Recently, many researchers paid more attentions to the association between air pollution and chronic obstructive pulmonary disease (COPD). Haze, a severe form of outdoor air pollution, affected most parts of northern and eastern China in the past winter. In China, studies have been performed to evaluate the impact of outdoor air pollution and biomass smoke exposure on COPD; and most studies have focused on the role of air pollution in acutely triggering symptoms and exacerbations. Few studies have examined the role of air pollution in inducing pathophysiological changes that characterise COPD. Evidence showed that outdoor air pollution affects lung function in both children and adults and triggers exacerbations of COPD symptoms. Hence outdoor air pollution may be considered a risk factor for COPD mortality. However, evidence to date has been suggestive (not conclusive) that chronic exposure to outdoor air pollution increases the prevalence and incidence of COPD. Cross-sectional studies showed biomass smoke exposure is a risk factor for COPD. A long-term retrospective study and a long-term prospective cohort study showed that biomass smoke exposure reductions were associated with a reduced decline in forced expiratory volume in 1 second (FEV1) and with a decreased risk of COPD. To fully understand the effect of air pollution on COPD, we recommend future studies with longer follow-up periods, more standardized definitions of COPD and more refined and source-specific exposure assessments.
Objective The purpose of this study was to explore the correlation between peripheral blood eosinophil (EOS) count and smoking history, some inflammatory indicators, lung function, efficacy of ICS, risk of respiratory failure and chronic pulmonary heart disease, risk of acute exacerbation within 1 year, readmission rate and mortality in patients with acute exacerbation of COPD. Methods Retrospective analysis of the baseline clinical data of 816 patients with acute exacerbation of chronic obstructive pulmonary disease in the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Shihezi University from January 1,2019 to December 31,2021. The patients were divided into EOS ≥ 200 cells / μL (High Eosinophi, HE) group and EOS<200 cells / μL (low Eosinophi, LE) group according to whether the peripheral blood EOS was greater than 200 cells / μL at admission. Peripheral venous blood data (including blood eosinophil count, white blood cell count, lymphocyte percentage, neutrophil percentage), blood gas analysis value, lung function index and medication regimen of all patients were collected, and the efficacy of ICS was recorded. The patients were followed up for 1 year to observe the acute exacerbation and readmission rate, and the mortality rate was followed up for 1 year and 2 years. Results Neutrophil count, lymphocyte count and peak expiratory flow (PEF) in HE group were positively correlated with EOS value (P<0.05), and smoking was more likely to increase EOS value. HE group was more sensitive to ICS. The risk of acute exacerbation in HEA group was higher than that in LE group. ICS could reduce the rate of acute exacerbation in HE group. EOS value in LE group was inversely proportional to FEV1 / FVC and MMEF values (P<0.05). The risk of chronic pulmonary heart disease in LE group was higher than that in HE group. The 2-year mortality rate in HE group was higher than that in LE group. Conclusions Peripheral blood EOS count is correlated with some inflammatory indicators, acute exacerbation risk, and lung function. ICS can improve the clinical symptoms and prognosis of patients with higher EOS count.
Vascular cognitive impairment (VCI), a syndrome induced by cerebrovascular disease and its risk factors, has become a major public health challenge worldwide. Especially in the context of an increasingly aging population, its impact is becoming more significant. In recent years, research has gradually revealed the crucial role of chronic cerebral hypoperfusion (CCH) in the occurrence and development of VCI. CCH leads to long-term ischemia and hypoxia in brain tissue, which seriously threatens mitochondrial function and triggers a series of problems such as mitochondrial oxidative stress, calcium homeostasis disturbance, dynamic abnormalities, autophagy dysregulation, and impaired biogenesis. These issues are extensively involved in the pathological process of VCI. This article provides an overview of the correlation between mitochondrial dysfunction and VCI under CCH conditions, aiming to explore new directions for the treatment of VCI.
Objective To analyse the content and structure of the health management policy text for chronic obstructive pulmonary disease (COPD) in China, and to provide a reference for the optimization and improvement of subsequent relevant policies. Methods We searched for relevant policy documents on COPD health management at the national level from January 2017 to December 2023, constructed a two-dimensional analysis framework for policy tools and chronic disease health management processes, coded and classified policy texts, and used content analysis method to analyze policy texts. Results Twenty-four policy texts were included. There were 183 codes for policy tool dimension, with supply based, environmental based, and demand based tools accounting for 43.72%, 47.54%, and 8.74%, respectively. There were 124 codes for the dimension of health management processes, with health information collection and management accounting for 12.10%, risk prediction accounting for 14.52%, intervention and treatment accounting for 66.13%, and follow-up and effectiveness evaluation accounting for 7.26%. Conclusions At present, the proportion of policy tools related to the management of COPD in China needs to be dynamically adjusted. Environmental tools should be appropriately reduced, the internal structure of supply tools should be optimized, the driving effect of demand tools should be comprehensively enhanced, the coupling of COPD health management processes should be strengthened, and the relevant policy system and overall quality should be continuously improved.
Objective To compare outcomes after single versus bilateral lung transplantation in patients with end-stage chronic obstructive pulmonary disease (COPD) with retrospective cohort study, and to provide a reference for surgical selection. Methods One hundred and two patients with end-stage COPD who received lung transplantation in Wuxi People's Hospital affiliated to Nanjing Medical University from January 2010 to May 2019 were evaluated, including 97 males and 5 females, aged from 42 to 82 years, with an average age of (59.8±8.0) years. Recipients were divided into single lung transplantation (SLT) group (31 cases) and bilateral lung transplantation (BLT) group (71 cases). Preoperative characteristics, postoperative outcomes, postoperative complications, functional improvement and survival between the two groups were analyzed retrospectively. Results The SLT group were significantly older than the BLT group [(62.6±8.8) years vs. (58.6±7.4) years, P<0.05], which was consistent with the practice mode of single lung transplantation in the elderly patients in this center. The FEV1% predicted and the six‐minute walk distance (6-MWD) in the BLT group were better than those in the SLT group (P<0.05). The cumulative survival rate in 1, 3 and 5 years after operation in the BLT group was higher than that in the SLT group (70.4%, 63.2%, 61.5%, respectively vs. 67.7%, 58.1%, 54.6%, respectively), but there was no statistical difference (P=0.388). The two groups were comparable in other preoperative clinical data (P>0.05). The cold ischemia time and total operation time were shorter in the SLT group than in the BLT group, and the intraoperative blood loss was less than that in the BLT group, but more patients required intraoperative extracorporeal membrane oxygenation support than the BLT group (P<0.05). There were no significant differences in postoperative ventilator support, reoperation, length of intensive care unit stay, postoperative hospital stay, and perioperative mortality (P>0.05). In terms of postoperative complications, the incidence of primary graft dysfunction grades 3 was higher in the SLT group than in the BLT group (35% vs. 8%, P=0.001). There were no significant differences between the two groups in chest complications, airway complications, acute rejection, infection, and bronchial occlusion syndrome (P>0.05). Nine patients (29%) developed acute native lung hyperinflation in the SLT group. ConclusionsBilateral lung transplantation is superior to single lung transplantation in the treatment of end-stage COPD. The advantage is mainly reflected in the simple perioperative management, better functional improvement after operation. Single lung transplantation as a beneficial supplement to double lung transplantation should still be considered in selected patients.
摘要:目的:观察伴有抑郁症状的心力衰竭患者加用黛力新干预的疗效。方法: 65例用Zung抑郁自评量表检测评测诊断为抑郁症并心力衰竭患者,将患者分为黛力新治疗组及对照组,治疗组在常规治疗基础上加用黛力新(2片/d),治疗1个月后再行Zung抑郁自评量表粗分及24项症状统计,同时观察治疗前后患者心功能改善情况。结果: 35例治疗组患者心功能的改善及Zung抑郁自评量表检测粗分及24项症状改善明显优于对照组。〖HTH〗结论〖HTSS〗: 黛力新使心衰患者的抑郁症状很快得到改善,并提高了心力衰竭的疗效。Abstract: Objective: To observe the curative efficacy of deanxit to the patients suffering by heart failure with depression. Methods: Sixtyfive patients who were diagnosed as depression by Zung Selfrating Depression Scale are into deanxit treatment group and control group,and treatment group receive the treatment with two pieces of deanxit everyday besides the conventional therapy.After a month,we count the Zung selfrating depression scale score and study the24 symptoms,at the same time,we observed the change of cardiac function in the patients. Results:The curative efficacy in the treatment group is better than those in the control group with improvement in cardiac function and Zung selfrating depression scale score and the alleviation for 24 symptoms. Conclusion:Deanxit can alleviate symptoms of depression in patients with heart failure soon and increase the efficacy of heart failure.
ObjectiveTo analyze the causes of death of patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). MethodsA total of 493 patients admitted between January 2006 and Octomber 2015 were respectively analyzed, including 348 asthma patients and 145 ACOS patients. The patients was divided into a survival group and a death group based on the outcome. The ACOS patients were divided into three subgroups based on FEV1% pred level (≥80%, 50%-80%, and < 50%, respectively). The basic characteristics and causes of death were analyzed using χ2-test, t-test and Fish-test based on data type. ResultsThe age (t=3.457, P < 0.001), male proportion (χ2=15.394, P < 0.001) and smoking history (χ2=12.418, P=0.002) had significant differences between the survival group and the death group. The proportion of ACOS patients was higher in the death group (42% vs. 27%, χ2=7.033, P=0.008), and the mortality was also higher in the ACOS patients (21% vs. 12%). The proportion of male patients was higher in the ACOS patients than that in the asthma patients (86% vs. 38%, P < 0.001). The leading three causes of death in the ACOS patients were malignant diseases (45%), pneumonia (26%), and cardiovascular diseases (16%). Malignant diseases were the main cause of death in the ACOS patients with FEV1% pred≥50%, while pneumonia was the main cause of death in those with FEV1% pred≥50%. There was no significant difference in cause of death distribution between three subgroups with different FEV1% pred (P=0.318). ConclusionThe main cause of death of ACOS patients is malignant diseases, the followed are pneumonia and cardiovascular diseases.
摘要:目的:总结胸心血管外科慢性伤口换药的经验。方法：2008年11月2009年4月我科共发生12例手术切口裂开病例，使用贝复济喷洒创面，藻酸钙敷料填塞创面，外用二层敷料固定，根据渗液情况决定更换敷料的频率，高渗出时每天更换，中等渗出时每2天更换，少量渗出时每3天更换。结果：本组12例患者，11例患者伤口均达到二期愈合，平均愈合时间为（12±2）天，另外1例转烧伤科行植皮术，后愈合。结论：通过联合使用贝复济和藻酸钙敷料，使本组病例的渗出减少，创面肉芽生长迅速，伤口疼痛减轻或消失，伤口周围皮肤免受浸渍，伤口快速愈合。Abstract: Objective: To introduce the methods of using streptogenin spray and the alginate dressing on Cardiac wound disruption. Methods: Our department had 12 cases of wound disruption from the November 2008 to the April 2009, We sprinkled the streptogenin spray to wound, then filled wound with the alginate dressing, finally fix wound with gauze and adhesive tape.According to the volume of the exudation, we decided how often to change the dressings. When the exudation volume was high ,We changed the dressing every day; While medium, We changed every two days ; When low ,We changed every three days. Results:Eleven 11 of 12 wounds got second phase of healing, the average healing time was (12±2) days. Conclusion: Using of the Streptogenin spray and the alginate dressing on disruption wound can reduce the exudation volume and wound pain, meanwhile it can progress the growth of granulation , so the wounds healed quickly.
Abstract: Objective To compare the multiple organ dysfunction score (MODS), the sequential organ failure assessment (SOFA), the acute physiology, age, and chronic health evaluation system Ⅱ(APACHE Ⅱ), the acute physiology, age, and chronic health evaluation system Ⅲ(APACHE Ⅲ) in evaluating risks for patients after cardiac surgery, in order to provide better treatment and prediction of prognosis after cardiac operation. Methods A prospective study was carried out on 1 935 cardiac postoperative patients, including 1 050 males and 885 females, enrolled in cardiac postoperative intensive care unitof Anzhen hospital between October 2007 and April 2008. The age of the patients ranged from 18 to 86 years with the mean age of 53.96 years. The patients underwent the surgery because of various cardiac diseases including coronary heart disease, valve disease, congenital heart disease, aortic aneurysm, pericardial disease, atrial fibrillation, and pulmonary embolism. We used MODS, SOFA, APACHE Ⅱ, and APACHE Ⅲ respectively to calculate the value of the first day after operation, the maximum value during the first three days, the maximum value, and the change of the value between the third day and the first day for every patient, and then we compared the calibration and discrimination of these different systems using HosmerLemeshow goodnessoffit analysis and Receiver Operating Characteristic (ROC) curve. Results There were 47 perioperative deaths because of circulating system failure, respiration failure, kidney failure, liver failure or nervous system diseases. The death rate was 2.43%. In discrimination analysis, the area under the curve (AUC) in ROC of the first day value after operation, the maximum value, the maximum value during the first three days, and the change of value between the third day and the first day for MODS were respectively 0.747, 0.901, 0.892, and 0.786; for SOFA were respectively 0.736, 0.891, 0.880, and 0.798; for APACHE Ⅱ were respectively 0.699, 0.848, 0,827, and 0.562; for APACHE Ⅲ were respectively 0.721, 0.872, 0.869, and 0.587. In calibration analysis, we compared the χ2 value of the first day value, the maximum value, the maximum value during the first 3 days, and the change of value between the third day and the first day of these systems. χ2 value of MODS was 4.712, 5.905, 5.384, and 13.215; χ2 value of SOFA was 8.673, 3.189, 3.111, and 14.225; χ2 value of APACHE Ⅱ was 15.688, 10.132, 8.061, and 42.253; χ2 value of APACHE Ⅲ was 13.608, 11.196, 19.310, and 47.576. AUC value of MODS and SOFA were all larger than those of APACHE Ⅱ and APACHE Ⅲ (Plt;0.05); AUC value of APACHE Ⅱ was smaller than that of APACHE Ⅲ (Plt;0.05). Conclusion MODS, SOFA, APACHE Ⅱ and APACHE Ⅲ are all applicable in evaluating risks for patients after cardiac surgery. However, MODS and SOFA are better than APACHE Ⅱ、APACHE Ⅲ in predicting mortality after cardiac surgery. In cardiac surgery, the complicated APACHE Ⅱ and APACHE Ⅲ systems can be replaced by MODS and SOFA systems which are simpler for use.
摘要:目的:应用区域阻抗法测定慢性阻塞性肺疾病（COPD）患者的肺血流灌注及肺通气分布的变化,与放射性核素肺显像方法比较,探讨肺区域阻抗方法的临床应用价值。 方法: 测定对象为18例中重度COPD患者,均为男性,平均年龄63.8岁,应用肺区域阻抗法及放射性核素法,分别测定肺血流灌注及肺通气的分布。〖HTH〗结果〖HTSS〗: 本研究发现肺区域阻抗法在测定肺血流灌注分布方面,仅在左下肺区域高于核素法测得的数值(Plt;0.05),余肺区测定结果相近,无显著差异。在肺通气的测定方面,阻抗法所得数值与核素法测得的数值有一定的不同,在左上、右上区域高于核素法测得的数值,在左中肺区测得的数值低于核素法测得的数值(Plt;0.05),余肺区测定结果相近,无显著差异。结论: 虽然目前区域阻抗方法暂不能取代放射性核素的测定,但作为一种辅助手段,可简便、快速了解肺内的通气、血流等生理病理改变。Abstract: Objective: To evaluate the clinical capability of regional electric impedance pneumograph and scintigraphy in measurement of pulmonary perfusion and ventilation in patients with COPD. Methods: Thirtytwo patients with different respiratory diseases underwent regional electric impedance pneumograph and scintigraphy, the pulmonary perfusion and ventilation were obtained and recorded. Results:The pulmonary perfusion results got by regional electric impedance pneumograph in the left lower region was lower than the results measured by scintigraphy, there were significant difference (Plt;0.05), and no difference in other pulmonary region. The pulmonary ventilation results got by regional electric impedance pneumograph in the both upper region were higher and in the left middle region were lower than the results measured by scintigraphy, there were significant difference(Plt;0.05), and no difference in other pulmonary region. Conclusion:The result got by regional electric impedance pneumograph could not replace the result got by scintigraphy at present, but this is a quick, simple,and convenient measurement to get parameter of the pulmonary perfusion and ventilation.