81–0.99,P=0.030;I2=0%,P=0.74).Nevertheless,there was no significant difference in the efficacy of clopidogrel at reducing the risk of cardiovascular events in patients with DM vs those without(P for interaction=0.062).CONCLUSION Thus,the present study shows that the addition of clopidogrel to aspirin significantly lowers cardiovascular risk in patients with or without DM who have experienced ischemic cardiovascular disease.The beneficial effect of the addition of clopidogrel to aspirin for patients with DM was lower than that in patients without DM,although the modifying effect of DM did not reach significance.

Characteristics of Callers Accessing the Tobacco Cessation Quitline in China's Mainland

To describe the characteristics of callers accessing the first national smoking quitline in China's Mainland. The national quitline provides residents in China's Mainland with free telephone smoking cessation services. Of 8260 callers from December 1, 2009 to May 31, 2012, the study included 1049 callers to the non-automated service who gave basic information during the call. Of the 1049 live-access callers.

Elevated Circulating Levels of Osteopontin Are Associated with Metastasisin Advanced Non-Small Cell Lung Cancer

Objective：To investigate the relationship between postoperative metastasis and circulating levels of osteopontin in non-small cell lung cancer（NSCLC）.Methods：The expression of osteopontin mRNA were detected with RT-PCR technique.The circulating levels of osteopontin were measured through ELASA in 46 NSCLC cases that had not been received any anti-cancer treatment at the time of sampling.The tissues from fifteen patients with benign pulmonary diseases were studied as control group.Results：The overall median mRNA expression level of osteopontin was approximately 70-fold higher in tumor tissues than in matched normal lung tissues（P0.001）.Over-expression of osteopontin mRNA was significantly associated with clinical stage（P=0.009）.Advanced disease states had higher circulating level of osteopontin（stage I＋II versus stage III＋VI）.In multivariate analysis,stage was the only independent factor influencing circulating levels of osteopontin.All patients were followed up for 12 months,2 of the 46 patients with both osteopontin mRNA expression and elevated plasma osteopontin levels had local recurrence and 10 had distant metastasis.There was a significant difference in the osteopontin levels between metastasis group and non-metastasis group.Conclusion：Preoperative plasma levels of osteopontin are significantly associated with post-operative metastasis in advanced NSCLC.

Dimensionless Study on Secretion Clearance of a Pressure Controlled Mechanical Ventilation System with Double Lungs

A pressure controlled mechanical ventilator with an automatic secretion clearance function can improve secretion clearance safely and efficiently.Studies on secretion clearance by pressure controlled systems show that these are suited for clinical applications.However,these studies are based on a single lung electric model and neglect the coupling between the two lungs.The research methods applied are too complex for the analysis of a multi-parameter system.In order to understand the functioning of the human respiratory system,this paper develops a dimensionless mathematical model of doublelung mechanical ventilation system with a secretion clearance function.An experiment is designed to verify the mathematical model through comparison of dimensionless experimental data and dimensionless simulation data.Finally,the coupling between the two lungs is studied,and an orthogonal experiment designed to identify the impact of each parameter on the system.

Evaluation of the diagnostic value of serum-based proteomics for colorectal cancer

BACKGROUND Colorectal cancer(CRC)is a highly malignant cancer with a high incidence and mortality in China.It is urgent to find a diagnostic marker with higher sensitivity and specificity than the traditional approaches for CRC diagnosis.AIM To provide new ideas for the diagnosis of CRC based on serum proteomics.METHODS Specimens from 83 healthy people,62 colon polyp(CRP)patients,and 101 CRC patients were analyzed by matrix-assisted laser desorption/ionization time-offlight mass spectrometry.The diagnostic value of the profiles of differentially expressed proteins was then analyzed.RESULTS Compared with the healthy control group,CRC patients had elevated expression of 5 proteins and reduced expression of 14 proteins.The area under the curve(AUC)for a differentially expressed protein with a mass-to-charge ratio of 2022.34 was the largest;the AUC was 0.843,which was higher than the AUC of 0.717 observed with carcinoembryonic antigen(CEA),and the sensitivity and specificity of this identified marker were 75.3%and 79.5%,respectively.After cross-validation,the accuracy of diagnosis using levels of this differentially expressed protein was 82.37%.Compared with the CRP group,the expression of 3 proteins in the serum of CRC patients was elevated and 11 proteins were expressed at reduced levels.Proteins possessing mass-to-charge ratio values of 2899.38 and 877.3 were selected to establish a classification tree model.The results showed that the accuracy of CRC diagnosis was 89.5%,the accuracy of CRP diagnosis was 81.6%,and the overall accuracy of this approach was 86.3%.The overall sensitivity and specificity of diagnosis using the proteomics approach were 81.8%and 66.75%,respectively.The sensitivities and specificities of diagnoses based on CEA and carbohydrate antigen 19-9 expression were 55.6%and 91.3%and 65.4%and 65.2%,respectively.CONCLUSION We demonstrated that serum proteomics may be helpful for the detection of CRC,and it may assist clinical practice for CRC diagnosis.

Late-stage Use of Low-dose Corticosteroids Aid Recovery of Severe H1N1 Viral Pneumonia

The role of corticosteroids in the management of severely ill patients with inlfuenza A (H1N1) viral infection is unclear and controversial. Two critically ill cases with influenza A (H1N1) infections complicated with organizing pneumonia (OP) in 2011 successfully treated with low dose corticosteroids were reported here. After initial clinical improvement, the condition of both patients aggravated 20-23 days after the onset of illness. Chest X-ray and computed tomographies (CT) showed an increment of lung infiltrates. Cultures of blood, pleural lfuid and transbronchial aspirate were negative for bacteria and fungi. Organizing pneumonia was diagnosed clinically and both patients were successfully treated with low-dose corticosteroids. Low-dose corticosteroids initiated during convalescence may be beneficial for severe swine-origin influenza A H1N1 pandemic 2009 virus (S-OIV) infections.

Effectiveness and Acceptability of a Comprehensive Mobile Health-Based Modality for Smoking Cessation-Beijing Municipality,China,2022

Summary What is already known on this topic?Mobile health interventions have been demonstrated to be effective in aiding smoking cessation among smokers.Nevertheless,research on this topic remains limited in China.What is added by this report?Following two months of utilizing the services of a comprehensive mobile health(mHealth)-based modality(“Way to Quit”modality)which integrated three online interventions through the WeChat application,29.1%of participating smokers successfully quit smoking.Participants who used a greater number of online services were more likely to cease smoking.All services were scored highly for satisfaction among smokers.What are the implications for public health practice?This study presents a practical and feasible method to assist Chinese smokers in quitting smoking.The results of this research suggest a promising direction for enhancing the accessibility and utilization of smoking cessation services.Additionally,these findings serve as a critical reference for addressing the obstacles faced by smoking cessation services in China.

Should we initiate vasopressors earlier in patients with septic shock: A mini systemic review

Septic shock treatment remains a major challenge for intensive care units,despite the recent prominent advances in both management and outcomes.Vasopressors serve as a cornerstone of septic shock therapy,but there is still controversy over the timing of administration.Specifically,it remains unclear whether vasopressors should be used early in the course of treatment.Here,we provide a systematic review of the literature on the timing of vasopressor administration.Research was systematically identified through PubMed,Embase and Cochrane searching according to PRISMA guidelines.Fourteen studies met the eligibility criteria and were included in the review.The pathophysiological basis for early vasopressor use was classified,with the exploration on indications for the early administration of mono-vasopressors or their combination with vasopressin or angiotensinII.We found that mortality was 28.1%-47.7%in the early vasopressors group,and 33.6%-54.5%in the control group.We also investigated the issue of vasopressor responsiveness.Furthermore,we acknowledged the subsequent challenge of administration of high-dose norepinephrine via peripheral veins with early vasopressor use.Based on the literature review,we propose a possible protocol for the early initiation of vasopressors in septic shock resuscitation.

Significance of Aspergillus spp. isolation from lower respiratory tract samples for the diagnosis and prognosis of invasive pulmonary aspergillosis in chronic obstructive pulmonary disease

Background Chronic obstructive pulmonary diseases （COPD） is an emerging population at risk for invasive infection of Aspergillus. Isolation of Aspergillus from lower respiratory tract （LRT） samples is important for the diagnosis of invasive pulmonary aspergillosis （IPA）. The purpose of this study was to investigate the value of Aspergillus isolation from LRT samples for the diagnosis and prognosis of IPA in COPD population. Methods Clinical record with Aspergillus spp. isolation in COPD and immunocompromised patients was reviewed in a retrospective study. Patients were categorized and compared according to their severity of illness （admitted to general ward or ICU） and immunological function （COPD or immunocompromised）. Results Multivariate statistical analysis showed that, combined with Aspergillus spp. isolation, APACHE II scores 〉18, high cumulative doses of corticosteroids （〉350 mg prednisone or equivalent dose） and more than four kinds of broad-spectrum antibiotics received in hospital may be predictors of IPA in COPD （0R=9.076, P=0.001; 0R=4.073, P=-0.026; OR=4.448, P=-0.021, respectively）. The incidence of IPA, overall mortality, mortality of patients with IPA and mortality of patients with Aspergillus spp. colonization were higher in COPD patients in ICU than in general ward, but were similar between COPD and immunocompromised patients. Conclusions Aspergillus spp. isolation from LRT in COPD may be of similar importance as in immunocompromised patients, and may indicate an increased diagnosis possibility of IPA and worse prognosis when these patients received corticosteroids, antibiotics, and need to admit to ICU. Aspergillus spp. isolation from LRT samples combined with certain risk factors mav be useful in differentiating colonization from IPA and evaluating the prognosis of IPA in COPD patients.

Application of Venovenous Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Failure： Situations, Issues, and Trends

Extracorporeal membrane oxygenation （ECMO） is a type of extracorporeal life support （ECLS）, and technological advances have expanded the use of this technique from the confines of the operating room by producing a compact system that could revolutionize the treatment of different types of respiratory failure.

ALK gene expression status in pleural effusion predicts tumor responsiveness to crizotinib in Chinese patients with lung adenocarcinoma

Objective： The relationship between anaplastic lymphoma kinase（ALK） expression in malignant pleural effusion（MPE） samples detected only by Ventana immunohistochemistry（IHC） ALK（D5F3） and the efficacy of ALKtyrosine kinase inhibitor therapy is uncertain.Methods： Ventana anti-ALK（D5F3） rabbit monoclonal primary antibody testing was performed on 313 cell blocks of MPE samples from Chinese patients with advanced lung adenocarcinoma, and fluorescence in situ hybridization（FISH） was used to verify the ALK gene status in Ventana IHC ALK（D5F3）-positive samples. The follow-up clinical data on patients who received crizotinib treatment were recorded.Results： Of the 313 MPE samples, 27（8.6%） were confirmed as ALK expression-positive, and the Ventana IHC ALK（D5F3）-positive rate was 17.3%（27/156） in wild-type epidermal growth factor receptor（EGFR） MPE samples. Twenty-three of the 27 IHC ALK（D5F3）-positive samples were positive by FISH. Of the 11 Ventana IHC ALK（D5F3）-positive patients who received crizotinib therapy, 2 patients had complete response（CR）, 5 had partial response（PR） and 3 had stable disease（SD）.Conclusions： The ALK gene expression status detected by the Ventana IHC ALK（D5F3） platform in MPE samples may predict tumor responsiveness to crizotinib in Chinese patients with advanced lung adenocarcinoma.

Facing the challenges in modern respiratory medicine

Respiratory medicine in China has made great .progress in the past decades. Today, modemrespiratory and critical care medicine faces tremendous new challenges and is also provided with greater opportunities. Respiratory diseases are a leading cause of morbidity and mortality that carry a huge economic and social burden in China. Chronic obstructive pulmonary disease （COPD） alone affects 8.2% of people aged 40 and over; nearly 43 million people in China.1 Respiratory diseases, excluding lung cancer, cor pulmonale and respiratory tuberculosis （TB）, are the 4th leading cause of death in China.2

Novel assisted cough system based on simulating cough airflow dynamics

Cough is a defensive behavior that protects the respiratory system from infection and clears airway secretions.Cough airflow dynamics have been analyzed by a variety of mathematical and experimental tools.In this paper,the cough airflow dynamics of 42 subjects were obtained and analyzed.An identification model based on piecewise Gauss function for cough airflow dynamics is proposed through the dimensionless method,which could achieve over 90%identification accuracy.Meanwhile,an assisted cough system based on pneumatic flow servo system is presented.The vacuum situation and feedback control are used to increase the simulated peak cough flow rate,which are important for airway secretion clearance and to avoid airway collapse,respectively.The simulated cough peak flow could reach 5 L/s without the external assistance such as manual pressing,patient cooperation and other means.Finally,the backstepping control is developed to generate a simulated cough airflow that closely mimics the natural cough airflow of humans.The assisted cough system opens up wide opportunities of practical application in airway secretion clearance for critically ill patients with COVID 2019 and other pulmonary diseases.

Strengthen national action for the prevention and control of chronic respiratory diseases

Chronic respiratory diseases are chronic diseases of the airways and other structures of the lung.Some of the most common are asthma,chronic obstructive pulmonary disease （COPD）,respiratory allergies,occupational lung diseases and pulmonary hypertension.Hundreds of millions of people suffer every day from chronic respiratory diseases.COPD is one of the most representative chronic respiratory diseases.A population-based,cross-sectional survey of COPD conducted between 2003 and 2004 showed that the overall prevalence of the disease in people aged above 40 years was 8.2%,1 which would result in a COPD patient population of over 43 million.

How to manage isolated tension non-surgical pneumoperitonium during bronchoscopy?A case report

BACKGROUND Tension pneumoperitonium is a rare complication during bronchoscopy that can cause acute respiratory and hemodynamic failure,with fatal consequences.Isolated pneumoperitonium during bronchoscopy usually results from ruptures of the abdominal viscera that need surgical repair.Non-surgical pneumoperitoneum(NSP)refers to some pneumoperitoneum that could be relieved without surgery and only by conservative therapy.However,the clinical experience of managing tension pneumoperitonium during bronchoscopy is limited and controversial.CASE SUMMARY A 51-year-old female was admitted to our hospital for cough with bloody sputum of seven days.On the 8th day of her admission,a bronchoscopy was arranged for bronchial-alveolar lavage to detect possible pathogens in the lower respiratory tract,as oxygen was delivered via a 12 F nasopharyngeal cannula,approximately 5-6 cm from the tip of the catheter,with a flow rate of 5-10 L/min.After four minutes of bronchoscopy,the patient suddenly vomited 20 mL of water,followed by severe abdominal pain,while physical examination revealed obvious abdominal distension,as well as hardness and tenderness of the whole abdomen,which was considered pneumoperitonium,and the bronchoscopy was terminated immediately.A computer tomography scan indicated isolated tension pneumoperitonium,and abdominal decompression was performed with a drainage tube,after which her symptoms were relieved.A multidisciplinary expert consultation discussed her situation and a laparotomy was suggested,but finally refused by her family.She had no signs of peritonitis and was finally discharged 5 d after bronchoscopy with a good recovery.CONCLUSION The possibility of tension pneumoperitonium during bronchoscopy should be guarded against,and given its serious clinical consequences,cardiopulmonary instability should be treated immediately.Varied strategies could be adopted according to whether it is complicated with pneumothorax or pneumomediastinum,and the presence of peritonitis.When considering NSP,conservative therapy maybe a reasonable option with good recovery.An algorithm for the management of pneumoperitonium during bronchoscopy is proposed,based on the features of the case series reviewed and our case reported.

Chinese patients’and physicians’perspectives on the burden and management of asthma

To the Editor:The overall prevalence of asthma among Chinese adults(aged≥20 years)was 4.2%,representing 45.7 million people.[1]With high disease burden of asthma in China,it needs to better understand the status of asthma treatment in China from physicians’and patients’perspectives.The 2021 Global Initiative of Asthma(GINA)report developed two Treatment Tracks based on the choice of relievers.[2]For patients with moderate asthma(Steps 3 and 4),the recommended regimen is low-or medium-dose inhaled corticosteroid(ICS)/formoterol as daily maintenance therapy with additional low-dose ICS/formoterol as needed(known as maintenance and reliever therapy[MART])in Track 1,or medium-or high-dose ICS/long-acting b2-agonist(LABA)as daily maintenance therapy with additional short-acting b2-agonist(SABA)as needed in Track 2.

Prevention and Treatment of Pneumoconiosis in the Context of Healthy China 2030

Since the onset of reform and opening-up policies,China has risen to become the world’s second-largest economy.This transformative period has witnessed considerable advancements in medical services provision,resulting in significant improvements in the overall healthcare landscape.A noteworthy accomplishment is the creation of the world’s largest and most comprehensive social security system.Adhering to principles of inclusivity,multi-tiered coverage,and long-term sustainability,this system guarantees the fulfillment of basic life necessities.