Objective To explore the treatment effects of one-way valve lung volume reduction surgery for heterogeneous emphysema.Methods Seven heterogeneous emphysema Beagle dogs were each implanted in right lung2-4 pieces ofbronchial one-way valve.The animals were sacrificed two months later.Macro- and microscopic pathology changes of the lungs were observed.Results Of 21 valves implanted，2 were expectorated，and 19 were in normal position.The dogs did not have obvious adverse reactions.Generally specimens of the occluded lobes had different levels of lung volume decrease，such as texture stiffened，focal scar formation，atelectasis，pulmonary fibrosis.Pathological biopsy showed moderate alveolitis and pulmonary interstitial fibrosis.Conclusion One-way valve lung volume reduction is effective for heterogeneous emphysema
Objective To investigate whether the sleep-induced hypoxemia ( SIH) at different time and different level have different effects on pulmonary emphysema and coagulation systemfunction in the rats with pulmonary emphysema. Methods Thirty Wistar rats were randomly divided into three groups( n = 10 in each group) . All rats were exposed to cigarette smoke twice a day ( 30 min each time) . From29th day on, the rats in Group A ( pulmonary emphysema with short SIH) were also exposed to mixed gas of 12. 5% oxygen for 1. 5 hours during sleeping time every day ( the expose time was divided into 4 periods, 22. 5 min each) . The rats in Group B ( pulmonary emphysema with mild SIH) were also exposed to mixed gas of 15% oxygen for three hours during sleeping time every day( the expose time was divided into 4 periods, 45 min each) . The rats in Group C( pulmonary emphysema with standard SIH) were also exposed to mixed gas of 12. 5% oxygen for three hours during sleeping time every day( the expose time was divided into 4 periods,45 min each) . After continuous exposure for 56 days, the rats were sacrificed. Semi-quantitative image analytic method was employed for histopathological analysis including pathological score of lungs, mean linear intercept ( MLI) and mean alveolus number( MAN) . ATⅢ, FIB, vWF, FⅧ were measured. Results All animals in three groups manifested the histopathological features of emphysema. Pathological scores of lungs and MLI of every group were significantly different from each other( F = 21. 907, F = 18. 415, all P lt; 0. 05) , Group A [ ( 61. 90 ±4. 25) % , ( 92. 45 ±1. 78) μm] and Group B[ ( 64. 60 ±3. 95) % , ( 92. 80 ±3. 65) μm] were significantly lower than Group C[ ( 73. 30 ±3. 86) % , ( 99. 32 ±2. 81) μm, q= 8. 96, q =6. 84, q = 12. 64, q =9. 65, all P lt; 0. 05] . Levels of FIB were significantly different among three groups ( F = 20. 592, P lt; 0. 05) while FIB in Group A[ ( 189. 98 ±5. 29) mg/ dL] and Group B[ ( 182. 70 ±2. 78) mg /dL] were significantly lower than that in Group C[ ( 198. 40 ±7. 37) mg/ dL, q = 4. 86, q= 9. 07, all P lt; 0. 05] , and FIB in Group A was significantly higher than that in Group B( q = 4. 20, P lt; 0. 05) . Levels of FⅧ were significantly different from each other( F = 33. 652, P lt;0. 05) while FⅧ in Group A[ ( 232. 26 ±4. 17) % ]and Group B[ ( 242. 53 ±14. 50) % ] were significantly lower than that in Group C[ ( 303. 25 ±32. 93) % ,q= 10. 73, q = 9. 18, all P lt; 0. 05] . Conclusions Pulmonary emphysema and hypercoagulable states increases with time and severity of SIH in rats with pulmonary emphysema. The elevated activity of blood coagulation factor may be a critical role in the hypercoagulable states.
Abstract: Objective To evaluate the clinical effects and health economics of lung volume reduction surgery（LVRS）, single lung transplantation（SLTx） and bilateral lung transplantation（BLTx） for patients with end-stage emphysema. Methods A total of 61 patients with end-stage emphysema, including 39 patients who underwent LVRS（LVRS group）, 14 patients who underwent SLTx（SLTx group）, and 8 patients who underwent BLTx（BLTx group） from September 2002 to August 2008 in Wuxi People’s Hospital, were analyzed retrospectively. Lung function, arterial blood gas analysis and 6-minute walk distance（6-MWD）were assessed before their surgery and 6 months, 1-year and 3-year after their surgery respectively. Their 1-year and 3-year survival rates were observed. Cost-effectiveness analyses were made from a health economics perspective. Results Compared with their preoperative results, their mean forced expiratory volume in 1 second（FEV1.0）in LVRS group increased by 75%, 83% and 49% at 6 months, 1-year and 3-year postoperatively, by 176%, 162% and 100% in SLTx group, and by 260%, 280% and 198% in BLTx group respectively. Their mean forced vital capacity（FVC）in LVRS group increased by 21%, 41% and 40% at 6 months, 1-year and 3-year postoperatively, by 68% , 73% and 55% in SLTx group, and by 82%, 79% and 89% in BLTx group respectively. Their exercise endurance as measured by 6-MWD increased by 75%, 136% and 111% in LVRS group at 6 months, 1-year and 3-year postoperatively, by 513%, 677% and 608% in SLTx group, and by 762%, 880% and 741% in BLTx group respectively. The 1-year and 3-year survival rates after operation were 74.40% and 58.90% in LVRS group, 85.80% and 64.30% in SLTxgroup, and 62.50% and 50.00% in BLTx group respectively. The three years’ cost utility of SLTx group was significantly higher than that of BLTx group（1 668.00 vs.1 168.55, P＜ 0.05）and LVRS group （1 668.00 vs. 549.46, P＜ 0.05）. Conclusion SLTx and BLTx are better than LVRS in improving patients’ lung function and exercise endurance for end-stage emphysema patients. LVRS is more cost-effective than SLTx and BLTx in the early postoperative period. With the development of medical technology and decreased expenses of lung transplantation and immunosuppressive agents, lung transplantation will become the first surgical choice for end-stage emphysema patients.
Objective To investigate the effect of lung volume reduction surgery （LVRS） on messenger RNA expression levels of cytoskeletal proteins in diaphragmatic muscle tissues of emphysematous rabbits. Methods A total of 40 rabbits were randomly divided into 4 groups （10 rabbits in each group） ：normal control group, emphysema group, sham operation group and LVRS group. Rabbits in control group were intratracheally administered with 0.9% normal sodium, but those in other groups were intratracheally administered with 0.4% papain at the dose of 0.5 ml/kg and inhaled cigarette smoke to induce emphysema model. Then, rabbits in emphysema group were fed routinely, however, after median sternotomy , bilateral LVRS was performed in LVRS group but not in sham operation group. The mRNA expression levels of titin and nebulin in the diaphragmatic muscles of rabbits in each group were detected by reverse transcription-polymerase chain reaction（RT-PCR）. Results Compared with control group, the mRNA expression levels of titin and nebulin in the rabbit diaphragm of emphysema groups and sham operation group decreased significantly （P〈0.01 ）, so did those in LVRS group （P〈0.05）. But it increased significantly in LVRS group compared with emphysema group and sham operation group （P〈0.05）. Conclusion LVRS can increase the mRNA expression levels of titin and nebulin in diaphragmatic muscle tissues of emphysematous rabbits, which may be the associated mechanisms at the molecular level in restoring the functions of the emphysematous diaphragm by LVRS.
ObjectiveTo investigate the feasibility and efficacy of staged bilateral single-port thoracoscopic lung volume reduction surgery (LVRS) for the patients with chronic obstructive pulmonary emphysema (COPE). MethodsWe retrospectively analyzed clinical data of eleven male patients with bilateral COPE and bullae in Xuzhou Central Hospital Affiliated to Southeast University from January 2013 through June 2014. All the patients underwent staged bilateral single-port thoracoscopic LVRS with their age of 60.27± 12.11 years. The hyperinflated bullae were resected using endoscopic staplers (Endo-GIA), followed by continuous suture and biological glue for reinforcement of the margin. Besides, the pulmonary function, blood gas assay, 6-minute walk distance (6-MWD), and life quality evaluated by short form 36 Health survey questionnaire (SF-36) were recorded before and after LVRS respectively. ResultsAll the patients survived after surgery. Chest tube drainage time was 9.09± 1.31 days. Postoperative hospital stay was 15.73± 2.75 days. There were 5 patients with persistent air leakage and 7 patients with pulmonary infection who were cured finally. The pulmonary function, arterial partial pressure of oxygen(PaO2), 6-MWD and life quality after unilateral or bilateral LVRS improved than those before surgery in postoperative 3 months. However, there was no statistical difference in outcomes between unilateral and bilateral LVRS patients. ConclusionStaged bilateral single-port thoracoscopic LVRS could improve short-term life quality of patients with COPE.
Objective To improve the knowledge and diagnostic accuracy of combined pulmonary fibrosis and emphysema (CPFE) syndrome in connective tissue diseases (CTD) by summarizing the clinical characteristics of 20 CTD patients with CPFE and reviewing literatures. Methods The medical records of 20 CTD patients with CPFE from January 2011 to June 2015 were retrospectively analyzed. Results There were 11 males and 9 females. The average age was 47 years. Among them, 4 patients were smokers and 15 patients were nonsmokers. The average duration of CTD was 3.5 years with an average onset age of 41 years. Respiratory symptoms were reported in 17 patients and Velcro rale was found in 9 patients; The most common type of CTD disease in these 20 patients was inflammatory myopathy (9 patients, 45%) followed by systemic sclerosis (SSc) (4 patients, 20%). High resolution computerized tomography of lung showed typical radiological features of CPFE containing fibrosis lesions predominantly distributed in the subpleural (14 patients) and basal (18 patients) parts and emphysema mainly located in upper zones. Relatively normal results of lung volume and ventilation function, and markedly reduced carbon monoxide transfer capacity were observed. One patient was confirmed with pulmonary hypertension and 1 patient died from severe inflammation and acute respiratory distress syndrome. Conclusions The CPFE syndrome can be identified in CTD patients as an entity with male predominance, especially among patients with inflammatory myopathy and SSc. Higher risk of secondary pulmonary hypertension and acute lung injury in these patients may increase mortality. Early differentiation of CPFE from pure interstitial lung disease in CTD patients could be helpful in improving prognosis.
ObjectiveTo study the possbility of using intranasal instillation of fine particulate matter (PM2.5) combined with inhalation of ozone (O3) to establish mouse model of combined pulmonary fibrosis and emphysema (CPFE), and to provide a reference for the establishment of CPFE model.MethodsMale C57/BL6 mice were divided randomly into phosphate buffer saline (PBS) intranasal instillation+air inhalation group, PBS intranasal instillation+O3 inhalation group and PM2.5 intranasal instillation+O3 inhalation group, with 8 mice in each group. The mice were intranasally instilled with PBS or PM2.5 suspension (7.8 mg/kg) followed by air or ozone inhalation 24 hours later, twice a week over 8 weeks. Lung function, bronchoalveolar lavage fluid (BALF) cell counts and classification were detected, the pathological changes of lung tissues in hematoxylin-eosin staining were observed, including inflammation scores and mean linear intercept (Lm). The thickness of collagen deposition in subepithelium was measured in lung tissues in Masson staining, and simultaneously hydroxyproline contents in lung tissues were determined.ResultsCompared to PBS instillation+air inhalation group, inspiratory capacity (IC), total lung capacity (TLC) and chord compliance (Cchord) were increased, FEV25 (the forced expiratory volume at 25 ms)/FVC (forced vital capacity) was decreased, total cell counts in BALF, Lm and lung inflammatory scores were increased, the thickness of the subepithelial collagen layer (SEc/Pbm) or hydroxyproline contents was not changed in PBS instillation +O3 inhalation group; IC was decreased, functional residual capacity (FRC) was increased, TLC was increased, Cchord was decreased, FEV25/FVC and FEV50 (the forced expiratory volume at 50 ms)/FVC were decreased, total cell counts in BALF, Lm, lung inflammatory scores, SEc/Pbm and hydroxyproline contents were increased in PM2.5 instillation+O3 inhalation group. Compared to PBS instillation+O3 inhalation group, IC was decreased, FRC was increased, Cchord was decreased, FEV25/FVC and FEV50/FVC were decreased, total cell counts in BALF, Lm, lung inflammatory scores, SEc/Pbm and hydroxyproline contents were increased in PM2.5 instillation +O3 inhalation group.ConclusionCPFE mouse model can be successfully established by PM2.5 intranasal instillation combined with ozone inhalation for consecutive 8 weeks.
ObjectiveTo investigate the effects of closed thoracic drainage with single tube or double tubes after video-assisted thoracoscopic lung volume reduction surgery.MethodsRetrospective analysis was performed on 50 patients (39 males, 11 females) who underwent three-port thoracoscopic lung volume reduction surgery in our hospital from January 2013 to March 2019. Twenty-five patients with single indwelling tube after surgery were divided into the observation group and 25 patients with double indwelling tubes were divided into the control group.ResultsThere was no significant difference in pulmonary retension on day 3 after surgery, postoperative complications, the patency rate of drainage tube before extubation, retention time or postoperative hospital stay (P>0.05). Postoperative pain and total amount of nonsteroidal analgesics use in the observation group was less than those in the control group (P<0.05). ConclusionIt is safe and effective to perform closed thoracic drainage with single indwelling tube after video-assisted thoracoscopic lung volume reduction surgery, which can significantly reduce the incidence of related adverse drug reactions and facilitate rapid postoperative rehabilitation with a reduction of postoperative pain and the use of analgesic drugs.
ObjectivesTo compare the clinical features of combined pulmonary fibrosis and emphysema (CPFE) and idiopathic pulmonary fibrosis (IPF).MethodsEighty-three patients diagnosed as CPFE or IPF for the first time were retrospectively analyzed from June 2014 to July 2018 in Nanjing Drum Tower Hospital, including 47 patients in the CPFE group and 36 in the IPF group. The demographic characteristics, clinical manifestations, pulmonary function, cardiac ultrasound, blood gas analysis and prognosis of the two groups were compared.ResultsThe proportion of smokers in the CPFE group was higher than IPF group (P<0.05), but dyspnea was lower (P<0.05). The FVC, FVC%pred, FEV1, FEV1%pred and VC% of the CPFE group were higher than IPF group (P<0.05), while FEV1/FVC%pred in the IPF group was higher than CPFE group (P<0.05). DLCO/VA%pred of CPFE group decreased more significantly than IPF group (P<0.05), RV/TLC%pred of CPFE group increased annually, while decreased annually in IPF group (P<0.01). The RV%pred of CPFE increased annually, while that of IPF group decreased annually (P<0.05). There was no significant difference in arterial oxygen pressure and pulmonary artery pressure between the two groups. As for prognosis, the 1- and 3-year survival rate of the CPFE group were 87.9% and 73.8% respectively, those of the IPF group were 84.1% and 65.8% respectively, and no significantly difference was observed between two groups (P=0.95).ConclusionsCompared with IPF, patients with CPFE usually have more smokers, less proportion of dyspnea, almost normal lung volume, more rapidly decreased DLCO/VA%pred, and no significant difference in prognosis.
ObjectiveBased on real-word data, and compared with two common chronic respiratory diseases, interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD), this case-control study plans to investigate the risk factors and clinical characteristics of patients with combined pulmonary fibrosis and emphysema syndrome (CPFE).MethodsA retrospective case-control study was carried out to screen the clinical data of 96 patients with CPFE, 133 patients with COPD and 164 patients with ILD, analyze their demographics, clinical data, complications and related clinical indicators. Univariate analysis was used to compare the differences among the three groups, and multivariate logistic analysis was used to screen for risk factors.ResultsAll three groups were in old age with the average age of above 71 years. In terms of male ratio and smoking rate, the CPFE group (93.8%, 85.4%) was higher than the ILD group (75.0%, 64.0%), but there was no significant difference when compared with the COPD group (90.2%, 82.0%). Regarding comorbid disease, the proportion of connective tissue disease (CTD) in the CPFE group (10.4%) and the ILD group (13.4%) was higher than that in the COPD group (1.5%). The proportion of hyperlipidemia in the CPFE group (8.3%) was higher than that in the COPD group (1.5%) and the ILD group (1.2%). There were differences in the abnormal proportion of antinuclear antibody among the three groups, but no significant difference was found when compared with the CPFE group alone. The CPFE group (46.9%, 12.5%) and the ILD group (54.9%, 9.8%) were significantly higher than the COPD group (34.6%, 2.3%) in terms of carcinoembryonic antigen (CEA) abnormal proportion and cancer rate. In terms of the prevalence of pulmonary hypertension, the CPFE group (41.7%) > the COPD group (33.1%) > the ILD group (32.9%) was shown, but no statistical significance was found among the three groups.ConclusionsMale and smoking are not only risk factors for COPD but also for CPFE. At the same time, the suffering of CPFE may be affected by immune factors and hyperlipidemia. The proportion of CPFE patients complicated with cancer and CEA abnormalities is higher than COPD patients. The severity of pulmonary hypertension in CPFE patients is significantly higher than the other two diseases.