A comparative study of the effectiveness of hospital-based versus home-based pulmonary rehabilitation in candidates for bronchoscopic lung volume reduction

BackgroundThe Bronchoscopic Lung Volume Reduction (BLVR) is recommended in patients with severe Chronic Obstructive Pulmonary Disease (COPD) who are still symptomatic and have hyperinflation despite having received optimal medical therapy and Pulmonary Rehabilitation (PR). However, the small number of PR centers is insufficient to compensate for the need for existing hospital-based PR programs.ObjectiveThis article aimed to compare between hospital-based and home-based PR programs in terms of effectiveness on BLVR candidates.MethodsThis study is a prospective, controlled, nonrandomized clinical trial. Stable COPD patients who were referred to our PR clinic prior to BLVR were recruited consecutively. Patients were evaluated in two groups, hospital-based PR (Group 1) or home-based PR (Group 2). Both groups were admitted to the recommended PR for eight weeks. Pulmonary function tests, modified Medical Research Council (mMRC) dyspnea scale, COPD Assessment Test (CAT) and the 6-min walk distance (6MWD) were assessed for each patient before and after PR.ResultsA total of 67 patients were enrolled in the study. The max. age was 79 years and min. age was 49 years, with 65(±7.45) as a mean ±SD. Improvements in the mMRC and CAT scores after PR in both groups were significant and a similar level. Whereas, 6MWD was only significantly increased in Group 1.ConclusionsThis study, demonstrated that both home-based and hospital-based PR provided significant and similar improvements in the mMRC and CAT scores but 6MWD was only significantly increased in the hospital-based PR. Since 6MWD after PR plays a major role in BLVR eligibility, our findings suggest that hospital-based PR may be the most appropriate method for BLVR candidates.     

人ATG4B的表达及蛋白纯化和鉴定

目的构建含His标签的自噬相关蛋白4同源物B(ATG4B)重组质粒以得到His-ATG4B蛋白,初步鉴定其生物学活性。方法利用PCR技术从人乳腺文库中扩增出ATG4B基因的编码序列,插入p ET-28a(+)载体中得到重组质粒,经酶切鉴定后转化Rossate菌,挑选小量诱导出的His-ATG4B菌液进行His-ATG4B蛋白的纯化,SDS-PAGE和Western blot法检测His-ATG4B蛋白的纯化效果,GST pull-down技术对蛋白生物学功能进行鉴定。结果用PCR技术从人乳腺文库中扩增得到大小约1100 bp的目的片段,插入p ET-28a(+)载体中构建出His-ATG4B重组质粒,酶切鉴定及测序结果均表明His-ATG4B质粒构建成功;转化Rossate菌并小量诱导,表达鉴定成功后纯化蛋白,得到相对分子质量(Mr)约为47 000的His-ATG4B蛋白,且SDS-PAGE检测蛋白纯化效果较好;GST pull-down实验证实His-ATG4B蛋白可以和LC3B蛋白在体外相互作用,生物学活性良好。结论本实验成功得到His-ATG4B蛋白,为研究ATG4B在自噬中的作用机制奠定实验基础。     

Epidemiology of maternal morbidity and mortality

Maternal morbidity and mortality remains a significant health care concern in the United States, as the rates continue to rise despite efforts to improve maternal health. In 2013, the United States ranked 60th in maternal mortality worldwide. We review the definitions, rates, trends, and top causes of severe maternal morbidity and mortality, as well as risk factors for adverse maternal outcomes. We describe current local and national initiatives in place to reduce maternal morbidity and mortality and offer suggestions for future research.     

前列腺特异性抗原比值在前列腺癌诊断灰区的临床意义

目的:探讨游离前列腺特异性抗原(fPSA)与总前列腺特异性抗原(tPSA)比值(f/t)在tPSA为4~10ng/ml时对前列腺癌诊断的意义。方法:对83例血清tPSA为4~10ng/ml的前列腺增生和前列腺癌患者进行回顾行分析。均经由B超引导下行前列腺穿刺组织学验证。酶免微粒子捕捉法测定血清中tPSA与fPSA。结果:本组中32例(38%)为前列腺癌,51例(62%)为前列腺增生。前列腺癌及前列腺增生组tPSA的平均值分别为6.63ng/ml和6.99ng/ml,两者间无显著性差异(P>0.05);前列腺癌患者f/t值显著低于前列腺增生患者(0.16vs0.23,P<0.01)。以f/t比值0.16作为前列腺癌的诊断临界值时,其敏感性及特异性分别为71%、78%。结论:f/t值对前列腺癌及前列腺增生的鉴别有重要意义,以0.16作为诊断临界值准确率较高。     

肺磨玻璃结节的胸部CT影像特征及其对结节良恶性的诊断价值

目的:观察肺磨玻璃结节（GGN）的胸部CT征象,分析其在结节良恶性诊断中的价值。方法:回顾性分析2019年1月至2019年9月解放军总医院收治的65例具有GGN的CT影像征象的患者,根据病理结果分为良性组（26例）、恶性组（39例）,收集整理相关临床及影像资料,分析良、恶性GGN不同CT影像特点及诊断价值。结果:良、恶性肺GGN在病变直径、形状、边界、分叶征、毛刺征、空泡征、支气管充气征、血管集束征、胸膜凹陷征和密度具有差异,差异有统计学意义（P<0.05）。 其中胸膜凹陷征的诊断灵敏度和特异度最高,分别为76.92％和73.08％;而粗糙边界的诊断灵敏度和特异度最低,分别为25.64％和26.92％。分叶征、胸膜凹陷征的AUC值分别为0.718、0.75,对恶性GGN有较高的预测价值。结论:肺GGN的胸部CT征象（病变直径、形状、边界、分叶征、毛刺征、空泡征、支气管充气征、血管集束征、胸膜凹陷征、密度）有助于鉴别诊断良、恶性肺GGN。     

Coping resources of heart failure patients – a comparison with cancer patients and individuals having no chronic condition results from the esther study

BackgroundHeart failure (HF) and cancer patients share similarities in symptom burden and depression prevalence. Coping resources, such as optimism have been associated with improved health-related quality of life (HRQoL) and mental health.ObjectivesTo investigate a wide range of resources in a large population-based sample of HF patients; to compare resources between three groups: HF patients, cancer patients, and individuals having no chronic condition.MethodsThis cross-sectional analysis was performed among n = 2761 subjects who participated in home visits during the 11-year follow-up of the epidemiological ESTHER study. Resources were assessed by trained medical doctors through a questionnaire that lists 26 items. One-way analyses of covariance (ANCOVAs) controlled for sociodemographic variables and depression were performed to compare resources between groups.ResultsFamily and self-efficacy were the most frequently reported resources in all groups. HF patients reported optimism significantly less frequently as a resource in comparison to cancer patients (p=.031). HF patients showed significantly lower levels of resource factor 3 (positive attitude), compared to cancer patients (p=.006), and not chronically ill participants (p=.037).ConclusionsFamily and self-efficacy seem to be the most important resources, regardless of diagnosis. HF patients appear to have significantly lower levels of resources concerning positive attitude, compared to cancer patients, and not chronically ill individuals. We suggest the development of psychosocial interventions to enhance optimism in HF.     

老年人无痛结肠镜检查的可行性研究

背景欧美及日本等国有关老年人消化内镜的指南均不推荐无痛结肠镜检查用于65岁以上的老年人,此年龄界限是否适合我国尚无资料可鉴。目的研究无痛结肠镜在65～70岁老年人中应用的可行性。方法对128例接受无痛结肠镜诊治(无痛组)和同期119例接受常规结肠镜检查(对照组)的65～70岁老年患者的血压、心率、血氧饱和度(SpO2),疼痛程度,检查成功率,不良反应,苏醒时间以及满意度和复检意向进行比较分析。结果无痛组操作过程中均可见一过性血压和心率下降,与检查前比较有显著性差异,但检查结束后可恢复术前水平。对照组检查过程中均有不同程度的血压升高和心率加快,检查前、后比较有显著性差异。两组操作过程前、中、后的SpO2无显著性差异。无痛组和对照组的安静率、成功率、满意率、复检意向率分别是94.5%,25.2%;99.2%,92.4%;98.4%,61.3%;98.4%,31.9%;无痛组均明显优于对照组。结论无痛结肠镜在基本生命体征指标、患者反应,检查成功率、并发症发生率以及患者满意度和复检意向率方面均明显优于或等同于常规结肠镜检查,可见适合无痛结肠镜检查的老年人年龄上限可从65岁提高至70岁。