We report a rare case of IgG4-related lung disease (RLD) with pulmonary lesions and recurrent pleural effusion to improve the diagnosis and treatment of this disease. A 60-year-old man was admitted to hospital for cough and dyspnea. CT scan showed a right lower lobe intrapulmonary mass with unilateral right-sided pleural effusion. Histology revealed no malignant findings. After 1 year, the patient re-admitted to our hospital with high serum level of IgG4 and IgE concentrations. CT scan demonstrated partial resolution of intrapulmonary mass and right-sided pleural effusion, while concurrently revealing interval development of substantial left-sided pleural effusion. The patient was diagnosed with IgG4-RLD by biopsy finally. This is a first case report of IgG4-RLD with intrapulmonary lesions accompanied by asynchronous, rapidly accumulating bilateral pleural effusions. Clinicians should consider the possibility of IgG4-RLD with intrapulmonary lesions accompanied by asynchronous, rapidly growing bilateral pleural effusion, particularly after rigorously excluding common diseases.

Purpose: Reduced slow wave sleep (SWS) has been linked to hypertension in some studies. The aim of the study is to investigate the association between SWS and office blood pressure (BP) in non-hypertensive obstructive sleep apnea (OSA). Methods: This is a retrospective study of 3350 patients who underwent polysomnography (PSG) in our hospital. Based on quartiles of percent SWS, participants were classified into four groups. BP was measured manually on the randomly chosen arm in a seated position with sphygmomanometer after PSG in the morning, and the average of the second and third measurements was used for this analysis. Elevated office BP was defined as a systolic BP≥140 mmHg or diastolic BP≥90 mmHg. Results: There were 1365 patients with OSA and 597 primary snorers included in our study. In OSA group, OSA patients with SWS <13.5% had a significant elevated risk with elevated office BP (OR,1.49[95%CI 1.05-2.10], P=0.025), compared to the highest quartile (percent SWS >39.2%). However, no significant relationship between decreased SWS and elevated office BP was found in primary snorers group. Conclusion: In non-hypertensive OSA patients, decreased SWS is associated with elevated office BP.

目的 回顾性分析阻塞性睡眠呼吸暂停患者睡眠效率与糖尿病发病率的相关性.方法 回顾性分析2002年10月1日-2021年9月30日某院呼吸科睡眠医学中心接受睡眠监测,并符合OSA诊断及纳入标准的2360名患者.所有患者根据睡眠效率比例不同分为≥85％,80％～84.9％和＜80％3个组别,以多因素Logistic模型分析睡眠效率与DM之间的相关性.结果 在所有OSA患者中,校正相关因素后,与睡眠效率≥85％相比,睡眠效率＜80％组其发生DM的概率明显升高(OR 1.476,95％CI 1.073～2.030,P=0.017).年龄＜60岁、男性以及BMI≥25kg/m2患者中,校正相关因素后,睡眠效率＜80％与DM的发生存在独立相关性(OR 1.619,95％CI 1.094～2.398,P=0.016;OR 1.712,95％CI 1.161～2.524,P=0.007;OR 1.500,95％CI 1.043～2.158,P=0.029).结论 在OSA患者中,睡眠效率差与DM的发生存在显著的相关性,尤其在年轻男性及肥胖的人群中尤为显著.

Objective We aimed to explore the relationship of sleep efficiency (SE) with the prevalence of hypertension in Chinese obstructive sleep apnea (OSA) patients based on polysomnography (PSG) records. Methods We studied 2360 patients with OSA and 764 primary snorers who underwent PSG in our hospital. SE was divided into three grades, including ≥85%, 80%~84.9%, and <80%. Hypertension was defined based either on direct blood pressure measurements, under anti-hypertensive treatments or on physician diagnosis. Multivariate logistic regression models were conducted to investigate the association between SE and hypertension. Results After adjusting for potential confounding factors, OSA patients with <80% SE and those with 80% to 84.9% SE were significantly associated with the prevalence of hypertension (OR = 1.248, 95% CI 1.018~1.531, P=0.033; OR = 1.380, 95% CI 1.040~1.832, P=0.026). Compared to primary snorers, OSA combined with <85% SE increased the odds of hypertension. In stratified analysis by SE, risk of hypertension only in those with <80% SE was significantly different between OSA and primary snorers. Furthermore, this relationship between reduced SE and hypertension was evident especially in female, younger ages, obese, moderate and severe OSA patients. No significant relationship between reduced SE and hypertension was found in primary snores group. Conclusion We found that poor SE was correlated with the prevalence of hypertension in Chinese OSA patients, but not in those with primary snoring. Moreover, this relationship was evident especially in female, younger ages, obese, moderate and severe OSA patients.

Abstract Background: Lung adenocarcinoma (LUAD) is the most common subtype of lung cancer and is significantly correlated with poor prognosis. N7-methylguanosine (m7G) modification plays an important role in occurrence, progression, and prognosis of cancer. The present study aimed to construct a prognostic risk model based on m7G-related genes for LUAD. Methods: In this study, we used data from TCGA-LUAD for the training cohort and GSE72049 and GSE31210 for the validation cohorts. Univariate Cox regression, Lasso regression analyses, and multivariate Cox regression analyses were conducted to construct an m7G-related genes risk model. We then applied multivariate Cox regression, Kaplan-Meier analysis, and Receiver operating characteristic (ROC) curves to evaluate the risk model. Finally, we analyzed the immune microenvironment and immunotherapy response with the risk score model in LUAD.Results: A novel prognostic risk model based on the four m7G-related genes (ANLN, KRT6A, NTSR1 and RHOV) was constructed. The multivariate Cox analysis showed that the prognostic risk model was an independent risk factor (HR 1.224, 95% CI 1.162-1.290, P＜0.001). Patients in the high-risk group showed an increased risk of mortality in training cohort(HR 2.04, 95%CI 1.49-2.79, P＜0.001) and validation cohorts(HR 2.46, 95%CI 1.7-3.56; HR 3.85, 95%CI 1.98-7.49). The 1, 3, and 5-year AUC value in TCGA was 0.755, 0.71, and 0.631, respectively; The 1, 3, and 5-year AUC value in GSE72049 was 0.709, 0.672, and 0.762, respectively; The 1, 3, and 5-year AUC value in GSE31210 was 0.715, 0.649, and 0.709, respectively. The high-risk patients were more likely to respond to immunotherapy than the low-risk group(P＜0.001).Conclusion: A novel prognostic risk model based on m7G-related genes was established in this study, which may predict clinical prognosis and immunotherapeutic responses in LUAD patients.

We aimed to investigate the efficacy of four severity-of-disease scoring systems in predicting the 28-day survival rate among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring emergency care. Clinical data of patients with AECOPD who required emergency care were recorded over 2 years. APACHE II, SAPS II, SOFA, and MEDS scores were calculated from severity-of-disease indicators recorded at admission and compared between patients who died within 28 days of admission (death group; 46 patients) and those who did not (survival group; 336 patients). Compared to the survival group, the death group had a significantly higher GCS score, frequency of comorbidities including hypertension and heart failure, and age (P < 0.05 for all). With all four systems, scores of age, gender, renal inadequacy, hypertension, coronary heart disease, heart failure, arrhythmia, anemia, fracture leading to bedridden status, tumor, and the GCS were significantly higher in the death group than the survival group. The prediction efficacy of the APACHE II and SAPS II scores was 88.4%. The survival rates did not differ significantly between APACHE II and SAPS II (P = 1.519). Our results may guide triage for early identification of critically ill patients with AECOPD in the emergency department.

Objective To evaluate the safety and efficacy of indacaterol in treatment of stable chronic obstructive pulmonary disease (COPD).Methods The related databases were electronically searched for the randomized controlled trials (RCT) on the treatment of stable COPD with indacaterol published before November 1st, 2016.The quality of the reports enrolled into the Meta-analysis was evaluated by Jadad scoring system.The Meta-analysis was conducted using Review Manager 5.3 software.The results were presented as relative risk (RR) and 95% confidence intervals (CI).Results A total of 10 RCTs involving 7 315 patients were enrolled, including 4 439 in the indacaterol group and 2 876 in the placebo group.The Jadad score of all literatures was 3 to 5.They were all high quality documents.The results of Meta-analysis showed that the incidence of COPD acute exacerbation in the indacaterol group was lower than that in the placebo group, the difference was statistically significant[20.6% (914/4 439) vs.22.4% (643/2 876), RR=0.85, 95%CI: 0.77-0.92, P<0.01].The results of subgroup analysis showed that the incidence of COPD acute exacerbation in doses of 150 μg/d and 600 μg/d in the indacaterol group were lower than those in the placebo group, the differences were statistically significant[(20.4% (384/1 878) vs.22.2% (359/1 617), RR=0.84, 95%CI: 0.74-0.95, P<0.01;27.5% (117/425) vs.34.7% (150/432), RR=0.79, 95%CI: 0.65-0.97, P=0.02)].The incidence of severe COPD acute exacerbation in the indacaterol group was lower than that in the placebo group, the difference was statistically significant[2.3% (103/4 439) vs.2.9% (84/2 876),RR=0.72, 95%CI: 0.54-0.96, P=0.03].The results of subgroup analysis showed that the incidence of severe COPD acute exacerbation at dose of 600 μg/d in the indacaterol group was lower than that in the placebo group, the difference was statistically significant[0.9% (4/425) vs.3.9% (17/432), RR=0.24, 95%CI: 0.08-0.7, P<0.01].The overall fatality rate in the indacaterol group was lower than that in the placebo group, but the difference was no statistically significant [0.25% (8/3 164) vs.0.58% (11/1 906), RR=0.48, 95%CI: 0.20-1.14, P=0.10].The fatality rate due to cardiovascular events in the indacaterol group was lower than that in the placebo group, but the difference was not statistically significant [0.22% (7/3 164) vs.0.42% (8/1 906), RR=0.56, 95%CI: 0.22-1.42, P=0.22].The fatality rate due to respiratory diseases in the indacaterol group was lower than that in the placebo group, but the difference was no statistically significant [0.12% (2/1 668) vs.0.20% (2/999), RR=0.65, 95%CI: 0.13-3.31, P=0.61].The result of sensitivity analysis showed that the outcome of the study was stable and not influenced by simplex trial.Conclusion Indacaterol is effective and relatively safe of treatment in patients with stable COPD.

Background The cardiovascular safety of inhaled long-acting β2-agonists (LABAs) in patients with chronic obstructive pulmonary disease (COPD) is a controversial problem. Certain studies have suggested that inhaled LABAs lead to an increased risk of cardiovascular events in patients with COPD. This meta-analysis aimed to assess the cardiovascular safety of inhaled LABAs in COPD. Methods A meta-analysis of randomized, double-blind, parallel-group, placebo-controlled trials for LABA treatment of COPD with at least 3 months of follow-up was performed. The fixed-effects model was used to evaluate the effects of LABAs on fatal cardiovascular adverse events. Adverse events were collected for each trial, and the relative risk (RR) and 95% confidence intervals (CI) for LABA/placebo were estimated. Results There were 24 trials included in this meta-analysis. Compared with placebo, inhaled LABAs significantly decreased fatal cardiovascular adverse events in COPD patients (RR 0.65, 95% CI 0.50 to 0.86, P = 0.002). In sensitivity analysis, there was still no increased risk of fatal cardiovascular events (RR 0.68, 95%CI 0.46 to 1.01, P = 0.06) after excluding the trial with the largest weight. Among the different types of LABAs, only salmeterol had a significant effect (RR 0.64, 95% CI 0.46 to 0.90). In subgroup analyses, inhaled LABAs were able to significantly decrease fatal cardiovascular events in long-term trials (RR 0.64, 95% CI 0.47 to 0.87) and in trials with severe COPD patients (RR 0.69, 95% CI 0.50 to 0.96). Conclusion Inhaled LABAs do not increase the risk of fatal cardiovascular events in COPD patients.

>目前,每年宫颈癌的新发病例数约为45万例 [1] ,对于早期宫颈癌患者,手术和放疗有着相似的疗效,5年生存率为87% 9 2% [2] 。子宫颈癌根治术（广泛性子宫切除+盆腔淋巴结清扫术）是早期宫颈癌的主要治疗手段。手术的优点在于能够通过对淋巴结的切除进行分期,从而进行个体化的规范治疗 [3] ;而且,手术可以保留卵巢的内分泌功能,与放射治疗相比,对阴道功能的影响也相对较小 [3-5] ,因此,手术依然是宫颈癌主要的治疗手段之一。另外,由于患者年轻化,治疗后对生活质量的要求不断提高,而放射治疗有可能破坏卵

Objective To investigate the effects of N-acetylcysteine(NAC) on constitutive(agonist-independent) and agonist-stimulated mGlu1a-mediated excitotoxicity associated with mGlu1a overexpression in HEK293 cells.MethodsThe signaling pathways,cell viability,the surface expression of mGlu1a and the intracellular oxidative stress were detected by western blot,MTT,trypan blue-exclusion assay,Elisa,Fluorescence-based Detection of Cellular ROS and HPLC methods.Results In mGlu1a-transfected cells and mGlu1a-transfected,DHPG-induced cells,NAC inhibited the excitotoxicity of mGlu1a by different mechanisms.Under two conditions,NAC prohibited the production of ROS and modulated the intracellular glutathione redox potential.Conclusion This study further suggested that the complex effects of mGlu1a activity under different conditions might play different role in the progress of many diseases,especially in terms of the effects of increased receptor expression.

目的分析高危子宫内膜癌术后单纯放疗与联合放化疗的疗效及毒性作用。方法回顾性分析1999～2007年接受病理分期性手术及术后辅助治疗的172例高危子宫内膜癌患者的临床资料。结果 172例患者3年和5年的疾病特异性生存（DSS）率分别为87.09%和78.17%。联合放化疗与单纯放疗的DSS率和复发率比较差异有统计学意义（P=0.020、0.004）。化疗后放疗与单纯放疗的毒性作用比较差异无统计学意义（P=0.638）。结论高危子宫内膜癌联合放化疗可明显提高DSS率,减少复发率。联合方式中,化疗后放疗更为安全,可行性大。