2020年 · 第133卷第13期

The Global Alliance Against Chronic Respiratory Diseases (GARD) is a voluntary alliance of national and international organizations, institutions, and agencies committed to the vision of "a world where all people breathe freely."^[1,2]Its goal is to reduce the global burden of chronic respiratory disease (CRD).

The growing public health concern caused by non-communicable diseases in urban surroundings cannot be solved by health care alone; therefore a multidisciplinary approach is mandatory. This study aimed to evaluate the airborne aerosol pollution level in primary schools as possible factor influencing origin and course of the diseases in children.

Seasonal aerosol particle number concentration (PNC) and mass concentration (PMC) were studied in the randomly selected eleven primary schools in the Lithuanian capital, Vilnius, as model of a middle-size Eastern European city. Total PNC in the size range from 0.01 to >1.0 μm in diameter was measured using a condensation particle counter. Using an optical particle sizer, PNC was measured and PMC estimated for particles from 0.3 to 10.0 μm. A descriptive statistics was used to estimate the aerosol pollution levels.

During all seasons, local cafeterias in the absence of ventilation were the main sources of the elevated levels of indoor PMC and PNC (up to 97,500 particles/cm³). The other sources of airborne particulates were the children’s activity during the lesson breaks with PMC up to 586 μg/m³. Soft furniture, carpets in the classrooms and corridors were responsible for PMC up to 200 μg/m³. Outdoor aerosol pollution (up to 18,170 particles/cm³) was higher for schools in city center. Elevated air pollution in classrooms also resulted from intermittent sources, such as construction work during classes (200-1000 μg/m³) and petrol-powered lawn trimmers (up to 66,400 particles/cm³).

The results of our survey show that even in a relatively low polluted region of Eastern Europe there are big differences in aerosol pollution within middle-sized city. Additional efforts are needed to improve air quality in schools: more frequent wet cleaning, monitoring the operation of ventilation systems, a ban on construction works during school year, on a use of sandblasting mechanisms in the neighborhood of schools.

According to the Independent High-level Commission on Non-communicable Diseases (NCD) of the World Health Organization (WHO), global reduction in lung cancer mortality has been achieved since the year 2000, although this effect is not sufficient to reach the 30% reduction of mortality from NCDs by the year 2030, as stipulated by the United Nations Sustainable Development Goal 3.4. The objective of this study was to analyze whether the lifestyle changes implemented by the WHO at country level could have an impact on mortality from this form of cancer.

WHO statistics, based on the unified mortality and causes-of-death reports of Member-State countries, were used to evaluate global lung cancer mortality trends and make comparisons and assessments of different types of community-based, country-wide interventions.

The lung cancer mortality decline was associated with the anti-tobacco campaign initiated by the WHO in the last 15 to 20 years. Comprehensive tobacco control remained the major and most successful lifestyle modification measure. In countries with declining lung cancer mortality, 91% of countries had decreasing tobacco prevalence in males and 82% in females. Country-wide measures to increase physical activity had a strong tendency to be better implemented in countries with declining lung cancer mortality (t = 1.79, P > 0.05). Other WHO "best-buy" lifestyle modification campaigns (diet and alcohol) had been carried out for shorter periods, and their associations with lung cancer were less strong than tobacco. There was no significant difference between countries with declining and increasing lung cancer mortality in the measures for reduction of harmful alcohol use (t= 0.92, P > 0.05) and unhealthy diet reduction measures (t= 0.84, P > 0.05).

Following WHO "best-buys" should facilitate to move countries towards the NCD including lung cancer mortality reduction targets. Governments and communities must embrace these targets with coordinated effective action for better health.

The detrimental outcomes of right ventricular pacing on left ventricular electromechanical function ultimately result in heart failure, a phenomenon termed pacing-induced cardiomyopathy (PICM) in clinical research. This study aimed to validate prognostic factors that can be used to identify patients with higher susceptibility to progress to the stage of cardiomyopathy before pacemaker implantation.

This observational analysis enrolled 256 patients between January 2013 and June 2016, 23 (8.98%) of whom progressed to PICM after 1 year of follow-up. A Cox proportional hazard model was used to analyze the prognostic factors associated with PICM. Dose-response analysis was used to evaluate the relationship between significant indicators in multifactor analysis and PICM.

The mean values of left ventricular ejection fraction before and after pacemaker implantation in 23 patients diagnosed with PICM were 62.3% and 42.7%, respectively. Univariate analysis showed that sex, atrio-ventricular block, paced QRS duration, and ventricular pacing percentage were significantly associated with PICM. In the multivariate analysis, male sex (hazard ratio: 1.20, 95% confidence interval [CI]: 1.09-1.33, P < 0.005), paced QRS duration (hazard ratio: 1.95 per 1 ms increase, 95% CI: 1.80-2.12, P < 0.001), and ventricular pacing percentage (hazard ratio: 1.65 per 1% increase, 95% CI: 1.51-1.79, P < 0.001) were independent prognostic factors associated with the development of PICM. The ventricular pacing percentage and paced QRS duration level defined by the dose-response analysis were positively associated with PICM (P < 0.05).

Our findings indicated that paced QRS duration and ventricular pacing percentage were the most sensitive prognostic factors for PICM.

About 10% of patients get a surgical-site infection (SSI) after radical gastrectomy for gastric cancer, but SSI remains controversial among surgeons. The aim of this study was to explore the risk factors for SSIs after radical gastrectomy in patients with gastric cancer to guide clinical therapies and reduce the incidence of SSI.

The study was a retrospective cohort study in patients who underwent radical gastrectomy for gastric cancer. SSI was defined in accordance with the National Nosocomial Infection Surveillance System. We evaluated patient-related and peri-operative variables that could be risk factors for SSIs. The Chi-squared test and logistic regression analysis were used to assess the association between these risk factors and SSI.

Among the 590 patients, 386 were men and 204 were women. The mean age was 56.6 (28-82) years and 14.2% (84/590) of these patients had an SSI. Among them, incisional SSI was observed in 23 patients (3.9%) and organ/space SSI in 61 patients (10.3%). Multivariate logistic regression analysis identified sex (odds ratios [ORs] = 2.548, and 95% confidence interval [CI]: 1.268-5.122, P = 0.009), total gastrectomy (OR = 2.327, 95% CI: 1.352-4.004, P = 0.002), albumin level (day 3 after surgery) <30 g/L (OR= 1.868, 95% CI: 1.066-3.274, P = 0.029), and post-operative total parenteral nutrition (OR = 2.318, 95% CI: 1.026-5.237, P = 0.043) as independent risk factors for SSI.

SSI was common among patients after radical gastrectomy for gastric cancer. The method supporting post-operative nutrition and the duration of prophylactic antibiotics may be important modifiable influencing factors for SSI.

To summarize the main updated evidence about the health effects of air pollution, with a special focus on Southern Europe.

Literature was obtained through PubMed Central and the official websites of European Agencies and Scientific Societies.

Recent shreds of evidence about the health effects of air pollution coming from international reports and original research were collected and described in this review.

Air pollution is an avoidable risk factor that causes a huge burden for society, in terms of death, health disorders, and huge socio-economic costs. The southern European countries face a more threatening problem because they experience the effects of both anthropogenic pollutants and natural dusts (particulate matter [PM]). The European Environment Agency reported the number of premature deaths in the 28 countries of the European Union attributable to air pollutant exposure in the year 2016: 374,000 for PM_2.5, 68,000 for nitrogen dioxide, and 14,000 for ozone. In Italy, time series and analytical epidemiological studies showed increased cardiorespiratory hospital admissions and mortality, as well as increased risk of respiratory diseases in people living in urban areas.

Based on abundant evidence, the World Health Organization, which hosts the Global Alliance against Chronic Respiratory Diseases (GARD), the scientific respiratory societies, and the patients’ associations, as well as others in the health sector, must increase their engagement in advocacy for clean air policies.

In December 2019, a novel coronavirus was identified in Wuhan, Hubei Province, China.^[1,2,3]On January 12, 2020, the World Health Organization (WHO) temporarily named the new coronavirus as "2019 novel coronavirus (2019-nCoV)." On February 8, the National Health Commission of the People’s Republic of China announced that the name of the pneumonia caused by 2019-nCoV was "novel coronavirus pneumonia (NCP)." On February 12, Coronaviridae Study Group of the International Committee on Taxonomy of Viruses proposed to officially name the new coronavirus "severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)." On the same day, the WHO announced the official name of the disease caused by the virus as "coronavirus disease 2019 (COVID-19)." On February 22, the National Health Commission of the People’s Republic of China issued a notice to amend the English name of "NCP" to "COVID-19."^[4]Currently, although the epidemic situation in China is under control, the number of cases globally has been increasing. On March 11, 2020, the WHO officially announced that COVID-19 had reached global pandemic status. As experience and understanding of disease prevention, control, diagnosis, and treatment continue to accumulate, a summary of the results of available studies and experience is needed to guide the management of the disease. This guidance explains the up-to-date etiology, pathogenesis, epidemiology, clinical characteristics, treatment principles, rehabilitation, and prevention and control measures of COVID-19.

Since December 2019, the coronavirus disease 2019 (COVID-19) has become a public health emergency. COVID-19 has already been classified as a category B infectious disease according to the Law of the People’s Republic of China on the Prevention and Treatment of Infectious Diseases, and control measures for category A infectious diseases have been adopted. The National Health Commission has also published diagnosis and treatment protocols to guide the clinical diagnosis and treatment. With the accumulating experience of treating COVID-19 patients, particularly severely and critically ill patients, in clinical practice, our understanding of COVID-19 has continuously deepened. With regard to varying degrees of respiratory, physical, and psychological dysfunction in patients,^[1]it is vital to standardize respiratory rehabilitation techniques and procedures for respiratory rehabilitation in various regions. Hence, we combined the opinions of frontline epidemic control experts and reviewed the evidence in relevant literature. Based on the "Coronavirus Disease 2019 Respiratory Rehabilitation Guidelines (First Edition),"^[2]we organized experts in evidence-based medicine, respiratory and critical care medicine, and rehabilitation medicine in China, and invited some experts at the frontline of epidemic control in Wuhan and other cities in Hubei province to jointly draft these recommendations.

Polycyclic aromatic hydrocarbon (PAH) molecules are a large group of organic compounds with two or more fused benzene rings arranged in various configurations.^[1]To date, hundreds of PAHs have been identified. PAHs are widespread environmental contaminants formed as a result of incomplete combustion of carbonaceous materials in both natural and anthropogenic process.^[2]Compared to the natural sources, such as volcanic eruptions and wild fires, anthropogenic sources, such as industrial processes, cigarette smoke, vehicular exhaust, residential heating fuels and charcoal-grilled and flame-broiled food, make a larger contribution to the generation of atmospheric PAHs.^[3]Through inhalation, ingestion and dermal contract, PAHs from all sources can easily be absorbed in the body and further metabolized and excreted in urine. The urinary monohydroxylated PAH (OH-PAH) has been widely considered as a biomarker to represent individual PAH exposure levels in many studies.^[4,5,6]

Coronary heart disease (CHD) is a complex metabolic syndrome, resulting in atherosclerotic lesions in one or more coronary arteries. CHD is associated with high morbidity and mortality worldwide. Coronary artery bypass grafting (CABG) is the gold standard for invasive treatment of severe CHD, especially triple-vessel disease and left main disease. Saphenous veins (SVs) are typically used in CABG because of their sufficient length and convenience, but SV graft (SVG) failure is a common finding in patients. Approximately 20% of SVGs fail within 1 year after CABG, and the 10-year post-CABG patency rate is 60%.^[1]

China has been experiencing some of the world’s most serious air pollution, especially severe smog events swept China in January of 2013, leading to extensive international attention. Efforts to understand and mitigate the impacts of ambient air pollution on public health have been taken to tackle this pollution in China. Clean air actions developed nationwide have aggressively lowered fine particulate matter (PM_2.5) pollution in recent years.^[1]National health plans and research projects on air pollution have been motivated and funded by the government. Rapidly growing epidemiological evidence has emerged to preliminarily uncover the effects of elevated levels of ambient air pollution on human health. However, China’s pollution levels still exceed that of the World Health Organization (WHO) least-stringent target.^[1]Ambient air pollution still poses a serious threat to human health and welfare. It is critical to elucidate targets and efforts on the improvement of air quality and the reduction of related health effects. Therefore, this paper has organized the development of clean air actions, health plans, relevant research projects, and reviewed key milestones of health evidence in China to propose suggestions to air pollution mitigation in its next stage.

To the Editor:In December 2019, coronavirus disease 2019 outbreak caused by the 2019 novel coronavirus (2019-nCoV) happened in Wuhan, China. Now, it has posed a worldwide public health threat. Real-time quantitative polymerase chain reaction (RT-qPCR) was recommended as an effective pathogen detection method and has played an important role in prevention and control of the current outbreak. Many research institutions have released their primer sets for RT-qPCR. If the variant sites were located in the primer regions, the efficiency of RT-qPCR would be reduced, thus possibly causing false negative results, and leading to unpredictable impact on the diagnosis of patients and the control of this outbreak. Therefore, a comprehensive investigation on 2019-nCoV genome variation is necessary to evaluate the effectiveness of current released RT-qPCR methods.

As a morphological sub-type of multiple myeloma (MM), anaplastic myeloma (AM), which includes anaplastic multiple myeloma and anaplastic plasmacytoma, is a rare disease that aggressively progresses. It is reported to be very resistant to chemotherapy and exhibits a poor prognosis.^[1]Although AM was detected in 2.6% of patients in a large series of cases,^[2]there have only been some case reports since AM was first reported in 1983.^[3]Therefore, AM lacks detailed descriptions and strict definitions. To further analyze the clinical and pathological features of AM patients and to provide some suggestions for diagnosis and treatment, we retrospectively analyzed four AM patients who were admitted to the Affiliated Hospital of Qingdao University.

To the Editor:Sex chromosomal aneuploidies (SCAs) are common chromosomal aberrations that are normally diagnosed after birth. It results in abnormal physical development or infertility. The prenatal incidence is as high as 1/435 and is usually identified by karyotyping. SCAs are characterized by an abnormal number of sex chromosomes and include monosomy (45, X), trisomy (47, XXX, 47, XXY, and 47, XYY), other aneuploidies and various forms of sex chromosome mosaicism. The phenotypes of SCA patients are diverse. The prenatal diagnosis of fetal SCAs affects the parents and there is a need for clinical counseling. What’s more, early diagnosis is important as it provides opportunities for early treatment and future healthcare for children with SCAs.

To the Editor:With the rapid economic growth and improvement of people’s living standards in China, ever-greater demands for high-level health-care services are expected. These expectations are bringing new challenges to the development of clinical doctors. However, the traditional path for doctor training is inadequate to meet these challenges, as both clinical and scientific practices are important for doctors but difficult to integrate into medical education. Thus, the current medical training system is challenged to combine scientific research training with conventional clinical training. To provide possible solutions, Health Science Center (HSC) of Xi’an Jiaotong University (XJTU) has been exploring a new mode of developing physician scientists: The Double Doctoral Program (DDP).

To the Editor: Neisseria gonorrhoeae(NG) with decreased susceptibility to ceftriaxone (CRO) and cefixime, the last option for first-line anti-microbial monotherapy, was spread globally. Until now, more than ten clinical treatment failures with CRO have been reported with minimum inhibitory concentration (MIC) range as 0.5 to 2.0 mg/L.^[1]CRO, thereafter, is no longer recommended as monotherapy for gonorrhea. Instead, dual therapy that combines CRO with azithromycin is currently exerted in many countries including China. However, the first treatment failure to dual therapy (500 mg CRO plus 1 g azithromycin) was identified in 2014 in London.^[1]The reasons for NG to gain the resistance to anti-microbial agents are either through spontaneous mutation and/or horizontal genetic transfer. Here, we applied whole-genome sequencing (WGS) to compare the mutation accumulation between NG isolates with susceptibility to CRO (CRO-S, MIC < 0.125 mg/L) and that with decreased susceptibility to CRO (CRO-DS, MIC ≥ 0.25 mg/L).

To the Editor: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis (NMDARE) is a potentially lethal autoimmune disease. Anti-myelin oligodendrocyte glycoprotein (MOG) antibody (Ab) could represent a diagnostic biomarker for a distinct spectrum of central nervous system (CNS) inflammatory demyelinating diseases (IDDs). Herein, we report two cases, positive for both NMDAR-Ab and MOG-Ab, which was presented with cortical encephalitis and subsequent demyelination.

To the Editor:The activity of fibrinolytic enzymes is complex. Abnormal bleeding can be caused by over-expression of plasminogen activators or a lack of fibrinolysis inhibitor. Quebec platelet disorder (QPD), an autosomal dominant disorder, with increased gene expression ofPLAUencoding urokinase plasminogen activator (u-PA), causes a gain-of-function abnormality in fibrinolysis. Tissue plasminogen activator (t-PA) exists in various tissues and cells. When pulmonary interstitial cells are damaged, t-PA can be released and promote the activation of plasminogen. The interstitial pulmonary fibrosis (IPF) can cause vascular injury and leakage of t-PA, resulting in their elevation in alveoli.^[1]Patients can present with fibrinolytic system abnormalities, and anti-fibrinolytic therapy combined with glucocorticoids can effectively prolong the survival time.

In the article titled, "Diagnosis of the accurate genotype of HKaa carriers in patients with thalassemia using multiplex ligation-dependent probe amplification combined with nested polymerase chain reaction" published in pages 1175-1181, Issue 10, Vol. 133 ofChinese Medical Journal,^[1]the author and affiliation section should be corrected as follows: