Objective To study the concentration of neurotrophins( including NGF, BDNF, NT3 and NT4) in the lung of SD rats infected by respiratory syncytial virus( RSV) , and to explore the relationship between the concentration of the neurotrophins, airway hyperresponsiveness and airway neural plasticity.Methods Twenty SD newborn rats were randomly divided into a control group and a RSV-infected group with ten rats in each group. The RSV-infected group were infected with 5 ×104 TCID50/0. 1 mL RSV each week. After 8 weeks, the bronchial responsiveness of the SD rats was assessed. The bronchial inflammation was assessed by HE staining with left lung. Synaptophysin and neurofilament expressions in the lung of SD rats were assayed by the immunohistochemistry staining. In situ hybridization was used to detect the RSV RNA in the lung. The concentration of neurotrophins in the lung of SD rats were detected by ELISA. Results The RSV-infected group showed elevated airway hyperresponsiveness and more inflammatory cells infiltrated in the lung; In situ hybridization showed positive signal of RSV RNA in lung interstitium of the RSV-infected rats. Synaptophysin and neurofilame levels in the airway were increased in the RSV-infected group. Supernatant levels of NGF and BDNF were significantly increased compared with the control group ( P lt;0. 05) . The NT3 and NT4 levels had no significant difference in all groups. The expressions of NGF and BDNF were positively related to the expressions of synaptophysin( r1 = 0. 892, r2 = 0. 995, P lt; 0. 05) and neurofilament( r1 = 0. 949, r2 =0. 936, P lt;0. 05) , also positively related to the airway hyperresponsiveness ( r1 =0. 929, r2 = 0. 910, P lt; 0. 05) . Conclusion RSV infection results in increased expressions of NGF and BDNF in the lung, which are correlated to the change of airway neural plasticity and airway hyperresponsiveness.
ObjectiveTo investigate the clinical characteristics and prognostic factors of severe viral pneumonia induced moderate to severe acute respiratory distress syndrome (ARDS). MethodsTwenty patients with severe viral pneumonia induced moderate to severe ARDS admitted in the Respiratory Intensive Care Unit(RICU) in Xiangya Hospital of Central South University from January 2011 to April 2014 were included in the study.The clinical characteristics and prognostic factors were analyzed retrospectively by analysis of variance(ANOVA). ResultsFive patients developed secondary bacterial infections,while three patients developed secondary fungal infections,among which 2 patients developed both bacterial and fungal infections.Fourteen patients died during hospitalization. ANOVA revealed that gender,body temperature,respiratory frequency,pulse frequency,white blood cell count (WBC),hemoglobin(Hb),platelet(Plt),prothrombin time (PT),albumin(Alb),blood urea nitrogen(BUN),serum creatinine(Scr),total bilirubin(TBIL),serum sodium,serum potassium,erythrocyte sedimentation rate (ESR),C-reactive protein(CRP),procalcitionin(PCT),pH,PaCO2,PaO2 and FiO2 were not significantly different between the dead patients and the alive patients (P>0.05).Whereas the age,length of hospital stay,duration of mechanical ventilation,oxygenation index,and the severity of ARDS were significantly different between the dead patients and the alive patients (P<0.05). ConclusionAge,oxygenation index and severity of ARDS can influence the prognosis of patients with severe viral pneumonia induced moderate to severe ARDS.
ObjectiveTo improve the diagnosis and treatment of the disease, the clinical symptoms, pathological features, diagnosis and differential diagnosis, treatment and prognosis of massive lung inflammatory myofibroblastic tumor (IMT) were analyzed.MethodsA case, admitted to the Department of Respiratory and Critical Care Medicine of Xiangya Hospital, Central South University, diagnosed as massive lung IMT, was retrospectively analyzed. His clinical and chest radiological data were collected and literature which searched through CNKI, WanFang Med online and PubMed on this subject were reviewed.ResultsThe patient, middle-age male, was presented with cough, dyspnea and weight loss, whose chest radiology was characterized by a large thoracic cavity occupation. He was confirmed with massive lung IMT by several lung biopsy. From above databases, 8 cases were retrieved, including 6 articles in English and 2 articles in Chinese. In 9 cases of massive lung IMT, there were 4 males and 5 females. The age was from 1.5 to 75 years old and the average age was 28 years old. The clinical symptoms were non-specific, and chest imaging was characterized by a large thoracic occupation. One case had distant metastases with bone, adrenal gland and lymph node, and one case had distant metastasis with brain after complete surgery.ConclusionsLung massive IMT has no characteristic clinical and radiological features. And a definite diagnosis depends on pathological biopsy and immunohistochemical analysis. It needs to be differentiated from other thoracic giant tumors. The preferred treatment is complete surgical resection. The prognosis after complete resection is usually good, and probably affected by size.
ObjectiveTo analyze the clinic characteristics and the flexible bronchoscopic findings of 1 221 cases of endobronchial tuberculosis,and try to find out some useful clues for the diagnosis of endobronchial tuberculosis. MethodsThe clinic characteristics and the bronchoscopic findings of 1 221 cases of endobronchial tuberculosis were summarized and analyzed. ResultsIn the 1 221 cases of bronchial tuberculosis,there were 491 males and 730 females with mean age of 45.5±16.8 years(ranged between 6 and 84 years). The peak incidence of endobronchial tuberculosis in females was between 20 and 50 years old,and in males was between 45 and 70 years old. The lesions were more common in the right lung (757 cases,62.00%). The most susceptible segment involved was the right upper lobe(316 cases,25.88%). The cases of left main bronchus tuberculosis (270 cases,22.11%) were more than right main bronchus tuberculosis(247 cases,20.23%). The most common bronchoscopic appearances were oedematous-hyperaemic and necrosis. The typical changes include caseous necrosis(117 cases,14.50%),fibrostenotic(130 cases,10.65%),and granuloma(92 cases,7.53%),which often occurred in the left main bronchus. The most common endoscopic classification of endobronchial tuberculosis was type Ⅱ(531 cases,43.49%)and type Ⅲ(505 cases,41.36%). ConclusionsBronchial tuberculosis occures in females more of ten than males. Female patients were mainly under the age of 50 years,while male patients was mainly above the age of 45 years. The most susceptible segments are the right upper lobe and the left main bronchus. The most common endoscopic classification is necrotizing ulcerative and granulation proliferative.
ObjectiveTracheobronchial foreign bodies (TFBs) aspiration is rare in adults,although it can occur at any age. This study aimed to report our experience in airway foreign body removal by flexible bronchoscopy in adult patients of central south China. MethodsA total of 244 patients with TFBs over the age of 14 years were reviewed retrospectively from January 1997 to February 2012. The incidence,risk factors,clinical manifestations,radiological findings,types and locations of TFBs were analyzed. ResultsAmong the 27719 patients,TFBs were found only in 0.88%(244) cases. The prevalence of TFB aspiration increased steadily with age beginning in the fifth decade. The incidence of TFBs was 0.62% among people aged 70 to 80 years. Risk factors such as cerebrovascular diseases and neural degenerative disease were found among 32 (6.6%) patients. Among 153 patients with clear history of foreign body aspiration,135 patients (88.2%) were addicted to the hot pepper. Paroxysmal cough (81.1%) was the most common clinical manifestations of TFBs. Only 12 cases (4.9%) were found with non-opaque foreign bodies by chest X-ray but 106 cases (43.4%) were found with opaque foreign bodies by chest CT. The most common indirect chest imaging findings were recurrent infections and consolidation of the same area.Bone fragments of animals was the most common type in foreign bodies (47.2%). The most common position of foreign bodies was the right bronchial (65.6%). Total foreign bodies of 234 patients (95.9%) had been successfully removed by flexible bronchoscopy. ConclusionAlthough TFBs is rare in adults in south China,but yield by flexible bronchoscopy (0.88%) is much higher than that is reported in western countries (0.32%-0.33%). Addiction to the hot pepper and speaking loudly when having dinner may be the major risk factor for high incidence in central south China.
ObjectiveTo study the clinical features, predictive factors and short-term prognosis of active pulmonary tuberculosis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsThis study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021. AECOPD patients with active pulmonary tuberculosis were included as case group, AECOPD patients without pulmonary tuberculosis were randomly selected as control group from the same hospitals and same hospitalization period as the patients in case group, at a ratio of 4:1. The basic information, comorbidities, clinical manifestations and auxiliary examinations, and adverse in-hospital outcomes between the two groups were compared.ResultsA total of 14007 inpatients with AECOPD were included in this study, and 245 patients were confirmed to have active pulmonary tuberculosis, with an incidence rate of 1.75%. In terms of basic information, the proportions of male and patients with history of acute exacerbation in the past year in the case group were higher than those in the control group (P<0.05), and the age and body mass index (BMI) were lower than those of the control group (P<0.05); in terms of comorbidities, the proportions of patients with hypertension and diabetes in the case group were lower than those in the control group (P<0.05). In terms of clinical manifestations, the prevalence of fever and hemoptysis in case group was higher than that of control group (P<0.05); as for laboratory examinations, the levels of hemoglobin, platelet count, serum albumin, inflammatory markers [erythrocyte sedimentation rate (ESR), C reactive protein] and the proportion of positive TB-IGRA were higher than that of control group (P<0.05). The prevalence of pulmonary bullae, atelectasis and bronchiectasis in the case group was higher than that in the control group. After multivariate logistic regression analysis, hemoptysis (OR= 3.68, 95%CI 1.15-11.79, P=0.028), increased ESR (OR=3.88, 95%CI 2.33-6.45, P<0.001), atelectasis (OR = 3.23, 95%CI 1.32-7.91, P=0.01) were independent predictors of active pulmonary tuberculosis in patients with AECOPD. In terms of in-hospital outcomes, there was a trend of higher hospital mortality than the control group (2.3% vs. 1%), but the difference was not statistically significant. However, the case group had longer hospital stay [9 d (6~14) vs. 7 d (5~11), P<0.001] and higher hospital costs [15568 ¥ (10618~21933) vs. (13672 ¥ (9650~21473), P=0.037]. ConclusionIt is not uncommon for AECOPD inpatients to be complicated with active pulmonary tuberculosis, which increases the length of hospital stay and hospitalization costs. When AECOPD patients present with hemoptysis, elevated ESR, and atelectasis, clinicians should be highly alert to the possibility of active pulmonary tuberculosis.
ObjectiveTo study the clinical features, short-term prognosis and risk factors of Pseudomonas Aeruginosa (P.aeruginosa) infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsThis study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021. AECOPD patients with P.aeruginosa infection were included as case group, AECOPD patients without P.aeruginosa infection were randomly selected as control group from the same hospitals and same hospitalization period as the patients in case group, at a ratio of 2∶1. The differences in basic conditions, complications, clinical manifestations on admission and in-hospital prognosis between the two groups were compared, and the risk factors of P.aeruginosa infection were analyzed. ResultsA total of 14007 inpatients with AECOPD were included in this study, and 338 patients were confirmed to have P.aeruginosa infection during hospitalization, with an incidence rate of 2.41%. The in-hospital prognosis of AECOPD patients with P.aeruginosa infection was worse than that of the control group, which was manifested in higher hospital mortality (4.4% vs. 1.9%, P=0.02) and longer hospital stay [13.0 (9.0, 19.25)d vs. 11.0 (8.0, 15.0)d, P=0.002]. In terms of clinical features, the proportions of patients with cough, expectoration, purulent sputum, dyspnea in the case group were higher than those in the control group, and the inflammatory indicators (neutrophil ratio, erythrocyte sedimentation rate) and partial pressure of carbon dioxide in arterial blood gas were higher than those in the control group, while the serum albumin was significantly lower than that in the control group (all P<0.05). Multivariate logistic regression analysis showed that Parkinson's disease [odds ratio (OR)=5.14, 95% confidence interval (CI): 1.43 to 18.49, P=0.012], bronchiectasis (OR=4.97, 95%CI: 3.70 to 6.67, P<0.001), invasive mechanical ventilation (OR=2.03, 95%CI: 1.23 to 3.36, P=0.006), serum albumin<35 g/L (OR=1.40, 95%CI: 1.04 to 1.88, P=0.026), partial pressure of carbon dioxide ≥45 mm Hg (OR=1.38, 95%CI: 1.01 to 1.90, P=0.046) were independent risk factors for P.aeruginosa infection in AECOPD patients. ConclusionsP.aeruginosa infection has a relative high morbidity and poor outcome among AECOPD inpatients. Parkinson’s disease, bronchiectasis, invasive mechanical ventilation, serum albumin below 35 g/L, partial pressure of carbon dioxide ≥45 mm Hg are independent risk factors of P.aeruginosa infection in AECOPD inpatients.
ObjectiveTo compare the predictive value of the BAP-65 score, the DECAF score, the CURB-65 score, and the Pneumonia Severity Index (PSI) on short-term mortality and adverse outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with community-acquired pneumonia (CAP). MethodsThis study enrolled patients hospitalized for AECOPD and CAP from ten hospitals in China from September 2017 to July 2021. All-cause mortality within 30 days was investigated. Patients were divided into the death and the survival groups according to their survival status. The differences in basic conditions, complications, symptoms, signs and auxiliary examination results between the two groups were compared, and the independent risk factors of all-cause mortality were analyzed. The included patients were scored and graded according to the 4 scales, respectively, and the validity of the four scales in predicting short-term mortality and adverse outcomes was compared based on the receiver operating charateristic (ROC) curve analysis. ResultsA total of 3375 patients including 2545 males and 830 females with a mean age of (73.66 ±10.73) years were enrolled in this study. Within 30 days, 129 (3.82%) patients died and 614 (18.19%) patients had an adverse outcome (including all-cause death, invasive mechanical ventilation and admission into intensive care unit). Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value were independent risk factors for 30-day mortality in AECOPD patients with CAP. The area under the ROC curve (AUC) of the CURB-65 score, BAP-65 score, DECAF score, and PSI score for predicting all-cause mortality were 0.780, 0.782, 0.614, and 0.816, and these AUCs for predicting adverse outcomes were 0.694, 0.687, 0.564 and 0.705, respectively. PSI score had the best predictive efficacy for all-cause mortality and adverse outcomes, and the DECAF score had the worst predictive efficacy. ConclusionsAECOPD patients with CAP have a relatively high incidence of all-cause mortality and adverse outcomes within 30 days. Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value are independent risk factors for 30-day mortality. PSI score has the best performance in predicting all-cause mortality and adverse outcomes, while the DECAF score has the worst performance.