Background：Hemoptysis is a significant clinical entity with high morbidity and potential mortality.Both medical management （in terms of resuscitation and bronchoscopic interventions） and surgery have severe limitat...Background：Hemoptysis is a significant clinical entity with high morbidity and potential mortality.Both medical management （in terms of resuscitation and bronchoscopic interventions） and surgery have severe limitations in these patients population.Bronchial artery embolization （BAE） represents the first-line treatment for hemoptysis.This article discusses clinical analysis,embolization approach,outcomes and complications of BAE for the treatment of hemoptysis.Methods：A retrospective analysis of 344 cases,who underwent bronchial arteriography at Tianjin Haihe Hospital between 2006 and 2013.Several aspects of outcome were analyzed：Demographics,clinical presentation,radiographic studies,results,complications and follow-up of BAE.Results：Three hundred and forty-four consecutive patients underwent bronchial arteriography,336 of 344 patients （97.7%） performed BAE; there were 1530 coils for 920 arteries embolized; the main responsible sources for bleeding were right bronchial artery （29.7%）,left bronchial artery （21.6%）,combined right and left bronchial trunk （18.4%）,right intercostal arteries （13.3%）; 61 patients （17.7%） had recurrent hemoptysis within 1 month after undergoing BAE,74 patients （21.5%） had recurrent hemoptysis over 1 month after undergoing BAE; The common complications of BAE included subintimal dissection,arterial perforation by a guide wire,fever,chest pain,dyspnea,etc.The follow-up was completed in 248 patients,28 patients had been dead,21 patients still bleed,92 patients had lost to follow-up.Conclusions：The technique of BAE is a relatively safe and effective method for controlling hemoptysis.The complications of BAE are rare.Although the long-term outcome in some patients is not good,BAE may be the only life-saving treatment option in patients who are poor surgical candidates.展开更多
Background Recent studies have shown that T helper type-2 （Th2） cells can induce the apoptosis of CD4＋CD25＋ Treg cells or resist the immunosuppressive effect of Treg cells.We hypothesize that an imbalance of Th2/T...Background Recent studies have shown that T helper type-2 （Th2） cells can induce the apoptosis of CD4＋CD25＋ Treg cells or resist the immunosuppressive effect of Treg cells.We hypothesize that an imbalance of Th2/Treg is present in patients with allergic asthma.Methods Twenty-two patients with mild asthma,17 patients with moderate to severe asthma,and 20 healthy donors were enrolled.All patients were allergic to house dust mites.The proportion of peripheral blood CD4＋CD25＋ Treg cells and Th2 cells were determined by flow cytometry.The concentration of interleukin （IL）-10,transforming growth factor （TGF）-β and IL-4 in plasma was determined by enzyme linked immunosorbent assay.In these subjects,peripheral blood mononuclear cells from 17 mild asthmatic patients,13 moderate to severe asthmatic patients and 14 healthy donors were acquired and expression of forkhead box P3 （Foxp3） and GATA-3 mRNA was detected by reverse-transcriptase polymerase chain reaction.Results Compared with healthy donors and patients with mild asthma,the percent of CD4＋CD25＋ Treg cells and plasma IL-10 levels were decreased in patients with moderate to severe asthma.There were no significant differences in Foxp3 mRNA expression among three groups,but a downward trend seen among patients with asthma.However,the percent of Th2 cells,IL-4 levels and expression of GATA-3 mRNA was markedly higher in patients with mild and moderate to severe asthma than in the control group.The ratio of Th2/Treg and their cytokines was increased in allergic asthma,especially for moderate to severe asthma.The ratio of GATA-3/Foxp3 mRNA was also increased in allergic asthma.In patients with moderate to severe asthma,the percentage of peripheral blood Treg cells was negatively correlated to the percentage of Th2 cells and IL-4 levels.Conclusions The decline of CD4＋CD25＋ Treg cells in patients with moderate to severe asthma may play an important role in progress of the disease.Furthermore,the deficiency of CD4＋CD25＋ Treg cells was associated with the overexpression of Th2 response.展开更多
Background： Bronchiolitis obliterans syndrome （BOS） often develops in transplant patients and results in injury to the respiratory and terminal airway epithelium. Owing to its rising incidence, the pathogenesis of ...Background： Bronchiolitis obliterans syndrome （BOS） often develops in transplant patients and results in injury to the respiratory and terminal airway epithelium. Owing to its rising incidence, the pathogenesis of BOS is currently an area of intensive research. Studies have shown that injury to the respiratory epithelium results in dysregulation of epithelial repair. Airway epithelial regeneration is supported by stromal cells, including fibroblasts. This study aimed to investigate whether the supportive role of lung fibroblasts is altered in BOS. Methods： Suspensions of lung cells were prepared by enzyme digestion. Lung progenitor cells （LPCs） were separated by fluorescence-activated cell sorting. Lung fibroblasts from patients with BOS or healthy controls were mixed with sorted mouse LPCs to compare the colony-forming efficiency of LPCs by counting the number of colonies with a diameter of_〉50/.tln in each culture. Statistical analyses were pertbrmed using the SPSS 17.0 software （SPSS Inc., USA）. The paired Student＇s t-test was used to test tbr statistical significance. Results： LPCs were isolated with the surface phenotype ofCD31-CD34-CD45- EpCAMtSca- I . The colony-lbrming efficiency of LPCs was significantly reduced when co-cultured with fibroblasts isolated from patients with BOS. The addition ofSB431542 increased the colony-forming efficiency of LPCs to 1.8%; however, it was still significantly less than that in co-culture with healthy control fibroblasts （P 〈 0.05）. Conclusion： The epithelial-supportive capacity offibroblasts is impaired in the development of BOS and suggest that inefficient repair of airway epithelium could contribute to persistent airway inflammation in BOS.展开更多
Background： Intermittent hypoxia （IH） is a key element of obstructive sleep apnea （OSA） that can lead to disorders in the liver. In this study, IH was established in a rat model to examine its effects on the expr...Background： Intermittent hypoxia （IH） is a key element of obstructive sleep apnea （OSA） that can lead to disorders in the liver. In this study, IH was established in a rat model to examine its effects on the expression of hepatic cytochrome P450 （CYP） and CYP regulators, including nuclear receptors. Methods： Hematoxylin and eosin staining was conducted to analyze the general pathology of the liver of rats exposed to IH. The messenger RNA （mRNA） expression levels of inflammatory cytokines, CYPs, nuclear factor-κB （NF-κB）, and nuclear factors in the liver were measured by quantitative reverse transcription polymerase chain reaction. Results： We found inflammatory infiltrates in the liver of rats exposed to IH. The mRNA expression level of interleukin-1beta was increased in the liver of the IH-exposed rats （0.005 ± 0.001 vs. 0.038 ± 0.008, P = 0.042）, whereas the mRNA expression level of Cyp1a2 was downregulated （0.022 ± 0.002 vs. 0.0050 ± 0.0002, P = 0.029）. The hepatic level of transcription factor NF-κB was also reduced in the IH group relative to that in the control group, but the difference was not statistically significant and was parallel to the expression of the pregnane X receptor and constitutive androstane receptor. However, the decreased expression of the glucocorticoid receptor upon IH treatment was statistically significant （0.056 ± 0.012 vs. 0.032 ± 0.005, P = 0.035）. Conclusions： These results indicate a decrease in expression of hepatic CYPs and their regulator GR in rats exposed to IH. Therefore, this should be noted for patients on medication, especially those on drugs metabolized via the hepatic system, and close attention should be paid to the liver function of patients with OSA-associated IH.展开更多
Background： The aim of this research was to evaluate long-term pulmonary sequelae on paired inspiration-expiration thin-section computed tomograpby （CT） scans 3 years after influenza A （H 1 N1 ） virus-associated ...Background： The aim of this research was to evaluate long-term pulmonary sequelae on paired inspiration-expiration thin-section computed tomograpby （CT） scans 3 years after influenza A （H 1 N1 ） virus-associated pneumonia, and to analyze the affecting factors on pulmonary fibrosis. Methods： Twenty-four patients hospitalized with H 1N 1 virus-associated pneumonia at our hospital between September 2009 and January 2010 were included. The patients underwent thin-section CT 3 years after recovery. Abnonnal pulmonary lesion pattems （ground-glass opacity, consolidation, parenchymal bands, air trapping, and reticulation） and evidence of fibrosis （architectural distortion, traction bronchiectasis, or honeycombing） were evaluated on follow-up thin-section CT. Patients were assigned to Group 1 （with CT evidence of fibrosis） and Group 2 （without CT evidence of fibrosis）. Demographics, rate of mechanical ventilation therapy, rate of intensive care unit admission, cumulative prednisolone-equivalent dose, laboratory tests results （maximum levels of alanine aminotransferase, aspartate transaminase [AST], lactate dehydrogenase [LDH], and creatine kinase [CK]）, and peak radiographic opacification of 24 patients during the course of their illness in the hospital were compared between two groups. Results： Parenchymal abnormality was present in 17 of 24 （70.8%） patients and fibrosis occurred in 10 of 24 （41.7%） patients. Patients in Group 1 （ 10/24; 41.7%） had a higher rate of mechanical ventilation therapy （Z- -2.340, P- 0.019）, higher number of doses of cumulative prednisolone-equivalent （Z = -2.579, P = 0.010）, higher maximum level of laboratory tests results （AST [Z = -2.140, P = 0.032], LDH [Z = -3.227, P = 0.001 ], and CK [Z= -3.345, P = 0.019]）, and higher peak opacification on chest radiographs （Z- -2.743, P = 0.006） than patients in group 2 （14/24; 58.3%）. Conclusions： H 1N 1 virus-associated pneumonia tYequently is followed by long-term pulmonary sequelae, including fibrotic changes, in lung parenchyma. Patients who need more steroid therapy, need more mechanical ventilation therapy, had higher laboratory tests results （maximum levels ofAST, LDH, and CK）, and had higher peak opacification on chest radiographs during treatment are more likely to develop lung fibrosis.展开更多
Pulmonary vein thrombosis is a rare disease and is usually represented as a complication of atrial fibrillation, pulmonary tumors, and Iobectomy. Although it is a potentially life threatening condition, the venous dis...Pulmonary vein thrombosis is a rare disease and is usually represented as a complication of atrial fibrillation, pulmonary tumors, and Iobectomy. Although it is a potentially life threatening condition, the venous disease is easy to misdiagnose because of the non-specific symptoms, In this article, we present a 30-year-old patient who suffered from pulmonary vein thrombosis without any causes. He was diagnosed with other pulmonary disorders till the thrombus within the pulmonary vein extended into the left atrium. Left atrium mass resection and a left lower Iobectomy were undertaken with relative urgency. The postoperative course was uneventful. The patient received a long course of oral anticoagulant therapy.展开更多
As an important barrier,the pulmonary alveolar epithelium plays an important role in lung gas exchange and host defense.The alveolar epithelium is mainly comprised of alveolar type I(AT1)and type II(AT2)cells that are...As an important barrier,the pulmonary alveolar epithelium plays an important role in lung gas exchange and host defense.The alveolar epithelium is mainly comprised of alveolar type I(AT1)and type II(AT2)cells that are tightly connected to maintain the integrity of the alveolar epithelium.There are several kinds of stem/progenitor cells capable of repairing the adult alveolar epithelium in response to various injuries.Kim and colleagues identified bronchioalveolar stem cells(BASCs)that are capable of differentiating into alveolar cells and airway cells.[1]In addition,a subset of alveolar cells expressing the laminin receptorα6β4 but not surfactant protein C(SPC)was able to regenerate into AT2 cells upon bleomycin-induced lung injury.[2]Rare keratin 5-positive basal cells give rise to alveolar epithelial lineages after influenza infection.[3,4]Sex-determining region Y-box 2(Sox2)is a transcription factor that maintains and regulates self-renewal and pluripotency in embryonic stem cells.[5]The functional roles of Sox2 in the repair of alveolar epithelium injuries remain unknown.This study aimed to investigate whether the alveolar cells expressing Sox2 are involved in alveolar epithelial repair.展开更多
To the Editor： A 65-year-old female patient presented with the complaints of hemoptysis and the left upper chest pain for about 1 week. The medical history revealed coronary heart disease and paroxysmal atrial fibril...To the Editor： A 65-year-old female patient presented with the complaints of hemoptysis and the left upper chest pain for about 1 week. The medical history revealed coronary heart disease and paroxysmal atrial fibrillation, smoking for about 40 years, no drinking, and no special contact history. There was a prior history of chronic cough without dyspnea or hemoptysis for about 20 years.展开更多
文摘Background：Hemoptysis is a significant clinical entity with high morbidity and potential mortality.Both medical management （in terms of resuscitation and bronchoscopic interventions） and surgery have severe limitations in these patients population.Bronchial artery embolization （BAE） represents the first-line treatment for hemoptysis.This article discusses clinical analysis,embolization approach,outcomes and complications of BAE for the treatment of hemoptysis.Methods：A retrospective analysis of 344 cases,who underwent bronchial arteriography at Tianjin Haihe Hospital between 2006 and 2013.Several aspects of outcome were analyzed：Demographics,clinical presentation,radiographic studies,results,complications and follow-up of BAE.Results：Three hundred and forty-four consecutive patients underwent bronchial arteriography,336 of 344 patients （97.7%） performed BAE; there were 1530 coils for 920 arteries embolized; the main responsible sources for bleeding were right bronchial artery （29.7%）,left bronchial artery （21.6%）,combined right and left bronchial trunk （18.4%）,right intercostal arteries （13.3%）; 61 patients （17.7%） had recurrent hemoptysis within 1 month after undergoing BAE,74 patients （21.5%） had recurrent hemoptysis over 1 month after undergoing BAE; The common complications of BAE included subintimal dissection,arterial perforation by a guide wire,fever,chest pain,dyspnea,etc.The follow-up was completed in 248 patients,28 patients had been dead,21 patients still bleed,92 patients had lost to follow-up.Conclusions：The technique of BAE is a relatively safe and effective method for controlling hemoptysis.The complications of BAE are rare.Although the long-term outcome in some patients is not good,BAE may be the only life-saving treatment option in patients who are poor surgical candidates.
文摘Background Recent studies have shown that T helper type-2 （Th2） cells can induce the apoptosis of CD4＋CD25＋ Treg cells or resist the immunosuppressive effect of Treg cells.We hypothesize that an imbalance of Th2/Treg is present in patients with allergic asthma.Methods Twenty-two patients with mild asthma,17 patients with moderate to severe asthma,and 20 healthy donors were enrolled.All patients were allergic to house dust mites.The proportion of peripheral blood CD4＋CD25＋ Treg cells and Th2 cells were determined by flow cytometry.The concentration of interleukin （IL）-10,transforming growth factor （TGF）-β and IL-4 in plasma was determined by enzyme linked immunosorbent assay.In these subjects,peripheral blood mononuclear cells from 17 mild asthmatic patients,13 moderate to severe asthmatic patients and 14 healthy donors were acquired and expression of forkhead box P3 （Foxp3） and GATA-3 mRNA was detected by reverse-transcriptase polymerase chain reaction.Results Compared with healthy donors and patients with mild asthma,the percent of CD4＋CD25＋ Treg cells and plasma IL-10 levels were decreased in patients with moderate to severe asthma.There were no significant differences in Foxp3 mRNA expression among three groups,but a downward trend seen among patients with asthma.However,the percent of Th2 cells,IL-4 levels and expression of GATA-3 mRNA was markedly higher in patients with mild and moderate to severe asthma than in the control group.The ratio of Th2/Treg and their cytokines was increased in allergic asthma,especially for moderate to severe asthma.The ratio of GATA-3/Foxp3 mRNA was also increased in allergic asthma.In patients with moderate to severe asthma,the percentage of peripheral blood Treg cells was negatively correlated to the percentage of Th2 cells and IL-4 levels.Conclusions The decline of CD4＋CD25＋ Treg cells in patients with moderate to severe asthma may play an important role in progress of the disease.Furthermore,the deficiency of CD4＋CD25＋ Treg cells was associated with the overexpression of Th2 response.
基金grants from the National Natural Science Foundation of China，the Natural Science Foundation of Tianjin City
文摘Background： Bronchiolitis obliterans syndrome （BOS） often develops in transplant patients and results in injury to the respiratory and terminal airway epithelium. Owing to its rising incidence, the pathogenesis of BOS is currently an area of intensive research. Studies have shown that injury to the respiratory epithelium results in dysregulation of epithelial repair. Airway epithelial regeneration is supported by stromal cells, including fibroblasts. This study aimed to investigate whether the supportive role of lung fibroblasts is altered in BOS. Methods： Suspensions of lung cells were prepared by enzyme digestion. Lung progenitor cells （LPCs） were separated by fluorescence-activated cell sorting. Lung fibroblasts from patients with BOS or healthy controls were mixed with sorted mouse LPCs to compare the colony-forming efficiency of LPCs by counting the number of colonies with a diameter of_〉50/.tln in each culture. Statistical analyses were pertbrmed using the SPSS 17.0 software （SPSS Inc., USA）. The paired Student＇s t-test was used to test tbr statistical significance. Results： LPCs were isolated with the surface phenotype ofCD31-CD34-CD45- EpCAMtSca- I . The colony-lbrming efficiency of LPCs was significantly reduced when co-cultured with fibroblasts isolated from patients with BOS. The addition ofSB431542 increased the colony-forming efficiency of LPCs to 1.8%; however, it was still significantly less than that in co-culture with healthy control fibroblasts （P 〈 0.05）. Conclusion： The epithelial-supportive capacity offibroblasts is impaired in the development of BOS and suggest that inefficient repair of airway epithelium could contribute to persistent airway inflammation in BOS.
文摘Background： Intermittent hypoxia （IH） is a key element of obstructive sleep apnea （OSA） that can lead to disorders in the liver. In this study, IH was established in a rat model to examine its effects on the expression of hepatic cytochrome P450 （CYP） and CYP regulators, including nuclear receptors. Methods： Hematoxylin and eosin staining was conducted to analyze the general pathology of the liver of rats exposed to IH. The messenger RNA （mRNA） expression levels of inflammatory cytokines, CYPs, nuclear factor-κB （NF-κB）, and nuclear factors in the liver were measured by quantitative reverse transcription polymerase chain reaction. Results： We found inflammatory infiltrates in the liver of rats exposed to IH. The mRNA expression level of interleukin-1beta was increased in the liver of the IH-exposed rats （0.005 ± 0.001 vs. 0.038 ± 0.008, P = 0.042）, whereas the mRNA expression level of Cyp1a2 was downregulated （0.022 ± 0.002 vs. 0.0050 ± 0.0002, P = 0.029）. The hepatic level of transcription factor NF-κB was also reduced in the IH group relative to that in the control group, but the difference was not statistically significant and was parallel to the expression of the pregnane X receptor and constitutive androstane receptor. However, the decreased expression of the glucocorticoid receptor upon IH treatment was statistically significant （0.056 ± 0.012 vs. 0.032 ± 0.005, P = 0.035）. Conclusions： These results indicate a decrease in expression of hepatic CYPs and their regulator GR in rats exposed to IH. Therefore, this should be noted for patients on medication, especially those on drugs metabolized via the hepatic system, and close attention should be paid to the liver function of patients with OSA-associated IH.
文摘Background： The aim of this research was to evaluate long-term pulmonary sequelae on paired inspiration-expiration thin-section computed tomograpby （CT） scans 3 years after influenza A （H 1 N1 ） virus-associated pneumonia, and to analyze the affecting factors on pulmonary fibrosis. Methods： Twenty-four patients hospitalized with H 1N 1 virus-associated pneumonia at our hospital between September 2009 and January 2010 were included. The patients underwent thin-section CT 3 years after recovery. Abnonnal pulmonary lesion pattems （ground-glass opacity, consolidation, parenchymal bands, air trapping, and reticulation） and evidence of fibrosis （architectural distortion, traction bronchiectasis, or honeycombing） were evaluated on follow-up thin-section CT. Patients were assigned to Group 1 （with CT evidence of fibrosis） and Group 2 （without CT evidence of fibrosis）. Demographics, rate of mechanical ventilation therapy, rate of intensive care unit admission, cumulative prednisolone-equivalent dose, laboratory tests results （maximum levels of alanine aminotransferase, aspartate transaminase [AST], lactate dehydrogenase [LDH], and creatine kinase [CK]）, and peak radiographic opacification of 24 patients during the course of their illness in the hospital were compared between two groups. Results： Parenchymal abnormality was present in 17 of 24 （70.8%） patients and fibrosis occurred in 10 of 24 （41.7%） patients. Patients in Group 1 （ 10/24; 41.7%） had a higher rate of mechanical ventilation therapy （Z- -2.340, P- 0.019）, higher number of doses of cumulative prednisolone-equivalent （Z = -2.579, P = 0.010）, higher maximum level of laboratory tests results （AST [Z = -2.140, P = 0.032], LDH [Z = -3.227, P = 0.001 ], and CK [Z= -3.345, P = 0.019]）, and higher peak opacification on chest radiographs （Z- -2.743, P = 0.006） than patients in group 2 （14/24; 58.3%）. Conclusions： H 1N 1 virus-associated pneumonia tYequently is followed by long-term pulmonary sequelae, including fibrotic changes, in lung parenchyma. Patients who need more steroid therapy, need more mechanical ventilation therapy, had higher laboratory tests results （maximum levels ofAST, LDH, and CK）, and had higher peak opacification on chest radiographs during treatment are more likely to develop lung fibrosis.
文摘Pulmonary vein thrombosis is a rare disease and is usually represented as a complication of atrial fibrillation, pulmonary tumors, and Iobectomy. Although it is a potentially life threatening condition, the venous disease is easy to misdiagnose because of the non-specific symptoms, In this article, we present a 30-year-old patient who suffered from pulmonary vein thrombosis without any causes. He was diagnosed with other pulmonary disorders till the thrombus within the pulmonary vein extended into the left atrium. Left atrium mass resection and a left lower Iobectomy were undertaken with relative urgency. The postoperative course was uneventful. The patient received a long course of oral anticoagulant therapy.
基金supported by the grants from the National Natural Science Foundation of China(Nos.81773394 and 81970001)the Natural Science Foundation of Tianjin(Nos.18ZXDBSY00150 and 19JCZDJC33600)Science and Technology Fund of Tianjin Haihe Hospital(Nos.HHYY-201901 and HHYY-201804)。
文摘As an important barrier,the pulmonary alveolar epithelium plays an important role in lung gas exchange and host defense.The alveolar epithelium is mainly comprised of alveolar type I(AT1)and type II(AT2)cells that are tightly connected to maintain the integrity of the alveolar epithelium.There are several kinds of stem/progenitor cells capable of repairing the adult alveolar epithelium in response to various injuries.Kim and colleagues identified bronchioalveolar stem cells(BASCs)that are capable of differentiating into alveolar cells and airway cells.[1]In addition,a subset of alveolar cells expressing the laminin receptorα6β4 but not surfactant protein C(SPC)was able to regenerate into AT2 cells upon bleomycin-induced lung injury.[2]Rare keratin 5-positive basal cells give rise to alveolar epithelial lineages after influenza infection.[3,4]Sex-determining region Y-box 2(Sox2)is a transcription factor that maintains and regulates self-renewal and pluripotency in embryonic stem cells.[5]The functional roles of Sox2 in the repair of alveolar epithelium injuries remain unknown.This study aimed to investigate whether the alveolar cells expressing Sox2 are involved in alveolar epithelial repair.
文摘To the Editor： A 65-year-old female patient presented with the complaints of hemoptysis and the left upper chest pain for about 1 week. The medical history revealed coronary heart disease and paroxysmal atrial fibrillation, smoking for about 40 years, no drinking, and no special contact history. There was a prior history of chronic cough without dyspnea or hemoptysis for about 20 years.
