ObjectiveTo investigate the expression of SIR2-related enzyme 1 (SIRT1) in serum of patients with chronic obstructive pulmonary disease (COPD) and its clinical significance.MethodsForty patients with acute exacerbation of COPD (acute-COPD group) and 30 patients with stable COPD (stable-COPD group) were selected as study groups. Twenty healthy subjects were recruited as a control group. Serum SIRT1, nuclear factor (NF) -κB, and matrix metalloproteinases (MMP) -9 levels were detected by enzyme-linked immunosorbent assay and Western blot.ResultsCompared with the control group, the FEV1%pred and FEV1/FVC were significantly decreased in the acute COPD patients and the stable COPD patients (P<0.05). Compared with the stable-COPD group, FEV1%pred and FEV1/FVC were significantly decreased in the acute-COPD group (P<0.05). Compared with control group, the serum SIRT1 in the stable-COPD group and the acute-COPD group were significantly decreased, while NF-κB and MMP-9 were significantly increased (P<0.05). Compared with the stable-COPD group, SIRT1 in the acute-COPD group was significantly decreased, while NF-κB and MMP-9 were significantly increased (P<0.05). SIRT1 were positively correlated with FEV1%pred (P<0.05) and FEV1/FVC (P<0.05) in the COPD patients by Pearson linear correlation analysis. SIRT1 was negatively correlated with NF-κB (P<0.05) and MMP-9 (P<0.05).ConclusionIn COPD patients, decreased levels of serum SIRT1 is associates with decreased lung function, which may be used as a potential biomarker of COPD.
ObjectiveTo compare the influence of intrathoracic and retrosternal esophagogastric anastomosis on pulmonary function in aged patients after esophagectomy.
MethodsForty patients (older than 62 years) with upper or middle thoracic esophageal carcinoma (EC) who underwent esophagectomy in Fengtian Hospital of Shenyang Medical College between February 2009 and May 2011 were enrolled in this study. According to different surgical approach, all the patients were divided into an intrathoracic esophagogastric anastomosis (IEGA) group and a retrosternal esophagogastric anastomosis (REGA) group. There were 20 patients in IEGA group including 16 males and 4 females with their age of 62-79 (64.70±11.47) years, who received cervical anastomosis after EC resection and intrathoracic gastric tube reconstruction. There were 20 patients in REGA group including 17 males and 3 females with their age of 63-77 (65.90±12.72) years, who received cervical anastomosis after EC resection and retrosternal gastric tube reconstruction. Pulmonary function test (PFT) was performed preoperatively and on the 15th and 30th postoperative day, and compared between the 2 groups.
ResultsThere was no statistical difference in preoperative PFT between the 2 groups (P > 0.05). PFT of IEGA group on the 15th and 30th postoperative day was significantly worse than preoperative PFT (P < 0.05). PFT of REGA group on the 15th and 30th postoperative day was not statistically different from preoperative PFT (P > 0.05). PFT of REGA group on the 15th and 30th postoperative day was significantly better than PFT of IEGA group (P < 0.05). In IEGA group, postoperative complications included anastomotic leak in 1 patient, anastomotic stenosis in 1 patient, pneumonia in 5 patients and atelectasis in 1 patient. In REGA group, postoperative complications included anastomotic leak in 1 patient, anastomotic stenosis in 1 patient, gastric outlet obstruction in 1 patient and pneumonia in 3 patients. All the patients were followed up for 1 year. There was no statistical difference between PFT at 1 year after discharge and PFT on the 30th postoperative day in either group.
ConclusionsIEGA can significantly reduce postoperative PFT. REGA has less negative influence on postoperative PFT, is suitable for aged patients and patients with unsatisfactory preoperative PFT, can reduce postoperative complications and improve postoperative quality of life.
ObjectiveTo investigate the changes of lung function after exposure to fine particulate matter (PM2.5) for 60 days and the expression of miR-146 in mice.MethodsThirty SPF BALB/c mice were treated with noninvasive tracheal instillation of fine particulate matter suspension at different doses (2.5 mg/kg, 5.0 mg/kg, 10.0 mg/kg) for 2 months (two times one week), the blank group and normal saline group were set as control groups. The mice were examined and killed on the next day after the last instillation. Histopathological changes of the lungs, pro-infammatory factors levels in the lung tissues, pulmonary functions and the relative expression of miR-146a and miR-146b in the lung tissues were detected.ResultsPeak inspiratory flow (PIF) and peak expiratory flow (PEF) were decreased significantly after PM2.5 exposure, however, lung resistance increased and maximal voluntary ventilation reduced from the general tendency without significant difference. Hematoxylin-eosin stain showed lymphocyte infiltration and macrophage infiltration by phagocytic particles, alveolar spacer widening, inflammatory response increased with the increase of PM2.5 exposure dosage. Pro-infammatory factors as interleukin-6 in the bronchoalveolar lavage fluid, interferon-γ and tumor necrosis factor-α in the lung homogenate were increased significantly by enzyme linked immunosorbent assay. The relative expressions of miR-146a and miR-146b were up-regulated remarkablely in treatment groups compared to the control group by real-time fluorescence quantitative polymerase chain reaction, which had negative relationships with PIF and PEF.ConclusionsThe lung function of mice decreases significantly after exposure to fine particulate matter, and the expression of miR-146 is up-regulated.
Objective To evaluate pulmonary function changes in patients with severe scol iosis undergoing anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib. Methods FromJanuary 2006 to July 2007, 16 patients with severe scol iosis were treated with anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib. There were 6 males and 10 females with an average age of 16.9 years (range, 10-24 years). There were 1 case of Lenke 1 curve, 9 cases of Lenke 2 curve, and 6 cases of Lenke 4 curve. The preoperative Cobb angle was (104.8 ± 10.9)° and the preoperative thoracic kyphotic angle was (30.0 ± 4.2)°. The preoperative height of “razor back” deformity was (5.9 ± 1.2) cm. Before operation, the actual value of forced vital capacity (FVC) was (2.04 ± 0.63) L and that of forced expiratory volume in 1 second (FEV1.0) was (1.72 ± 0.62) L. The percentage of actual values to expected ones in FVC was 70% ± 16%, and that in FEV1.0 was 67% ± 15%. All patients had pulmonary function tests before operation and 3, 6, 12, 24 months after operation. Results All wounds healed by first intention. The Cobb angle at 24-month follow-up was (53.4 ± 18.6)° and the correction rate was 49.0% ± 15.3%. The thoracic kyphotic angle at 24-month follow-up was (34.0 ± 2.4)° and the correction rate was 13.3% ± 2.2%. The height of “razor back” deformity at 24-month follow-up was (2.2 ± 0.8) cm. Compared with preoperative level, all these data showed significant differences (P lt; 0.05). At 3 and 6 months, the actual values of FVC and FEV1.0 decl ined, but no significant difference was found (P gt; 0.05). At 12 and 24 months, the actual values of FVC andFEV1.0 were close to the preoperative level (P gt; 0.05). The percentages of actual values to expected ones in FVC and FEV1.0 indicate continued improvement in pulmonary function from the postoperative 3 to 24 months follow-up. Compared with preoperative level, the percentages of actual values in FVC decl ined 19% 3 months postoperatively (P lt; 0.05) and 12% 6 months postoperatively (P lt; 0.05). The percentages of actual values to expected ones in FEV1.0 decl ined 16% 3 months postoperatively (P lt; 0.05), and 10% 6 months postoperatively (P lt; 0.05). The percentages of actual values to expected ones in FVC and FEV1.0 were close to the preoperative level 12 and 24 months after operation (P gt; 0.05). Conclusion In severe scol iosis patients who are treated with anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib, pulmonary function decreases obviously 3-6 months after operation. And it returns to the operative baseline 12-24 months after operation.
ObjectiveTo analyze the clinical characteristics of patients with amyopathic dermatomyositis with organizing pneumonia (ADM-OP).MethodsThe clinical data of 8 patients hospitalized with ADM-OP from June 2014 to June 2018 were retrospectively reviewed and simultaneously compared with those of 8 patients of cryptogenic organizing pneumonia (COP).ResultsThe incidence of skin lesion, Gottron’s sign, mechanic’s hand and positive anti-synthase antibodies in the ADM-OP patients were 87.5%, 87.5% 75.0% and 87.5% respectively. Gender, smoking, respiratory symptoms and signs, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide and treatment strategy were no statistical difference between ADM-OP and COP patients, but the onset age and Chest CT fibrosis scores (CTFS) on admission existed differences. After treatment for 3 months, CTFS, rate of change and forced vital capacity (FVC) existed differences. After treatment for 6 months, CTFS, rate of change, FVC and diffusing capacity of the lung for carbon monoxide existed differences.ConclusionsSkin lesion, Gottron’s sign, mechanic’s hand and positive anti-synthase antibodies are more common in ADM-OP patients. Their response to treatment is good but the improvement rates in CTFS and pulmonary function are slower than those of COP patients.
ObjectiveTo observe the curative effect of pulmonary rehabilitation in patients with stable moderate to severe chronic obstructive pulmonary disease (COPD).MethodsSixty-four patients with stable moderate to severe COPD who visited during January 2016 and December 2017 were recruited in the study. They were randomly divided into an observation group and a control group, with 32 cases in each group. The spirometry was conducted in all patients. The right deep inspiratory end diaphragm thickness and the quiet end expiratory diaphragm thickness were measured by ultrasound, and the diaphragm thickness fraction (DTF) was calculated. The routine drug treatment was given in both groups. The comprehensive pulmonary rehabilitation treatment was given in the observation group (include breath training, exercise training, health education and nutrition guide). The pulmonary function, diaphragm function, severity and quality of life were evaluated before and 6 months later after the treatment.ResultsIn the observation group, the predicted value of forced expiratory volume in one second (FEV1%pred), FEV1/FVC ratio and DTF were all significantly improved compare with before treatment and the control group (all P<0.05). While the BODE index was significantly declined compare with before treatment and the control group (all P<0.05).ConclusionPulmonary rehabilitation treatment can help improve pulmonary function, diaphragm function, condition of the disease and quality of life.
ObjectiveTo know about equipment of pulmonary function tests (PFTs) in community health service centers and the knowledge of pulmonary function in general physicians.MethodsThis questionnaire survey was carried out sponsored by Shanghai Basic Alliance for Respiratory Diseases Prevention and Treatment from June to December in 2016. Most community health service centers in 16 districts of Shanghai participated the survey. The questionnaire included education background, professional qualification, PFTs equipment, and knowledge about PFTs.ResultsThere were 963 general physicians in 131 community health service centers completed the questionnaire. There were 27 (20.6%) community health service centers equipped with simplified pulmonary function test device and 910 (94.5%) physicians knowing PFTs. Out of these 910 physicians, 458 physicians (50.3%) gave the correct answer on question about the items of PFTs. The accuracy of question about the diagnosis of chronic obstructive pulmonary disease (COPD) was 24.0% (218/910).ConclusionsThe rate of community health service centers with equipment on PFTs is low and the knowledge on pulmonary function in general physicians is insufficentt in Shanghai. Training on pulmonary function is essential to adapt the stratified treatment of COPD.
Objective To investigate the lung involvement in Chinese patients with systemic sclerosis ( SSc) and its functional impact. Methods 68 patients with SSc were enrolled in Scleroderma study of PUMCH ( Peking Union Medical College Hospital) . All the patients underwent high resolution computed tomography ( HRCT) , pulmonary function testing, 6-minute walk testing, and echocardiography. And 36 patients filled in the Saint George’s Respiratory Questionnaire ( SGRQ) for assessment of healthrelated quality of life. Results HRCT revealed interstitial lung disease ( ILD) in 52 ( 76. 5% ) patients, 20 out of them without respiratory symptoms. Reticular opacification, ground-glass opacity ( GGO) , traction bronchiectasis, and honeycomb were presented respectively in 80.8% , 73.1% , 59.6% , and 30.8% of patients with SSc-ILD. Fibrosis was the predominant HRCT finding, and pure GGO ( in the absence of reticulation or architectural distortion) was only present in 8 ( 15. 7% ) patients. 57 (83.8% ) patients presented with diffusion defect, with most of them having moderate to severe impairent. Reduced FVC or TLC presented in 20 ( 29.4% ) and 28 ( 41.2% ) of patients respectively. The significant correlation was observed between the DLCO and the extent of ILD on HRCT ( rs = -0.476, P =0.000) . DLCO showed significant correlations with all the four components of the SGRQ ( Plt;0.05) . Significant correlations were also observed among the SGRQ scores and SpO2 ( maximum desaturation) or Borg index. Stepwise multiple regression analysis confirmed that the DLCO, SpO2 , and Borg index contributed to the SGRQ. Conclusions Lung involvement in Chinese SSc patients is common and insidious. The HRCT features of SSc-ILD are predominant fibrosis plus GGO, indicating little reversibility. Thus HRCT should be performed routinely in newly diagnosed SSc patients for early screening of lung involvement. The lung function defect of SSc is characterized by reduced diffusing capacity, and DLCO show better correlations with HRCT abnormities or SGRQ than FVC or TLC. Thus DLCO is of great value for early detection or severity assessment of SSc-ILD. SGRQ can be used to examine the health related quality of life of SSc patients and may reflect severity of lung involvement.
The American Thoracic Society Committee Task Force on Standards for Pulmonary Function had recommended a standardized reporting format for pulmonary function tests due to considerable variability in pulmonary function reports presented to end users, which might lead to potential confusion and miscommunication. This recommendation includes seven parts: overview, introduction, methods, report format, selecting and reporting reference values, grading the quality of pulmonary function tests and conclusions. This document presents a reporting format in test-specific units for spirometry, lung volumes, and diffusing capacity that can be assembled into a report appropriate for a laboratory’s practice. Recommended reference sources are updated, with especially emphasizing to adapt lower limit of normal (LLN) or z score instead of percent of prediction to estimate the abnormal results. This document provides detail and clear explanation on the recommendations, which might improve the interpretation, communication, and understanding of test results. However, parts of recommendation might not be used directly in our clinical practice owing to some specific conditions in China. We suggest to use appropriate normal predictions from Chinese population, to include small airway parameters such as mid-maximal expiratory flow for early detection of pulmonary function deterioration, and to include inspiratory flow volume curve, as well as strengthen the quality control data and figures in the report format.
Objective
To explore the effect of smoking on pulmonary function parameters of male patients with chronic obstructive pulmonary disease (COPD) and to analyze the correlation between smoking and pulmonary function parameters.
Methods
From January 2014 to October 2015, the pulmonary function parameters of 223 male outpatients or hospitalized patients with COPD in the Department of Respiratory Medicine were retrospectively analyzed by using SPSS 17.0 software. The patients were randomly divided into smoking group (n=98), smoking cessation group (n=82) and non-smoking group (n=43).
Results
Various degrees of damage or abnormality of lung capacity, ventilatory function, gas exchange function and airway resistance (Raw) existed in the patients with COPD. Compared with smoking cessation group and non-smoking group, residual volume/ total lung capacity (RV/TLC) and Raw were significantly higher (P< 0.05), maximum ventilatory volume, ventilation reserve percent, forced vital capacity, the percent of first second forced expiratory volume compared its predicted value (FEV1%pred), maximum mid-expiratory flow (MMEF), forced expiratory flow 50%, forced expiratory flow 75% and diffusing capacity of carbon monoxide were significantly lower (P<0.05) in the smoking group. There was a negative relationship between MMEF, FEV1%pred and smoking index (r=–0.352, –0.381, P<0.05), and a positive relationship between Raw, RV/TLC and smoking index (r=0.403, 0.378, P<0.05).
Conclusions
Most of the male COPD patients smoke or used to smoke. Smoking leads to ventilation and gas exchange function decrease, small airway limitation aggravation, airway resistance and emphysema degree increase in COPD patients. Smoking index has a negative relationship with MMEF, FEV1%pred and a positive relationship with Raw and RV/TLC.
