The Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease is produced based on important studies published in last five years and published online. So far it is the most influential evidence-based strategy for the diagnosis, treatment and prevention of chronic obstructive pulmonary disease to guide clinical professionals.
Objective To observe the efficacy and safety of sildenafil in one case of PoPH patients. Methods A case of PoPH patient who was successfully treated with sildenafil was retrospectively analyzed，and literatures related sildenafil and PoPH were reviewed. Results A case of PoPH patient admitted with dyspnea on extetion was diagnosed with echocardiography，gastroscrope and other examinations. She was treated with sildenafil and responded well by decreased pulmonary arterial pressure，improved exercise tolerance and life quality，without obvious side effects. Literatures review suggested that PoPH is an under-recognized but life-threatening complication of cirrhosis or noncirrhotic portal hypertension with poor prognosis which exists in decompensated chronic liver diseases patients. The most classic symptoms of PoPH is progressive dyspnea on extertion. PoPH patients may benefit from sildenafil therapy with decreased pulmonary arterial pressure and improved life quality. Conclusions Theawareness of PoPH should be increased and Sildenafil may be effective and safe for PoPH patients. However，more evidences from clinical trials are needed.
The management of malignant pleural effusion remains a clinical challenge. In November 2018, American Thoracic Society, Society of Thoracic Surgeons, and Society of Thoracic Radiology summarized the recent advances and provided 7 recommendations for clinical problems of the management of malignant pleural effusion. This paper interprets these recommendations to provide references for management and research on malignant pleural effusion.
Objective To explore the effects of SU5416，a vascular endothelial growth factor receptor (VEGFR) inhibitor，on inflammation in mice with bleomycin-induced pulmonary fibrosis.Methods C57BL/6 mice were randomly divided into four groups，ie.a control group，a bleomycin-induced pulmonary fibrosis (BPF) group,early intervention with SU5416 group (days 1-14，SE)，and delayed intervention with SU5416group (days 15-28，SD).Bleomycin (10 mg/kg) was instilled into the trachea of the mice to induce pulmonary fibrosis.After the instillation，SU5416 (50 mg/kg) was injected into the peritoneal cavities of the mice twice a week.The mice treated with bleomycin alone or with bleomycin followed by SU5416 were sacrificed on the day 14 and day 28 after the instillation of bleomycin.Lung tissues were taken and processed for determination of hydroxyl proline content.Bronchoalveolar lavage fluid (BALF) was collected for total and differential cell counts and measurements of lactic dehydrogenase (LDH) levels.Results It was found that the hydroxyl proline contents，the number of macrophages，and the LDH contents from the mice treated with bleomycin alone on day 14 were greatly increased.However，only the hydroxyl proline showed a significant increase in the mice treated with bleomycin alone on day 28.The number of macrophages，LDH contents，and hydroxyl proline contents were greatly reduced in the mice treated with bleomycin and early administration of SU5416 on day 14 when compared with those treated with bleomycin alone.But there were no significant differences in the above parameters of the mice treated with bleomycin and delayed administration of SU5416 on day 14.Conclusion This study indicates that early intervention by SU5416 might attenuate the fibrosis through inhibiting early inflammation in animal model of pulmonary fibrosis induced by bleomycin.
Objective
To determine the role of serum cystatin C in evaluating the severity and predicting in-hospital mortality in patients with community-acquired pneumonia (CAP).
Methods
The clinical data of 176 patients with CAP treated between January 2015 and October 2016 were collected in a retrospective way. The CURB-65 score was used to assess the severity. The serum levels of cystatin C and C-reactive protein (CRP) on admission were measured. The correlations between cystatin C and CURB-65 score and between cystatin C and CRP were calculated. Receiver operating characteristic curve was used to determine the ability of cystatin C in predicting in-hospital mortality.
Results
The serum level of cystatin C increased with the increasing CURB-65 score (P<0.001). The serum level of cystatin C was correlated positively with CRP level (rs=0.190, P<0.011). There were 22 patients died in hospital, the mean serum cystatin C level of non-survivor was significantly higher than that of survivors [(1.51±0.56)vs. (1.02±0.29) mg/L, P<0.001]. At a cut-off 1.18 mg/L, the sensitivity and specificity of cystatin C in predicting in-hospital mortality were 68.18% and 81.17%, respectively. The area under the receiver operating characteristic curve was 0.793. The combination of cystatin C and CRP increased the predictive accuracy for in-hospital mortality.
Conclusion
Cystatin C level increases with the increaseing severity of CAP, and it may be a clinical biomarker to evaluate the severity and prognosis of patients with CAP.
ObjectiveTo explore the clinical value of age/pleural fluid adenosine deaminase (age/ADA) ratio and serum lactate dehydrogenase/pleural fluid adenosine deaminase ratio (Cancer Ratio, CR) in the diagnosis of malignant pleural effusions (MPE). MethodsThe study collected 44 patients with MPE and 48 patients with benign pleural effusion (BPE) to compare the differences in age, gender, carcinoembryonic antigen (CEA), age/ADA ratio and CR between the groups. The receiver operating characteristic (ROC) curve of CEA, age/ADA and CR was constructed and the area under the ROC curve (AUC), sensitivity and specificity was calculated to identify the diagnostic performance of the three indicators alone or in combination in MPE. ResultsCEA, age/ADA and CR were significant higher in the MPE group than those in the BPE group (all P<0.05), the AUCs of CEA, age/ADA and CR were 0.768, 0.837 and 0.866, respectively; the sensitivity was 61.36%, 88.64% and 81.82%, the specificity was 85.42%, 75.00%, 83.33%, respectively. The AUCs of CEA combined with age/ADA, CEA combined with CR, age/ADA combined with CR, CEA combined with age/ADA and CR were respectively 0.892, 0.911, 0.837 and 0.907; the sensitivity was 81.82%, 86.36%, 88.64% and 90.91%, the specificity was 79.17%, 79.17%, 75.00% and 77.08%, respectively. ConclusionsAge/ADA and CR demonstrated good diagnostic performance in MPE, moreover, the diagnostic performance can be further improved when combined with the traditional tumor marker CEA, and more research about its diagnostic value is needed in the future.
目的 研究同型半胱氨酸轉硫途徑、維生素B6及內源性硫化氫在慢性阻塞性肺疾病急性加重期（AECOPD）中的作用。 方法 2010年2月－4月間篩選AECOPD患者16例和健康志愿者（對照組）13例，測定AECOPD患者加重期、緩解期及對照組的肺功能、血清硫化氫（H2S）、丙二醛（MDA）、葉酸、維生素B12、C反應蛋白、白介素6、血漿同型半胱氨酸、胱硫醚、半胱氨酸和維生素B6的濃度。計算半胱氨酸轉化率（半胱氨酸濃度/胱硫醚濃度）與胱硫醚轉化率（胱硫醚濃度/同型半胱氨酸濃度）參與分析。 結果 ① 加重期血清MDA水平[（7.3 ± 5.1）nmol/L ]比緩解期[（3.0 ± 1.4）nmol/L ]和對照組[（3.0 ± 2.2）nmol/L ]均升高（P＜0.01）；血清MDA水平與第1秒用力呼氣容積/用力肺活量（FEV1/FVC）、第1秒用力呼氣容積占預計值百分比（FEV1%預計值）呈負相關。② 加重期血清H2S水平與血漿維生素B6水平較緩解期與對照組降低（P＜0.01）；緩解期血清H2S水平[（47.2 ±5.1） μmol/L ]高于對照組[（38.8 ± 2.1） μmol/L ]，P＜0.01；血清H2S水平、血漿維生素B6水平均與FEV1%預計值呈正相關（r=0.651、0.680，P＜0.01），均與血清MDA水平呈負相關（r=-0.334、-0.448，P＜0.05）。③ 加重期半胱氨酸轉化率（3.97 ± 2.41）低于緩解期（5.92 ± 2.18）與對照組（6.14 ± 3.15）差異有統計學意義（P＜0.05）；而胱硫醚轉化率則相反。④ 葉酸與維生素B12水平各組間均無差異。 結論 提高AECOPD患者維生素B6及H2S濃度可能能促使AECOPD患者向穩定狀態轉歸，減輕氧化應激損傷。維生素B6與H2S可能成為AECOPD患者的一個新的治療點。Objective To study the roles of homocysteine (Hcy) transsulfuration pathway, Vitamin B6 and endogenous hydrogen sulfide in treating patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Sixteen AECOPD patients and 13 healthy controls (Control group) from February to April 2010 were recruited in this study. Lung function, serum hydrogen sulfide (H2S), malondialdehyde (MDA), folate, vitamin B12, C-reactive protein (CRP), interleukin-6 (IL-6), Hcy, cystathionine, cystein (Cys) and vitamin B6 were all measured for all the patients in the acute exacerbation period and alleviation period and healthy controls. The conversion rate of Cys (expressed as Cys/cystathionine) and the conversion rate of cystathionine (expressed as cystathionine/Hcy) were calculated for analysis. Results Serum MDA level for patients in the acute exacerbation period (AE period) [(7.3 ± 5.1) nmol/L] was significantly higher than that in the alleviation period [(3.0 ± 1.4) nmol/L] and in the healthy controls [(3.0 ± 2.2) nmol/L] (P ＜ 0.01). Serum MDA level was negatively correlated with percentage of FEV1 in predicted FEV1 (FEV1% pred) and FEV1/FVC. Serum H2S level and plasma vitamin B6 level for patients in the AE period were significantly lower than those in the alleviation period and in the healthy controls (P ＜ 0.01), and serum H2S level was significantly higher in the alleviation period [(47.2 ± 5.1) μmol/L] than in the controls [(38.8 ± 2.1) μmol/L] (P ＜ 0.01). Both serum H2S and plasma vitamin B6 levels were correlated positively with FEV1% pred for patients in the AE period and healthy controls (r=0.651, 0.680; P ＜ 0.01), but negatively correlated with serum MDA level (r=-0.334, -0.448; P ＜ 0.05). The conversion rate of Cys for patients in the AE period (3.97 ± 2.41) was significantly lower than that in the alleviation period (5.92 ± 2.18) and the control group (6.14 ± 3.15) (P ＜ 0.05), but the conversion rate of cystathionine was just the opposite (P ＜ 0.05). There were no significant differences in the levels of serum folate and vitamin B12 among the three groups. Conclusion Raising the Vitamin B6 and H2S level may facilitate stabilizing of conditions in patients with AECOPD and reduce oxidative stress. Therefore, it may become a new treatment method for AECOPD.
