小气道病变曾经是全球呼吸界研究的热点，许多肺功能测定方法和指标被用于小气道功能的诊断，其后热度骤减，最近又引起一些学者的重视。
COPD是以不完全可逆性气流受限为特征的进展性肺疾病， 与肺部对香烟烟雾等有害气体或有害颗粒的异常炎症反应有关。病理改变存在于外周气道、中央气道、肺实质和肺血管系统等， 也可引起肺外的不良效应， 但外周气道病变和功能异常是导致不完全可逆气流受限的主要原因。国内外采用吸入支气管舒张剂后一秒率( FEV1／FVC) 小于70％来进行定性诊断。
Objectives To study the role of the kidney in the maintenance of metabolic alkalosis of critically ill patients during perioperative period.Methods The patients who had metabolic alkalosis in the surgical intensive care unite（SICU） from Nov 2004 to Feb 2005 were enrolled in the alkalosis group；and the control group were the perioperative patients in the department of hepatic surgery at the same time，those who had acid-base imbalance were excluded.The enrolled patients underwent routine tests and some parameters such as creatinine clearance rate（Ccr，to evaluate glomerular filtration rate），titratible acid，ammonium ion，urinary bicarbonate，net acid excretion were calculated.Results The Ccr of the alkalosis group and control group was（76.2±37.1）mL/min vs（98.5±31.9）mL/min，respectively（P=0.042） with a decrement of 22% in the alkalosis group.The titratible acid was（25.2±19.4）mmol/24 h vs（49.9±26.4）mmol/24 h，respectively（P=0.002）；the net acid excretion was（156.5±84.3） mmol/24 h vs（117.5±32.1）mmol/24 h，respectively（P=0.047）；the ammonium ion was（140.6±81.6） mmol/24 h vs（78.7±16.3）mmol/24 h，respectively（P=0.002）.The postoperative electrolytes of the alkalosis group and control group：[K+] was（3.51±0.67）mmol/L vs（4.14±0.59）mmol/L，respectively（P=0.002）；[Cl－] was（98.4±8.3）mmol/L vs（102.8±3.0）mmol/L，respectively（P=0.035）；[Ca2+] was（2.14±0.21）mmol/L vs（2.25±0.14）mmol/L，respectively（P=0.049）；[P] was（0.83±0.34）mmol/L vs（1.11±0.23）mmol/L，respectively（P=0.004）；[Na+] was（139.6±7.7）mmol/L vs（140.8±4.6）mmol/L，respectively（P=0.535）；[Mg2+] was（0.94±0.15）mmol/L vs（0.90±0.16）mmol/L，respectively（P=0.338）.Conclusions Decreased glomerular filtration rate and enhanced renal acidification function are the important factors that maintain the metabolic alkalosis during perioperative period.Potassium，chloride，calcium and phosphorus are decreased during metabolic alkalosis，while sodium and magnesium has no significant change.
Objective To assess the value of pulmonary ventilation test in evaluating the prognosis of cardiac surgery patients. Methods Data were collected retrospectively from consecutive patients with coronary heart disease or valvular disease, who were prepared for cardiac surgery in Zhongshan Hospital from January 2007 to December 2008. The main outcome indices were mortality of surgery, the prolonging time of using artificial airway ( ≥3 days) , and the prolonging time in intensive care units ( ICU) ( ≥5 days) . Then the relationship between the poor outcome and ventilation disorder was analyzed. Results In the 422 cases,the incidence of ventilation disorder was 55% , included 27. 5% restrictive ventilation disorder, 15. 6% obstructive ventilation disorder, and 11. 8% mixed ventilation disorder. And the severity of pulmonaryventilation disorder was mild of 34. 6% , moderate of 15. 2% , and severe of 5. 2% . Among the 42 patients who gave up surgery,50% were due to ventilation dysfunction, and the patients were prone to give up surgery with the deterioration of pulmonary function( P lt; 0. 001) . But comparing with the patients with normal pulmonary function, the risk of poor outcome after surgery did not significantly increase in the patients with ventilation disorder ( P gt; 0. 05 ) . The logistic regression analysis indicated that cardiopulmonary bypass ( CPB) was an absolute risk factor ( P lt; 0. 05) . Conclusions The incidence of ventilation disorder in patients with cardiac disease is quite high. Severe pulmonary ventilation disorder is the significant cause of giving up surgery, but may be not the absolute contraindication of cardiac surgery.
Objective To investigate the differences between six parts of China in prediction models of lung function.Methods The predicted values of 360 healthy volunteers underwent pulmonary functiontest in east China were compared with that of north China, northeast China, northwest China, southwest China, south China and Asian American. Results In the male group, the prediction values of east China were as follows: VC ( 4. 19 ±0. 33) L, coefficient correlation( r) to the other five regions were 0. 803-0. 983,the differences to the other five regions were 1. 90% -4. 30% ; FVC ( 4. 06 ±0. 35) L, r to the others were 0. 912-0. 981, the differences to the other four regions were 0-2. 46% except for south China of 8. 10% , to Asian American ×0. 88 and Asian American ×0. 94 were 1. 97% and 4. 68% ; FEV1 ( 3. 34 ±0. 40) L, r to the others were 0. 963-0. 992, the differences to north China and east China were 0. 9% and 3. 59% , to southwest China and south China were gt;5% , to Asian American ×0. 88 and Asian American×0. 94 were 6. 89% and 0. 6% ; FEV1 /FVC ( 80. 87 ±3. 84) % , r to the others were 0. 989-0. 999, the differences to north China, northeast China and south China were 0. 42% -3. 04% , to the others were gt;5% . In the female group, the prediction values of east China were as follows: VC ( 3. 00 ±0. 33) L, r to the other five regions were 0. 899-0. 993, the differences to the other five regions were 0. 33% -3. 67% ; FVC( 2. 92 ±0. 34) L, r to the other five regions were 0. 929-0. 990, the differences to the other five regions were 1. 02% -2. 40%, to Asian American ×0. 88 and Asian American ×0. 94 were 4. 79% and 6. 16% ; FEV1 ( 2. 38 ±0. 39) L, r to the other five regions were 0. 958-0. 994, the differences to northeast China, southwest China, south China were 0. 84% -3. 36% , to north china was 7. 19% , to Asian American ×0. 88 and Asian American ×0. 94 were 2. 10% and 4. 62% ; FEV1 /FVC ( 82. 04 ±3. 94) % , r to the others were 0. 991-1. 000, the differences to the other four regions were 1. 34% -4. 55% except for southwest China was 7. 59% . Conclusions VC and FVC predicted values are coincident between six parts of China. FEV1 /FVC predicted values are coincident in the four parts of China except for westnorth and westsouth China. FEV1 predicted values are different. The oversea predicted values should be used with appropriate conversion factors.
Objective To explore the effect of rolling compression loading bioreactor on chondrogenesis of rabbit bone marrow mesenchymal stem cells (BMSCs) with different loading parameters. Methods BMSCs were isolated from New Zealand rabbits, aged 2.5 months. BMSCs at passage 3 were used to prepare BMSCs-agarose gels (4 mm in diameter and height, respectively). Samples were divided into 8 groups: 10% (group A1), 20% (group A2), and 30% (group A3) compression groups (0.4 Hz, 3 h/ d) and 20 minutes (group B1), 3 hours (group B2), and 12 hours (group B3) rolling time groups and static culture (control groups). The living cell rate, the collagen type II and Aggrecan gene expressions, and glycosaminoglycan (GAG) content were determined, and histological staining was done at 24 hours, 7 days, 14 days, and 21 days after culture. Results At 14 and 21 days, the living cell rates of groups A1 and A2 were significantly higher than that of group A3 (P lt; 0.05), groups B1 and B2 were significantly higher than group B3 (P lt; 0.05). Collagen type II and Aggrecan gene expressions of the experimental groups at each time point were significantly higher than those of the control groups (P lt; 0.05); at 14 and 21 days, collagen type II and Aggrecan gene expressions of groups A1 and A2 were significantly higher than those of group A3, and groups B1 and B2 were also significantly higher than group B3 (P lt; 0.05). At 14 and 21 days, the GAG contents of groups A1 and A2 were significantly higher than those of group A3 (P lt; 0.05); groups B1 and B2 were also significantly higher than group B3 (P lt; 0.05). At 21 days, toluidine blue staining showed that obvious blue-staining and even cartilage lacunae were seen in groups A2 and B2, but light and quite rare blue-staining in groups A1, A3, B1, and B3. Conclusion The rolling compression loading bioreactor has great promotion effect on chondrogenesis of rabbit BMSCs with rolling parameters of 0.4 Hz, 3 hours, and 20% compression.
Objective Collagen type II is a characteristic molecular of chondrocyte. With continuous subculture of chondrocytes, they progressively lose the abil ity to express collagen type II. To observe the effect of collagen type IIon redifferentiation of dedifferentiated rabbit chondrocytes so as to lay a experimental foundation for use of chondrocytes in cartilage tissue engineering. Methods Cartilage was harvested under sterile conditions from tibio-femoral joints of 7-monthold New Zealand white rabbit. The rabbit articular chondrocytes were subcultured in vitro to the 7th generation (named P1-P7).Dedifferentiated rabbit chondrocytes were chosen by RT-PCR, real-time PCR, and 1, 9-dimethylmethylene blue (DMMB) assay. Then dedifferentiated rabbit chondrocytes were treated with various concentrations (0, 0.5%, 1.0%, and 1.5%) of exogenous collagen type II. The redifferentiation of dedifferentiated chondrocytes was measured by RT-PCR and real-time PCR, and the glycosaminoglycan content was determined by DMMB assay. Results The glycosaminoglycan content of P1-P7 chondrocytes were (12.20 ± 0.17), (11.20 ± 0.24), (11.18 ± 0.16), (10.89 ± 0.50), (8.73 ± 0.19), (9.39 ± 0.32), and (8.18 ± 0.20) μg, respectively, showing no significant difference (P gt; 0.05) among P2, P3, and P4, and showing significant differences (P lt; 0.05) among other generations. The mRNA of collagen type I, collagen type II, and aggrecan expressed at P4-P7, showing no significant difference in the mRNA expression of collagen type I (P gt; 0.05) and significant differences in the mRNA expressions of collagen type II and aggrecan (P lt; 0.05) among P4-P7. The glycosaminoglycan content at concentrations of 0, 0.5%, 1.0%, and 1.5% were (8.20 ± 0.16), (14.61 ± 0.33), (13.93 ± 0.25), and (19.59 ± 0.46) μg, showing significant differences among different concentrations (P lt; 0.05). With exogenous collagen type II concentrations increased, the mRNA expressions of collagen type II and aggrecan gene were up-regulated gradually, but collagen type I gene was down-regulated, showing significant differences (P lt; 0.05). Conclusion Collagen type II can promote redifferentiation and activation of dedifferentiated rabbit chondrocytes.
ObjectiveTo determine the prognostic significance of change of systemic immune inflammation index (SII) before and after neoadjuvant chemotherapy (NCT) in advanced pancreatic cancer.MethodsThe patients with advanced pancreatic cancer who received the NCT before pancreatectomy and met the inclusion and exclusion criteria of this study from January 2013 to December 2016 in the Panjin Liao-Oil Gem Flower Hospital were retrospectively collected. The patients were designed into an increased SII group (SII before NCT was lower than after NCT) and decreased SII group (SII before NCT was higher than after NCT) according to the change of SII before and after NCT. The laboratory data before and after NCT were collected to calculate the SII and to analyze the relationship between the change of SII before and after NCT and the clinical outcomes. The clinicopathologic characteristics and postoperative 3-year survival rate of the two groups were compared. The Cox regression was used to evaluate the influencing factors of postoperative survival of advanced pancreatic cancer.ResultsAll of 103 patients were included, 42 of whom in the increased SII group and 61 in the decreased SII group. The proportions of the intraoperative tumor size >3 cm, CA19-9>37 U/mL after NCT, and postoperative complications in the increased SII group were significantly higher than those in the decreased SII group (P<0.05). All 103 patients were followed up from 9 to 81 months with median 13 months, the 3-year cumulative survival rate of patients in the increased SII group was significantly lower than that of patients in the decreased SII group (19.0% versus 42.6%, P=0.012). The results of the multivariate analysis showed that the CA19-9>37 U/mL after NCT [HR=2.084, 95%CI (1.140, 3.809), P=0.017], postoperative complications [HR=1.657, 95%CI (1.009, 2.722), P=0.046], the absent of postoperative adjuvant chemotherapy [HR=1.795, 95%CI (1.085, 2.970), P=0.023], and the elevated SII after NCT [HR=1.849, 95%CI (1.111, 3.075), P=0.018] were the independent risk factors affecting postoperative 3-year survival rate of patients with advanced pancreatic cancer.ConclusionsThe change value of SII before and after NCT is an independent risk factor for the prognosis of patient with advanced pancreatic cancer, the elevated SII after NCT is a poor prognosis index in patient with advanced pancreatic cancer. However, the evaluations of larger controlled trials are necessary at multiple institutions before introduction of SII as a prognostic indicator in clinical practice.
Objective To analyze the clinical features of immune checkpoint inhibitor-related pneumonia (CIP) in patients with lung cancer. Methods The case data of patients with CIP admitted to Zhongshan Hospital of Fudan University from January 2017 to December 2020 were retrospectively collected, and the basic data, clinical manifestations, imaging data, laboratory examination results, treatment and prognosis of the patients were analyzed. Results The ratio of male to female was 18:1, and the median age was 65 years (from 41 to 74 years). Fourteen patients received a programmed death protein-1 (PD-1) inhibitor and five patients received a programmed death protein-ligand-1 (PD-L1) inhibitor. The median time to CIP was 3.5 months. The respiratory symptoms of 15 patients were dyspnea in 11 cases, cough in 9 cases, chest tightness in 8 cases, fever in 4 cases, expectoration in 4 cases and hemoptysis in 2 cases. Chest CT findings mainly showed interstitial pneumonia, including 8 cases of implicit organizational pneumonia (COP), 7 cases of non-specific interstitial pneumonia (NSIP), 2 cases of acute interstitial pneumonia, and 2 cases of allergic pneumonia. C-reactive protein, erythrocyte sedimentation rate and lactate dehydrogenase were higher in CIP than before, and the difference was statistically significant. Follow-up observation was performed in 3 patients alone, 14 patients were treated with glucocorticoid alone, 2 patients were treated with immunosuppressant therapy, 19 patients had stable or more absorption of pneumonia lesions, and 5 patients had restarted immunotherapy. There were no deaths from CIP. Conclusions CIP mainly occurs in men, with slow onset, lack of specificity in clinical manifestations, and increased inflammatory indicators. Imaging findings are mainly NSIP and COP changes. Early identification, diagnosis and rational application of glucocorticoid therapy have good effects.
Objective To investigate clinical characteristics of community acquired pulmonary crypyococcosis（PC）.Methods A total of 30 cases of PC diagnosed at Zhongshan Hospital of Fudan University from Jan 2003 to Dec 2007 were retrospectively analysed.All cases were identified by pathological study.Results The patients consisted of 19 males and 11 females，with median age of 44 years（16 to 70 years），66.7% of whom without underlying deseases and with normal immune function.9 patients（30%） were asymptomatic，and 21 patients（70%） had respiratory and/or constitutional symptoms.The most common symptoms were dry cough（16.7%），expectoration（46.7%），fever（23.3%），chest pain（13.3%） and dyspnea on exertion（13.3%）.All symptoms were mild and often showed a self-limiting trend.The common imaging features were nodule and mass，either solitary or multiple（53.3%），infiltrates and consolidation（40%） or diffused and mixed lesions.Non-caseous granulomas was the main character of patholgical study（96.7%），in which 93.1% with multinucleated giant cells containing abundant vacuolus yeast forms with the periodic acid schiff（PAS） reaction and/or Grocott Gomori’s methenamine silver（GMS） staining postive.Only one case found Cryptococcus neoformans spores in biopsy tissue smear and another in sputum smear.16.7% of the patients had positive biopsy tissue cultures for Cryptococcus neoformans，and 3.3% were positive of sputum cultures.15 patients underwent latex agglutination test for pulmonary cryptococcosis，and 93.3% were positive.Conclusions Some immunocompetent healthy people may compromised with community acquired PC with mild symptoms or even not at all and heterogeneous imaging appearance.Pathology，etiology，and serology were valuable diagnostic tools.