肺表面活性蛋白A在皮质类固醇调节哮喘小鼠树突细胞共刺激分子表达中的作用

目的 研究皮质类固醇激素调节小鼠哮喘模型树突细胞表面共刺激分子表达的机制，以及肺表面活性蛋白A（SP-A）在其调节中的作用。方法 BALB/c小鼠30只，分为3组：哮喘组，采用卵蛋白（OVA）致敏和激发；对照组，以生理盐水代替OVA；治疗组，每次OVA激发后10min，腹腔注射地塞米松01mg。用免疫组化法检测SP-A在肺内的表达情况。采用Leica DM Snk软件进行图像采集，并用Qwin软件计算小气道内棕色区域面积，取平均值，进行统计分析。分离培养脾脏树突细胞，用流式细胞仪（FACS）检测树突细胞表面共刺激分子CD80的表达变化。结果 哮喘组肺组织表现为嗜酸性细胞及淋巴细胞浸润为主的炎症变化，治疗组和对照组无此变化。哮喘组的SP-A表达明显低于对照组和治疗组（P〈0．01），CD80的表达率明显高于治疗组（P〈0.01）；哮喘组小气道内SP-A表达与树突细胞CD80阳性率呈负相关（r=-0．907，P〈0．01）。结论 皮质类固醇对小鼠哮喘模型的肺表面活性蛋白有明显的保护作用，可通过激发肺表面活性蛋白抑制树突细胞表面共刺激分子CD80的表达。     

The severity of airways obstruction as a determinant of treatment response in COPD

Guidelines recommend that patients with COPD are stratified arbitrarily by baseline severity (FEV₁) to decide when to initiate combination treatment with a long-acting β₂-agonist and an inhaled corticosteroid. Assessment of baseline FEV₁ as a continuous variable may provide a more reliable prediction of treatment effects. Patients from a 1-year, parallel-group, randomized controlled trial comparing 50 μg salmeterol (Sal), 500 μg fluticasone propionate (FP), the combination (Sal/FP) and placebo, (bid), were categorized post hoc into FEV₁ <50% and FEV₁ ≥50% predicted subgroups (n=949/513 respectively). Treatment effects on clinical outcomes – lung function, exacerbations, health status, diary card symptoms, and adverse events – were investigated. Treatment responses based on a pre-specified analysis explored treatment differences by severity as a continuous variable. Lung function improved with active treatment irrespective of FEV₁; Sal/FP had greatest effect. This improvement appeared additive in milder disease; synergistic in severe disease. Active therapy significantly reduced exacerbation rate in patients with FEV₁ <50% predicted, not in milder disease. Health status and breathlessness improved with Sal/FP irrespective of baseline FEV₁; adverse events were similar across subgroups. The spirometric response to Sal/FP varied with baseline FEV₁, and clinical benefits were not restricted to patients with severe disease. These data have implications for COPD management decisions, suggesting that arbitrary stratifications of baseline severity are not necessarily indicative of treatment efficacy and that the benefits of assessing baseline severity as a continuous variable should be assessed in future trials.     

Determination of the mean transit time for the transport of aerosolized 99mTc-DTPA across the pulmonary epithelial membrane. A plasma sample method

Summary. During the last decade it has been customary to estimate pulmonary epithelial permeability (P-P) as the pulmonary clearance of inhaled nebulized ^99mTc-DTPA from a time-activity (t-a) curve registered externally by monitoring over the chest. The t-a curve, however, is not defined by the degree of P-P alone but also by factors such as the deposition of the ^99mTc-DTPA in the lungs. To avoid these problems a plasma sample method was derived. It describes P-P by the mean transit time (t?) for the transport of ^99mTc-DTPA across the pulmonary epithelial membrane, t? (L). The calculation of t? (L) involves two steps. Following the inhalation of Tc-DTPA the plasma t-a curve is defined and used to calculate t? for the transport for ^99mTc-DTPA across the pulmonary epithelial membrane, through the E?V and until elimination by the kidneys, t? (L+ECV). Subsequently, ^99mTc-DTPA is injected as a bolus i.v. and the new t-a curve is used to calculate t? for the transport of ^99mTc-DTPA through ECV to the kidneys, t? (ECV). Finally t? (L) is calculated as t? (L) = -t? (L+ECV) t? (ECV). We applied the method in nine non-smoking individuals (median age 25–5 years, range 20–28) and compared the results to t? as calculated from the initial slope of an externally derived t-a curve. The individual t? (L) values were systematically greater than those of the external detection method (P<0·05). It is concluded that the initial slope method overestimates total PCI as measured by the plasma sample method. When choosing between the two methods, special interest should be paid to the inherent problems of the methods.     

肺螨病的病理观察

本文报道螨类接种豚鼠气管引起的肺部病变,并对5种常见螨类的致病性进行比较。发现螨类接种后6天豚鼠肺部已形成典型的结节性病灶。结节圆锥形淡黄色,直径1～5mm之间。镜下表现为细支气管炎和细支气管周围炎,肺实质内有明显的异物肉芽肿形成,炎症在螨类接种豚鼠20天时,肺部嗜酸粒细胞浸润不明显,但30或40天时则出现明显的嗜酸细胞浸润,细支气管周围小动脉受到损害,部分小动脉内可见到螨体残骸。5种常见螨炎接种于5组豚鼠可引起大致相同的病变。从而证明豚鼠可作为动物模型以供肺螨病的研究,同时也证明5种常见贮藏螨具有相同的致病性。     

Coexisting Endogenous and Exogenous Llpold Pneumonia and Pulmonary Alveolar Proteinosis in a Patient with Neurodevelopmental Disease

We report a unique case of coexistingexogenous lipoid pneumonia, endogenous lipoid pneumonia (EU), and pulmonary alveolar proteinosis (PAP) in a 5-year-old patient with severe neurodevelop mental disease. The patient presented with gastroesophageal reflux and presumed chronic lung disease resulting from recurrent aspiration pneumonias and succumbed to respiratory failure. The autopsy showed lipid-laden macrophages and periodic acid-SchiJf9ositive granular matm'al i n alveolar spaces and multilamellated structures within both alveolar macrophages and extracellular debris.

These findings were similar to those in previous reports of coexisting E I P and PAP in the setting of gastroesophageal refux [I] . However, the present case diJfered by the presence of scattered large osmiophilic extracellular lipid vacuob. Besides strengthening the association between EIP and PAP and their relationship to gastroesophageal refux, this case suggests that t h q may arise together with exogenous lipoid pneumonia, through related mechanisms, in the setting of neurodevelopmental disease.     

大鼠肺微血管和肺泡铸型的扫描电镜观察

用扫描电镜观察以甲基丙烯酸甲酯灌注鼠的肺微血管和肺泡。胸膜下毛细血管较稀疏,网孔粗大。毛细血管部分成锐角折返,亦可见毛细血管盲端。肺泡隔毛细血管均成扁平状膨大,且相互吻合成单层密集网。肺泡铸型为大小不等、不规则的多面体,表面可见肺泡Ⅱ型细胞核之压迹。两肺泡之间可见呈桥式连接的肺泡孔,亦可见部分呈三通管样相连。     

类风湿性关节炎的肺部表现

本文对30例类风湿性关节炎患者中合并肺部损害的6例患者进行报道。其肺部的主要临床表现为胸痛、咳嗽、气短、长期低热及呼吸困难。体征主要为肺部干湿性罗音及胸膜摩擦音。胸部X线检查可见胸腔积液、胸膜肥厚粘连，弥漫性间质性肺纤维化、间质性肺炎。实验室检查可有嗜酸性粒细胞增高、类风湿因子阳性、血沉增快、免疫球蛋白增高等。本文并对类风湿性关节炎合并肺部病变的发生机理进行了初步探讨。     

Analysis of 23 cases of pulmonary cryptococcosis

Pulmonary cryptococcosis (PC) is a subacute or chronic pulmonary fungitis caused hy Cryptococcus neoformans.Because of no specific clinical symptoms or manifestaions in chest radiographs, misdiagnosis is common. Between January 1980 and january 2004, 23 eases of PC were diagnosed by pathological examinations in our hospital and the clinical data were retospectively analyzed to inprove the diagnosis of PC.     

股骨颈骨折并发肺栓塞1例

1 病例资料 患者,女,70岁.因跌伤致右髋部疼痛7 d,于2007年2月1日入院.既往有高血压和糖尿病史.入院查体:BP 21.9/12.3 kPa,神志清醒,说话流利,心、肺、腹未见异常.右下肢外旋短缩畸形,右髋有压痛及纵向叩击痛,双下肢无明显肿胀,Homans征阴性.     

Recurrence of left atrium-pulmonary vein conduction following successful disconnection in asymptomatic patients.

BACKGROUND: The clinical significance of conduction recurrences in isolated pulmonary veins of patients with atrial fibrillation is not established. METHODS: Twenty-two patients with paoxysmal atrial fibrillation underwent successful pulmonary vein isolation. Six months after the procedure, 14 patients were free of atrial fibrillation. Two of these patients were subjected to repeat mapping of the left superior pulmonary vein. RESULTS: There was recurrence of pulmonary vein to left atrium conduction despite complete lack of symptoms or evidence of recurrent atrial fibrillation. CONCLUSION: Successful pulmonary vein isolation with abolition of paroxysmal atrial fibrillation does not confer permanent disconnection of the pulmonary vein musculature from the left atrium.