Abstract Background & aims Aging is a pathophysiological process driven by a diverse set of complex biological processes, and environmental pollution plays an important role in this process. This study aimed to explore the association between serum α-Klotho levels and urinary perchlorate, nitrate, and thiocyanate levels. Methods This secondary dataset analysis included 4875 participants (mean age, 57.69 year; male, 49.58%; non-Hispanic White, 47.67%) from the US National Health and Nutrition Examination Survey (2007–2014). Enzyme-linked immunosorbent assay was used to quantify α-Klotho levels, and ion chromatography coupled with electrospray tandem mass spectrometry was used to quantify thiocyanate, nitrate, and perchlorate levels. Multivariate linear regression models were applied to estimate the association between perchlorate, nitrate, and thiocyanate levels and serum α-Klotho levels. Results Urinary thiocyanate levels were negatively associated with α-Klotho levels (β = − 0.006; 95% confidence interval, − 0.010 to − 0.003; P = 0.0004) after adjusting for age, sex, body mass index, race, alcohol consumption, estimated glomerular filtration rate, underlying disease, physical activity, smoking status, usual energy intake, and urinary creatinine and serum cotinine levels and mutual adjustment of urinary perchlorate, urinary nitrate, and urinary thiocyanate levels. The α-Klotho level in participants in the highest quartile was higher by 50.567 ng/mL (β = 50.567; 95% confidence interval, 14.407 to 86.726; P = 0.009) than that in participants in the lowest quartile of urinary perchlorate. A linear relationship was observed between urinary thiocyanate and α-Klotho levels. Conclusions Urinary thiocyanate levels were negatively associated with serum α-Klotho levels. Urinary thiocyanate should be further investigated as a potential mediator of aging and age-related diseases.

目的 比较经鼻高流量氧疗(high-flow nasal cannula oxygen therapy,HFNC)与无创机械通气(non-invasive ventilation,NIV)治疗新型冠状病毒肺炎(简称新冠肺炎)所致急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床疗效及安全性.方法 收集2020年1月25日—2020年3月10日武汉红十字会医院收治的新冠肺炎所致的ARDS患者68例的临床资料,根据治疗方法分为HFNC组36例和NIV组32例.所有患者均给予基础疾病对症治疗、抗病毒治疗、预防继发性感染等常规治疗,NIV组同时给予NIV治疗,HFNC组同时给予高流量湿化氧疗,比较两组呼吸与循环参数、舒适度与耐受性、并发症等指标.结果 在治疗3天、治疗1周、治疗2周后,两组患者呼吸频率(respiratory rate,RR)低于同组治疗前,动脉血氧分压(arterial partial pressure of oxygen,PaO2)、脉搏血氧饱和度(pulse oxygen saturation,SpO2)、氧合指数(PaO2/FiO2)高于同组治疗前(均P＜0.05),且治疗效果呈时间依赖性关系.但不同时间点HFNC组与NIV组患者RR、PaO2、SpO2、PaO2/FiO2比较,差异均无统计学意义(均P＞0.05);治疗2周内,HFNC组患者舒适度、呼吸困难、耐受性评分低于NIV组(均P＜0.05),而胃胀、口干等并发症的发生率低于NIV组(11.11％比37.50％,P＜0.05).两组有创机械通气率、病死率比较,差异无统计学意义(均P＞0.05).结论 HFNC与NIV均能有效改善新冠肺炎所致ARDS患者呼吸与循环参数,而HFNC具有更好的舒适性与耐受性,能减少相关并发症的发生.

目的:系统评价俯卧位肺复张对重症肺炎治疗的有效性和安全性.方法:检索中国期刊全文数据库、中文科技期刊数据库、万方数据库,纳入前瞻性临床研究.采用Cochrane Handbook 5.1.0标准评价纳入文献质量,采用Rev Man 5.3软件进行数据统计.结果:最终纳入5篇文献,各研究样本量为60～90例,俯卧位和俯卧位两组心率、平均动脉压、心脏指数、中心静脉压在复张疗法1h后差异无统计学意义,共报告不良反应16例(俯卧位组6例,仰卧位组10例),主要不良反应为气胸和纵隔气肿.俯卧位组PaO2/FiO2改善率显著高于仰卧位组[MD=-28.09,95％CI(-36.80,-19.38)],差异有统计学意义.结论:俯卧位机械通气在改善患者低氧血症方面的有效性和安全性优于仰卧位,但由于纳入文献的方法学质量较低,且数量较少,故本研究结果论证强度不强.建议开展严格设计和实施的大样本随机对照试验,评价俯卧位治疗重症肺炎的疗效和安全性.

目的 探讨非小细胞肺癌(NSCLC)组织中驱动蛋白家族成员11(KIF11)的水平及临床意义.方法 利用GEPIA分析癌症基因组图谱(TCGA)数据库中NSCLC(483例腺癌和486例鳞癌)组织的KIF11水平,从人类肿瘤相关基因表达汇编(GEO)数据库下载肺癌样本数据集GSE31210、GSE30219和GSE31908的KIF11表达谱数据;采用实时定量PCR检测本院2016年3月至2018年12月手术切除的NSCLC患者癌组织及配对癌旁组织共86对,分析KIF11水平与NSCLC临床病理特征的关系并采用受试者工作特征(ROC)曲线评价KIF11对NSCLC的诊断效能;采用GEPIA和Kaplan-Meier Plotter在线分析KIF11水平与NSCLC预后的关系.结果 TCGA数据库中483例腺癌和486例鳞癌组织的KIF11水平均高于正常组织(P<0.05);GSE31210、GSE30219和GSE31908数据集中癌组织的KIF11水平分别为553.437±32.961、6.760±1.351和4.824±0.109,均高于对应正常组织(P<0.05).86例NSCLC组织的KIF11水平为3.405±0.172,高于癌旁组织的1.038±0.074(P=0.001);ROC曲线分析显示组织KIF11水平诊断NSCLC的曲线下面积为0.906(95％CI:0.861～0.950,P<0.001);KIF11水平与NSCLC的性别、年龄、吸烟史和病理类型均无关(P>0.05),而与肿瘤直径、淋巴结转移、分化程度和TNM分期有关(P<0.05).GEPIA在线分析显示,KIF11水平与NSCLC总体及不同病理类型的无病生存期无关(P>0.05),但与NSCLC总体及肺腺癌的总生存期(OS)有关,其中KIF11高水平者的OS较差(HR=1.2,P=0.035;HR=1.7,P<0.001).Kaplan-Meier Plotter在线分析显示,KIF11高水平者的中位OS为47.9个月,低于低水平的87.7个月(HR=1.52,95％CI:1.4～1.73,P<0.001),进一步分析显示GSE31210、GSE30219数据集中高水平者的中位OS均低于低水平者(P<0.05).结论 NSCLC组织中KIF11高表达,对肿瘤大小、淋巴结转移、分化程度和TNM分期有一定预测价值,高水平者的预后较差,在NSCLC诊治和预后预测上有一定前景.

Background Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first identified in December 2019 in Wuhan. This study mainly analyzed the clinical characteristics, imaging features, and prognosis of patients with COVID-19 in Suining, one of China's fourth-tier cities, and Wuhan in 2019 and compared data between the 2 cities. Methods A retrospective analysis of the epidemiological history, clinical data, symptom presentation, laboratory test results, chest computed tomography (CT) imaging features, treatment measures and prognosis of 68 patients with COVID-19 diagnosed at Wuhan Red Cross Hospital and 17 patients with COVID-19 diagnosed at Suining Central Hospital from January 23, 2020, to February 27, 2020, was conducted. Results 1) The incidence rate of COVID-19 in Wuhan was 52.99‱, and the incidence rate in Suining was 0.04‱. The median age of patients with COVID-19 was 40.71 years old in Suining and 56.04 years old in Wuhan. The age of patients with COVID-19 in Wuhan was significantly older than that of patients with COVID-19 in Suining. Among the 68 patients with COVID-19 in Wuhan, 30 (44.1%) had hypertension, and 25 (36.8%) had diabetes. Three out of the 17 patients in Suining (17.6%) had hypertension, and 2 patients (11.8%) had diabetes. The proportion of patients with diabetes or hypertension in Wuhan was significantly higher than that in Suining ( P <0.05). In the clinical classification, there were 1 (5.9%) and 23 (33.8%) patients with severe COVID-19 in Suining and Wuhan, respectively. The proportion of patients with severe COVID-19 in Wuhan was significantly higher than that in Suining ( P <0.05).Fever and cough were the most common clinical symptoms, with 9 cases (52.9%) and 8 cases (47.1%) in Suining, respectively, and 54 cases (79.4%) and 42 cases (61.8%) in Wuhan, respectively. There was 1 patient (5.9%) with COVID-19 with dyspnea in Suining and 23 patients (33.8%) with COVID-19 with dyspnea in Wuhan; the difference was statistically significant ( P <0.05). Chest CT showed that lung consolidation occurred in 2 (11.8%) and 26 (38.2%) patients with COVID-19 in Suining and Wuhan, respectively. The proportion of lung consolidation in patients in Wuhan was significantly higher than that in patients in Suining ( P <0.05). The laboratory tests suggested that percentage ofelevated C-reactive protein (CRP) (58.8%), ALT (33.8%), blood glucose (45.6%), creatine kinase (CK) (33.8%) or D-dimer (47.1%) of patients in Wuhan were significantly increased than those in Suining (29.4%, 5.9%, 17.6%, 5.9%, and 17.7%, respectively). Moreover, the average length of hospital stay of patients in Wuhan was 17.49 days, which was significantly longer than that of patients in Suining (12.29 days). Conclusions The incidence of COVID-19 in fourth-tier cities, Suining, in China was significantly lower than that in Wuhan, and the disease severity was generally lower than that in Wuhan, with mostly good prognoses. Advanced age, diabetes, and hypertension are important factors that aggravate COVID-19, while elevated CRP, ALT, blood glucose, CK, and D-dimer levels are important indicators for severe disease.

目的 探讨孟鲁司特联合布地奈德对老年急性中、重度支气管哮喘患者嗜酸粒细胞及免疫功能的影响.方法 我院收治的老年急性中重度支气管哮喘住院患者112例,采用随机数字表法分为观察组和对照组各56例,两组均给予抗感染、祛痰、解痉等常规治疗,同时服用多索茶碱,对照组联合应用布地奈德雾化吸入治疗,观察组在对照组的基础上联合口服孟鲁司特钠,比较两组临床症状改善时间、嗜酸粒细胞、炎性因子、T淋巴细胞亚群等指标.结果 观察组咳嗽、胸闷、喘息、肺部症状等改善时间均短于对照组,血清嗜酸粒细胞(EOS)、白细胞介素-18(IL-18)、高敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)及CD3+、CD4+、CD4+/CD8+水平低于对照组,CD8+水平高于对照组(P<0.05).结论 孟鲁司特联合布地奈德有助于缓解老年急性中、重度支气管哮喘患者临床症状,拮抗炎症反应,改善细胞免疫功能.

To analyze the clinical efficacy of single‐port thoracoscopic and video‐assisted thora‐coscopic surgery for traumatic pneumothorax ,and provide more reference for clinical practice .[M ethods]A to‐tal of 70 patients with traumatic pneumothorax admitted to our hospital from August 2016 to August 2018 were enrolled .35 patients underwent single‐hole thoracoscopic surgery and 35 patients underwent video‐assis‐ted thoracoscopic surgery .T he changes of serum inflammatory cytokines and oxidative stress related indicators in the perioperative period ,the day of surgery and the 3 days after surgery were compared between the two groups ,and the incidence of complication was statistically analyzed .[Results]T he bleeding volume ,drainage volume ,thoracic tube placement time and hospitalization time of the observation group were less than those of the control group ,and the operation time was longer than that of the control group ,with statistical signifi‐cance ( P ＜0 .05).On the day after operation ,there was no significant difference in serum inflammatory cyto‐kines and oxidative stress related indicators between the two groups ( P ＞0 .05) ;on the 3rd day after opera‐tion ,the levels of inflammatory cytokines and oxidative stress related indicators in the two groups were lower than those in the day after operation ,and the observation group was lower than the control group ,the differ‐ence was statistically significant ( P ＜0 .05).T here was no significant difference in the incidence of complica‐tions between the two groups ( P ＞0 .05).[Conclusion]Compared with conventional video‐assisted thoracos‐copy ,single‐port video‐assisted thoracoscopy for traumatic pneumothorax has the characteristics of less trau‐ma ,faster recovery ,shorter hospitalization time ,and can more effectively reduce the inflammatory response and stress response of the body after operation ,w hich is worthy of popularization and application .

Objective To study the effect of ceftazidime combined with ambroxol on inflammatory factors and immune function of elderly diabetic patients with pulmonary infection .Methods A total of 112 elderly patients with diabetes com-plicated with pulmonary infection in Suining Central Hospital from Oct .2015 to Dec.2016 were divided into an observation group and a control group according to the treatment method ,56 patients each .The control group was given cefotaxime sodi-um combined with ambroxol therapy ,while the observatoin group was given ceftazidime combined with ambroxol therapy . After 2 weeks of treatment,the serum inflammatory factors,immune function,clinical efficacy,clinical symptoms improve-ment time and adverse reactions of the two groups were compared .Results The observation group′s effective rate was sig-nificantly higher than the control group′s[91.07%(51/56)vs 75.00%(42/56)](P<0.05).After treatment,fever,cough and expectoration improvement time of the observation group were significantly shorter than those of the control group [(35.42 ±4.21) h vs (41.36 ±5.26) h,(44.36 ±6.24) h vs (50.25 ±6.34) h](P<0.05).After treatment,serum tumor necrosis factor α,procalcitonin ,C reactive protein of the observation group were significantly lower than those of the control group[(31.14 ±3.45) ng/L vs (43.15 ±5.24) ng/L, (4.32 ±0.68) pg/L vs (7.12 ±1.14) pg/L,(56.24 ± 6.47) mg/L vs (75.36 ±9.52) mg/L](P<0.01).After treatment,CD3+, CD4+, CD4+/CD8+of the observation group were significantly higher than those of the control group [(62.35 ±6.24)%vs (59.78 ±6.15)%,(34.12 ±5.24)% vs (31.78 ±4.20)%,(1.20 ±0.34) vs (1.03 ±0.26)], CD8+ was significantly lower than that of the control group [(28.54 ±4.12)%vs (31.02 ±3.45)%](P<0.05).The complication rate in the observation group was significantly lower than that in the control group [7.14%(4/56) vs 21.43%(12/56)](P<0.05).Conclusion The combination of ceftazidime and ambroxol can improve the clinical efficacy and reduce the incidence of adverse reactions in elderly diabetic patients with pulmonary infection , which may be related to relieving inflammatory symptoms and improving immune func-tion.

Objective To explore the expression of the NOD-like receptor 3 (NLRP3) inflammasome in peripheral blood and its correlation to renal injury indicators in the elderly with diabetic nephropathy.Methods Real-time PCR was ap plied in detecting NLRP3 gene in 60 elderly with diabetic nephropathy (DN group) and 40 healthy elderly (norm group),and the contents of urine microalbumin (mAlb),transferring (TRF),immunoglobulins G (IgG),alpha-1-microglobulin (α1-MG) and N-acetyl-β-D-glucosaminidase (NAGase) were detected as well.Results The expression levels of NLRP3,apoptosis-associated speck-like protein containing CARD (ASC) and Caspase-1 in DN group were much higher than those in norm group (P＜0.05) and the expressions of early renal injury indicators including urine mAlb,TRF,IgG,αtl-MG and NAGase in the elderly in DN group increased much more significantly than those in the elderly in norm group (P＜0.05);NLRP3 of the 60 elderly in DN group was in positive correlation to mAlb (r=0.880,P＜0.05),in moderate positive correlation to TRF (r=0.560,P＜0.05) and in slight positive correlation to α1-MG (r=0.332,P＜0.05).Conclusions NLRP3 inflammasome may be in close correlation with renal injury indicators of the elderly with diabetic nephropathy,which provides a new basis for the diagnosis of renal injury of elderly diabetic nephropathy.

Objective To investigate the effect of proton pump inhibitors on patients with chronic obstructive pulmonary disease and gastroesophageal reflux in plateau region.Methods The patients with grade C or D stable phase of COPD were divided into two groups: the group A without gastroesophageal reflux (50 cases) and the group B with gastroesophageal reflux (74 cases), and the group B were sub-divided into two groups: the group B1 with omeprazole (36 cases) and the group B2 without omeprazole (38 cases).The 3 groups were followed up 2 months/time, for 3 times.The GERDQ table and COPD assessment test (CAT) questionnaire, pulmonary function test, 6 minutes walk test, and IL-1β, IL-6, IL-8, TNF-α, GM-CSF in sputum were tested at every follow-up.The times of exacerbation in the 6 months follow-up were also recorded.Results In the 6 months follow-up, the times of exacerbation of the group B2 was statistically more than in the group A and group B1 (P<0.05).The GERDQ scores in the group B1 and B2 were significantly higher than in the group A (P<0.05).After 2 months, the GERDQ scores of the group B2 were significantly higher than that of the group A and B1 (P<0.05).After 6 months, the CAT scores, forced expiratory volume at first second (FEV1), 6 minutes walk test, IL-1β, IL-6, IL-8, TNF-α and GM-CSF level of the group B2 showed significance with the group A and B1 (P<0.05).But the group A and the group B1 showed no statistical difference (P>0.05).Conclusion Omeprazole may reduce the times of acute exacerbation of COPD through alleviating gastroesophageal reflux.