Volume 133 · Issue 13 · 2020

全球抗击慢性呼吸道疾病联盟（GARD）是一个由国家和国际组织、机构和机构组成的自愿联盟，致力于“一个所有人都能自由呼吸的世界”的愿景。^[1,2]其目标是减轻慢性呼吸道疾病（CRD）的全球负担。

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.

2019年12月，湖北省武汉市发现新型冠状病毒。^[1,2,3]2020年1月12日，世卫组织（WHO）将新型冠状病毒暂时命名为“2019新型冠状病毒（2019新型冠状病毒）”。2月8日，国家卫健委宣布，2019新型冠状病毒引发的肺炎名称为“新型冠状病毒肺炎（NCP）”。2月12日，国际病毒分类委员会冠状病毒科研究组提议将新型冠状病毒正式命名为“严重急性呼吸综合征冠状病毒2（新型冠状病毒）”。同日，世卫组织宣布该病毒引起的疾病的正式名称为“2019冠状病毒病（COVID-19）”。2月22日，中华人民共和国国家卫生健康委员会发布通知，将“NCP”英文名称修改为“COVID-19”。^[4]当前，虽然中国疫情得到控制，但全球病例数一直在增加。2020年3月11日，世卫组织正式宣布新冠肺炎达到全球大流行状态。随着对疾病预防、控制、诊断和治疗的经验和认识不断积累，需要对现有研究和经验的结果进行总结，以指导疾病的管理。本指南解释了新冠肺炎的最新病因、发病机制、流行病学、临床特征、治疗原则、康复和预防控制措施。

自2019年12月以来，冠状病毒病2019（新冠肺炎）已成为突发公共卫生事件。根据《中华人民共和国传染病防治法》，新冠肺炎已被列为乙类传染病，并已采取甲类传染病的控制措施。国家卫健委也公布了诊疗方案，指导临床诊疗。随着临床上救治新冠肺炎患者特别是重症、危重症患者经验的积累，我们对新冠肺炎的认识也在不断加深。针对患者不同程度的呼吸、躯体、心理功能障碍，^[1]标准化呼吸康复技术和程序对于不同地区的呼吸康复至关重要。因此，我们结合了一线疫情控制专家的意见，并回顾了相关文献中的证据。基于《冠状病毒病2019呼吸康复指南（第一版）》，^[2]我们组织了国内循证医学、呼吸与危重症医学、康复医学等方面的专家，邀请了湖北省武汉市和其他地市疫情控制一线的一些专家，共同起草了这些建议。

多环芳烃（PAH）分子是一大类有机化合物，具有两个或多个以各种构型排列的稠合苯环。^[1]迄今为止，已鉴定出数百种多环芳烃。多环芳烃是广泛存在的环境污染物，是碳质物质在自然和人为过程中不完全燃烧的结果。^[2]与自然来源（如火山爆发和野火）相比，人为来源（如工业过程、香烟烟雾、汽车尾气、住宅取暖燃料以及木炭烧烤和火焰烧烤食品）对大气多环芳烃的产生贡献更大。^[3]通过吸入、摄入和皮肤接触，所有来源的多环芳烃都很容易在体内被吸收，并进一步代谢和排泄到尿液中。在许多研究中，尿单羟基化多环芳烃（OH-PAH）被广泛认为是代表个体多环芳烃暴露水平的生物标志物。^[4,5,6]

冠心病（CHD）是一种复杂的代谢综合征，导致一条或多条冠状动脉的动脉粥样硬化病变。CHD在世界范围内与高发病率和死亡率相关。冠状动脉旁路移植术（CABG）是严重CHD，尤其是三支病变和左主干病变侵入性治疗的金标准。隐静脉（SVs）由于其足够的长度和便利性而通常用于CABG，但SV移植物（SVG）失败是患者中的常见发现。大约20%的SVG在CABG后1年内失败，10年CABG后通畅率为60%。^[1]

中国一直在经历一些世界上最严重的空气污染，尤其是2013年1月席卷中国的严重雾霾事件，引起了国际社会的广泛关注。中国已努力了解和减轻环境空气污染对公众健康的影响，以解决这种污染。全国范围内开展的清洁空气行动大大降低了细颗粒物_2.5）近年来的污染。^[1]关于空气污染的国家卫生计划和研究项目得到了政府的激励和资助。迅速增长的流行病学证据已经初步揭示了环境空气污染水平升高对人类健康的影响。然而，中国的污染水平仍然超过了世界卫生组织（WHO）最不严格的目标。^[1]环境空气污染仍然对人类健康和福利构成严重威胁。阐明改善空气质量和减少相关健康影响的目标和努力至关重要。因此，本文组织了清洁空气行动、健康计划、相关研究项目的开发，并回顾了中国健康证据的关键里程碑，为下一阶段的空气污染缓解提出了建议。

致编辑：2019年12月，中国武汉市发生由2019年新型冠状病毒（2019新型冠状病毒）引起的2019冠状病毒病疫情。现在，它已经对全球公共健康构成威胁。实时定量聚合酶链反应（RT-qPCR）被推荐为一种有效的病原体检测方法，并在当前疫情的防控中发挥了重要作用。许多研究机构已经发布了他们用于RT-qPCR的引物组。如果变异位点位于引物区域，RT-qPCR的效率将会降低，从而可能导致假阴性结果，并对患者的诊断和此次疫情的控制导致不可预测的影响。因此，有必要对2019新型冠状病毒基因组变异进行全面调查，以评估当前发布的RT-qPCR方法的有效性。

作为多发性骨髓瘤（MM）的形态学亚型，间变性骨髓瘤（AM）包括间变性多发性骨髓瘤和间变性浆细胞瘤，是一种侵袭性进展的罕见疾病。据报道，它对化疗非常耐药，预后不良。^[1]尽管在大量病例中2.6%的患者中检测到AM，^[2]自1983年首次报道AM以来，只有一些病例报告。^[3]因此，AM缺乏详细的描述和严格的定义。为进一步分析AM患者的临床和病理特点，为诊治提供一些建议，我们对青岛大学附属医院收治的4例AM患者进行回顾性分析。

致编辑：性染色体非整倍体（SCAs）是常见的染色体畸变，通常在出生后诊断。它会导致身体发育异常或不孕。产前发病率高达1/435，通常通过染色体核型鉴定。SCA的特征在于性染色体数量异常，包括单体(45，X)、三体(47，XXX，47，XXY和47，XYY)、其他非整倍体和各种形式的性染色体镶嵌。SCA患者的表型多种多样。胎儿SCA的产前诊断影响父母，需要临床咨询。此外，早期诊断很重要，因为它为SCA儿童提供了早期治疗和未来医疗保健的机会。

致编辑：随着中国经济的快速增长和人民生活水平的提高，预计对高水平医疗服务的需求将越来越大。这些期待正在给临床医生的发展带来新的挑战。然而，传统的医生培训途径不足以应对这些挑战，因为临床和科学实践对医生来说都很重要，但很难融入医学教育。因此，当前的医学培训体系面临着将科研培训与常规临床培训相结合的挑战。为了提供可能的解决方案，*安安交通大学（XJTU）健康科学中心（HSC）一直在探索一种培养医师科学家的新模式：双博士项目（DDP）。

致编辑：淋病奈瑟菌（NG）随着对头孢曲松（CRO）和头孢克肟（一线抗菌单药治疗的最后选择）的敏感性降低，在全球范围内传播。到目前为止，已经报告了十多例CRO临床治疗失败，最低抑菌浓度（MIC）范围为0.5至2.0 mg/L。^[1]此后，不再推荐CRO作为淋病的单一疗法。相反，CRO与阿奇霉素相结合的双重疗法目前正在包括中国在内的许多国家发挥作用。然而，2014年在伦敦发现了首例双重疗法（500 mg CRO加1 g阿奇霉素）治疗失败。^[1]NG获得抗微生物剂耐药性的原因是通过自发突变和/或水平遗传转移。在这里，我们应用全基因组测序(WGS)来比较对CRO（CRO-S，MIC）易感性的NG分离株之间的突变积累<0.125 mg/L）和CRO易感性降低（CRO-DS，MIC≥0.25 mg/L）。

致编辑：反-N-甲基-D-天冬氨酸受体(NMDAR)脑炎(NMDAR)是一种潜在致死性自身免疫性疾病。抗髓鞘少突胶质细胞糖蛋白（MOG）抗体（Ab）可以代表不同范围的中枢神经系统（CNS）炎性脱髓鞘疾病（IDDs）的诊断生物标志物。在此，我们报告了两例NMDAR-Ab和MOG-Ab均呈阳性的病例，表现为皮质脑炎和随后的脱髓鞘。

致编辑：纤溶酶的活性是复杂的。异常出血可由纤溶酶原激活物过度表达或纤溶抑制剂缺乏引起。魁北克血小板疾病(QPD)，一种常染色体显性疾病，基因表达增加普劳编码尿激酶纤溶酶原激活剂（u-PA），导致纤溶中的功能获得性异常。组织型纤溶酶原激活物（t-PA）存在于多种组织和细胞中。当肺间质细胞受损时，t-PA可释放，促进纤溶酶原激活。间质性肺纤维化（IPF）可引起血管损伤和t-PA渗漏，导致其在肺泡中升高。^[1]患者可表现为纤溶系统异常，抗纤溶治疗联合糖皮质激素可有效延长生存时间。

在题为“使用多重连接依赖性探针扩增结合巢式聚合酶链反应诊断地中海贫血患者HKaa携带者的准确基因型”的文章中，该文章发表在第10期第1175-1181页。133的中华医学杂志,^[1]作者和隶属关系部分应更正如下：