Effects of Liandou Qingmai Recipe(连豆清脉方) on Endothelin-1,Nitric Oxide,Interleukin-6 and Interleukin-10 Levels in Patients with Coronary Heart Disease

Objective:To observe effects of Liandou Qingmai Recipe(连豆清脉方) on endothelin-1(ET-1),nitric oxide(NO),interleukin-6(IL-6) and IL-10 levels in patients with coronary heart disease.Methods:Total 101 cases with coronary heart disease were randomly divided into a treatment group(n=45) treated by Liandou Qingmai Recipe and a standard treatment group(control group,n=56),with a normal group of 16 health persons set up.Changes of ET-1,NO,IL-6 and IL-10 levels were measured before treatment and after treatment for two weeks.And the data were analyzed by SPSS 16.0 statistic software.Results:Before treatment,the levels of ET-1,IL-6 and IL-10 levels were significantly higher and NO was significantly lower in the patients with coronary heart disease than those in the normal group(90.7±12.7 ng/L vs 41.8±13.5 ng/L,9.17±0.18 ng/L vs 1.10±0.08 ng/L,1.94±0.26 ng/L vs 1.09±0.06 ng/L,and 92.2±17.7 μmol/L vs 124.5±27.2 μmol/L;all P<0.05),with no significant differences in the levels of ET-1,NO,IL-6 and IL-10 between the treatment group and the control group(P>0.05);After treatment,ET-1 and IL-6 significantly decreased in the treatment group and the control group,and NO increased in the treatment group;And IL-6 level was significantly lower and NO level was higher in the treatment group than those in the control group(4.48±1.22 ng/L vs 5.13±1.85 ng/L,117.4±22.3 μmol/L vs 92.4±17.1 μmol/L;both P<0.05);There was a positive correlation between IL-6 and IL-10,and a negative correlation between NO and IL-10(r=0.142,r=-0.152;both P<0.05).Conclusion:Liandou Qingmai Recipe can decline IL-6,IL-10 and ET-1 levels,and raise NO level in patients with coronary heart disease on the basis of standard treatment,so as to inhibit endothelial inflammatory response,improve vascular endothelial function,with stronger anti-AS action;And vascular endothelial lesion is related with inflammatory response.     

Plasma Homocysteine and Gene Polymorphisms Associated with the Risk of HyperUpidemia in Northern Chinese Subjects

Objective To examine the relationship between occurrence of hyperlipidemia, plasma homocysteine and polymorphisms of methylenetetra hydrofolate reductase （MTHFR） gene and methionine synthase （MS） gene. Methods A total of 192 hyperlipidemia patients were selected and divided into hypercholesterolemia group, hypertriglyceridemia group, and combined hyperlipidemia group. Another 208 normal individuals were selected as control. Total plasma homocysteine （tHcy） concentration was measured by high-performance liquid chromatography （HPLC）. Lipid profiles were measured for all subjects The polymorphisms of MTHFR gene C677T and MS gene A2756G were analyzed by PCR-RFLP. Results The tHcy concentration in the combined hyperlipidemia patients was significantly higher than that in the control （15.95μmol/L vs 13.43 μmol/L, P〈0.05）. The prevalence of hyperhomocysteinemia （HHcy） in the combined hyperlipidemia group was significantly higher than that in the control （42.2% vs 23.0%, P=0.015）, with the odds ratio （OR） of 3.339 （95%CI： 1.260-8.849）. The hyperlipidemia patients with HHcy had a higher concentration of total cholesterol （TC） than that in the normal tHcy patients （5.67±0.95 mmol/L vs 5.47±0.92 retool/L, P=0.034）. There was no significant difference in genotype or allele frequencies of MTHFR C677T between the hyperlipidemic and control groups. The hyperlipidemia patients with MTHFR CT/TT genotype had a higher concentration of triglyceride （TG） than those with CC genotype （2.24±1.75 mmol/L vs 1.87±0.95 mmol/L, P〈0.05）. Individuals with CT/TT genotype had a higher concentration of tHcy than those with 677CC genotype both in the hyperlipidemia group （12.61±1.24μmol/L vs 11.20±1.37 μmol/L, P〈0.05） and in the control group （14.04±1.48 μmol/L vs 12.61±1.24 μmol/L, P〈0.05）. The percentage of MS 2756 GG/AG genotype in the combined hyperlipidemia group was significantly higher than that in the control （26.7% vs 13.0%, P=0.012）, with the OR of 3.     

Effect of electroacupuncture preconditioning on serum S100β and NSE in patients undergoing craniocerebral tumor resection

Objective：To investigate the effect of electroacupuncture preconditioning on the serum level of S100 calcium-binding protein beta（S100β）and neuron-specific enolase（NSE）in patients undergoing craniocerebral tumor operation.Methods：A total of 32 patients,who would go through craniocerebral tumor resection under general anesthesia,were randomly assigned to two groups,16 in each group.Patients in the electroacupuncture（EA）group received electroacupuncture on Fengfu acupoint（Du16）and Fengchi acupoint （GB20）for 30 min,2 h before operation.The stimulus is 1-4 mA with a density wave frequency of 2/15 Hz. Patients in the control group received no pretreatment.Anesthesia was maintained with remifentanil at the dose of 4-8 mg/kg per hour,pumped intravenous drip of vecuronium at 1.0-2.0μg/kg each hour,and discontinuous intravenous dripped with vecuronium bromide at 0.5-1 mg.The serum levels of S100βand NSE were measured with ELISA before operation,before skin incision,after tumor removal,at the end of operation,and at 24 h after operation.Results：The serum level of S100βand NSE did not change before skin incision.The serum level of NSE increased significantly and the level of S100βincreased insignificantly after the tumor resection. The serum levels of S100βand NSE in the EA group and the control group were 1.16±0.28μg/L vs 1.47±0.33μg/L,24.7±13.3μg/L vs 31.4±14.1μg/L at the end of the operation,respectively.Twenty-four h after operation,the correspondence indices were 1.18±0.31μg/L vs 1.55±0.26μg/L,and 25.5±12.4μg/L vs 32.4±11.7μg/L.The two indices at these two time points were significantly increased than those before operation, respectively（P〈0.05）.At the end of the operation and 24 h post-operation,the serum levels of S100βand NSE in the EA group were significantly lower than those in the control group（P〈0.05）.Conclusion：Electroacupuncture Fengchi and Fengfu for 30 min before craniocerbral tumor operation could decrease the serum level of S100βand NSE,thus may have potential protective effect on brain damage,which needs to befurther studied.     

Microinflammation is involved in the dysfunction of arteriovenous fistula in patients with maintenance hemodialysis

Background Vascular access （VA） dysfunction is a major clinical complication in the hemodialysis population and has a direct effect on dialysis outcome. This study was conducted to explore the role of microinflammation in the VA dysfunction in maintenance hemodialysis patients.
Methods Forty-seven patients （male 35 and female 12） receiving maintenance hemodialysis were included for this study. They were divided into three groups： group 1 （n=15）, patients with initial hemodialysis and new arteriovenous fistula （AVF）; group 2 （n=18）, patients treated with hemodialysis for long term with well-functional VA; group 3 （n=14）, maintenance hemodialysis patients with VA dysfunction. Biochemical parameters and serum tumor necrosis factor-α （TNF-α）, interleukin 6 （IL-6） and monocyte chemoattractant protein-1 （MCP-1） were determined. High-sensitivity C-reactive protein （hs-CRP） was determined by latex-enhanced immuno-nephelometric method. Tissues of radial artery were taken from group 1 and group 3 for the histological study. Expression of CD68 and MCP-1 in the radial artery was determined by immunohistochemistry.
Results Serum hs-CRP in group 3 was significantly higher than those in group 1 and group 2 （（7.40±2.42） mg/L vs （4.21±1.62） mg/L and （5.04±3.65） mg/L, P 〈0.01 and P 〈0.05, respectively）. Serum TNF-α in group 3 was significantly higher than those in group 1 and group 2 （（64.03±9.29） pg/ml vs （54.69±12.39） pg/ml and （54.05±7.68） pg/ml, P 〈0.05 and P 〈0.01, respectively）. Serum IL-6 in group 3 was also significantly higher than those in group 1 and group 2 （（70.09±14.53） pg/ml vs （56.43±10.11） pg/ml and （60.77±9.70） pg/ml, P 〈0.01 and P 〈0.05, respectively）. Patients in group 3 had a thicker internal layer of vessels than in group 1 （（0.356±0.056） mm vs （0.111±0.021） mm, P 〈0.01）. Expression of CD68 and MCP-1 in the fistula vessel walls in group 3 were much higher than those in group 1     

Effects of activated protein C on coagulation and fibrinolysis in rabbits with endotoxin induced acute lung injury

Background Sepsis induced acute lung injury （ALI） as a common syndrome in clinical practice has a high mortality. Recombinant human activated protein C （APC） can significantly reduce the mortality of patients with severe sepsis. Several studies have implicated that APC may be protective in ALI. Methods Twenty-one rabbits were operatively prepared and randomly divided into sham, control, or APC groups （n=7 in each group）. After a tracheotomy had been performed, ALI was produced in the control and APC groups by infusion of Escherichia coil endotoxin 100 μg/kg per hour intravenously for 1 hour. The sham group received only the vehicle, infusion of 20 ml of 0.9% saline. The rabbits were studied under anesthesia for 6 hours and were ventilated with 40% oxygen. Bovine APC （25 μg·kg^-1·h^-1） was intravenously administered. The infusion was initiated half an hour post-injury and lasted for 4 hours. The animals were resuscitated with Ringer＇s lactate solution. Results In comparison with nontreatment in the control group, the infusion of APC significantly reduced the increase of thrombomodulin level （TM; control group was （0.68±0.06） ng/ml, vs APC group of （0.62±0.07） ng/ml at 6 hours, P 〈0.05）, and significantly attenuated the fall in protein S （PS; control group was （2.32±0.03） μg/ml at 2 hours, （2.24±0.06） μg/ml at 4 hours and （2.21±0.09）μg/ml at 6 hours, vs APC group （2.46±0.04） μg/ml at 2 hours, （2.40±0.05） μg/ml at 4 hours and （2.39±0.07） μg/ml at 6 hours, P 〈0.01）. In addition, APC limited the increase in plasminogen activator inhibitor-1 （PAI-1） both in plasma （control group was （0.68±0.12） ng/ml at 1 hour, （0.84±0.06） ng/ml at 2 hours, （0.87±0.08） ng/ml at 4 hours and （0.91±0.05） ng/ml at 6 hours, vs APC group （0.42±0.16） ng/ml at 1 hour, （0.43±0.04） ng/ml at 2 hours, （0.45±0.09） ng/ml at 4 hours and （0.45±0.14） ng/ml at 6 hours, P 〈0.01） and in bronchoalveolar lavage fluid （at 6 hour     

Effects of kadsurenone on the systemic inflammatory response in rat model of acute pancreatitis

Objective： To study the effects of kadsurenone on inflammatory mediators Platelet-activating factor （PAF）, tumor necrosis factor-α（TNF-α） and interleukin-6（IL-6） in rat model of acute pancreatitis（AP）. Methods： SD male rats （104） were randomly divided into sham group （n = 24）, AP group （n = 40） and kadsurenone group （n = 40）. The rats were killed 3, 6, 12 and 24 hours after operation. The serum level of PAF, TNF-α and IL-6 was measured. Results： The serum level of PAF, TNF-α and IL-6 of AP group was significantly increased（P 〈 0.01 ）compared with control group. The serum level of TNF-α got to a peak 6 hours after operation, and the serum IL-6 getting to a peak 12 hours after operation in AP group. After kadsurenone was administered to AP rats, pancreas and lung myeloperoxidase （MPO）, serum amylase activity was reduced. Histology showed a trend toward improvement. The serum level of PAF, TNF-α and IL-6 was significantly decreased （P 〈 0.05）. Conclusion. Kadsurenone can reduce the severity of systemic inflammation in rats with AP and relieve the damage of the pancreas and lung in AP rats. These results suggested that kadsurenone may be useful in the treatment of acute pancreatitis.     

Antithrombin-III without concomitant heparin improves endotoxin-induced acute lung injury rats by inhibiting the activation of mitogen-activated protein kinase

Background Antithrombin-Ⅲ （AT-Ⅲ）, the major inhibitor of thrombin in plasma, also has anti-inflammation property and might have positive effect on sepsis. The present study aimed to investigate the effects of AT-Ⅲ on inflammatory reaction and pulmonary protection in endotoxin-induced acute lung injury （ALI） rat. Methods Sixty male Sprague-Dawley rats were randomly assigned equally to normal control group, ALl group, AT-Ⅲ treatment group, AT-Ⅲ＋heparin treatment group, and heparin treatment group. The pulmonary vascular permeability index （PVPI） was measured by single nuclide tracer technique. The activity of AT-Ⅲ in plasma was determined by the method of synthetic chromogenic substrata. Tumor necrosis factor-a （TNF-a） and interleukin-6 （IL-6） levels in serum were determined by enzyme-linked immunosorbent assay. The expressions of lung tissue mitogen-activated protein kinases （ERK1/2, P38 and JNK MAPK） were determined by Western blotting. Results Rats had significantly improved lung histopathology in the AT-Ⅲ treatment group and heparin treatment group compared with the ALl group, The PVPI of the ALl group was 0.38±0.04, significantly higher than that of the normal control group （0.20±0.02, P 〈0.01）, AT-Ⅲ treatment group （0.30±0.04, P 〈0.01） and heparin treatment group （0.28±0.04, P 〈0.01） respectively. There were no significant differences of PVPI in the ALl group and AT-Ⅲ＋heparin treatment group. The activity of AT-Ⅲ in plasma in the ALl group was （76±8）%, significantly lower than that of the normal control group （（96±11）%, P 〈0.05） and AT-Ⅲ treatment group （（105±17）%, P 〈0.05） respectively. The serum levels of TNF-α and I L-6 of the ALl group were （2.770±0.373） μg/L and （1.615±0.128） ng/ml respectively, significantly higher than those of the normal control group （0.506±0.093） μg/L and （0.233±0.047） ng/ml respectively, all P 〈0.01）, AT-Ⅲ treatment group （（1.774±0.218） pg/L and （1.140±0145） ng/ml respectively, all P 〈0.01） and heparin treatment group （（1.924±0.349） μg/L and （1.223±0.127） ng/ml respectively, all P 〈0.01）. The lung tissue levels of phospho-ERK1/2 and phospho-P38 MAPK expressions were markedly higher in the ALl group than in the normal control group, AT-Ⅲ treatment group and heparin treatment group respectively. Conclusions AT-Ⅲ without concomitant heparin inhibited the activation of ERK1/2 and P38 MAPK, down-regulated the levels of downstream cytokines TNF-a and IL-6, relieved endothelial permeability, and improved the ALl in endotoxin-induced rats. It might be helpful to administrate AT-Ⅲ alone, not with concomitant heparin, to those patients with ALl and sepsis.     

Effect of Shengmai injection (生脉注射液) on vascular endothelial and heart functions in patients with coronary heart disease complicated with diabetes mellitus

Objective： To study the effect of Shengmai injection （生脉注射液, SMI） on vascular endothelial and heart functions in coronary heart disease patients complicated with diabetes mellitus （CHD-DM）. Methods： One hundred and twenty patients with CHD-DM, their diagnosis confirmed by coronary arteriography, were equally randomized into a control group treated with conventional treatment and a treated group treated with conventional treatment plus SMI. The changes in blood levels of nitric oxide （NO）, endothelin-1 （ET-1） and angiotensin Ⅱ （Ang Ⅱ）, as well as endothelium-dependent vascular dilating function and heart function in the patients were observed before treatment and after the 3-week treatment. Results： After being treated with SMI for 3 weeks, in the treated group, blood level of NO was raised significantly from 69.8±33.1 μmol/L to 120.1±50.8μmol/L, and ET-1 was lowered from 70.1±32.1 ng/L to 46.2±21.3 ng/L, respectively （P〈0.01）; that of Ang Ⅱ was lowered from 81.3±24.3 ng/L to 50.2±27.3 ng/L （P〈0.01）; brachial arterial post-congestion blood flow increasing rate was raised from 389.4±26.3% to 459.3±27.8% （P〈0.01）; and the improvement in heart function as seen through the ejection fraction （EF） was increased from 44±5% to 68±6% （P〈0.01）, all the changes being more significant than those in the control group （all P〈0.01）. Conclusion： SMI can improve not only the endothelial function in CHD-DM patients, but also heart contraction significantly.     

Prognostic value of serum galactomannan index in critically ill patients with chronic obstructive pulmonary disease at risk of invasive pulmonary aspergillosis

Background Critically ill chronic obstructive pulmonary disease （COPD） patients admitted to an intensive care unit （ICU） due to respiratory failure are at particularly high risk of Aspergillus infection.The serum galactomannan index （GMI） has proven to be one of the prognostic criteria for invasive pulmonary aspergillosis （IPA） in classical immunocompromised patients.However,the prognostic value of serum GMI in critically ill COPD patients needs evaluation.The purpose of this study is to investigate the prognostic value of serum GMI in patients with severe COPD.Methods In this single-center prospective cohort study,serum samples for GMI assay were collected twice a week from the first day of ICU admission to the day of the patients＇ discharge or death.Patients were divided into two groups according to their clinical outcome on the 28th day of their ICU admission.Univariate analysis and survival analysis were tested in these two groups.Results One hundred and fifty-three critically ill COPD patients were included and were divided into survival group （106 cases） and non-survival group （47 cases） according to their outcome.Univariate analysis showed that the highest GMI level during the first week after admission （GMI-high 1st week） was statistically different between the two groups.Independent prognostic factors for poor outcome in severe COPD patients were：GMI-high 1st week ＞0.5 （RR：4.04,95％ CI：2.17-7.51） combined with accumulative dosage of corticosteroids ＞216 mg before the RICU admission （RR：2.25,95％ CI：1.11-4.56） and clearance of creatinine （Ccr） ＜64.31 ml/min （RR：2.48,95％ CI：1.22-5.07）.Conclusions The positive GMI-high 1st week （＞0.5） combined with an accumulative dosage of corticosteroids ＞216 mg before the ICU admission and a low Ccr may predicate a poor outcome of critically ill COPD patients.     

Catheter ablation of paroxysmal atrial fibrillation in a young patient with a partial anomalous pulmonary venous connection

It has been demonstrated that pulmonary veins （PV）play an important role in the initiation and perpetuation of paroxysmal atrial fibrillation （PAF）.1-5 Therefore, PV isolation has become the cornerstone for catheter ablation in the majority of these AF patients.3-5 In addition, ectopic foci in the non-PVs areas, such as superior vena cava（SVC）,     

Potential biomarkers predicting risk of pulmonary hypertension in congenital heart disease: the role of homocysteine and hydrogen sulfide

Background Pulmonary hypertension （PH） is a common complication of congenital heart disease （CHD）.Although risk stratification is vital for prognosis and therapeutic guidance,the need for understanding the role of novel biomarkers cannot be overlooked.The aim of the present study was to investigate the changes of homocysteine and hydrogen sulfide levels and find potential biomarkers for early detection and treatment.Methods Between September 2012 and April 2013,we prospectively collected data on 158 pediatric patients with left to right shunt CHD at our institution.Standard right heart catheterizations were performed in all cases.Seventy-seven cases were associated with PH.The levels of homocysteine and hydrogen sulfide were detected with fluorescence polarization immunoassay and a sensitive silver-sulphur electrode,respectively.Enzyme-linked immunosorbent assay was used to determine the expression of methylenetetrahydrofolate reductase （MTHFR）,cystathionine β-synthase （CBS）,and cystathionine gamma-lyase （CSE）.Radioimmunoassays were used to obtain folic acid and vitamin B12 levels.Results The difference in the levels of homocysteine,folic acid,vitamin B12,hydrogen sulfide,as well as the MTHFR and CSE expression between patients with PH and without PH were statistically significant （all P ＜0.05）.Homocysteine had the best sensitivity and specificity to predict PH （P ＜0.001）.Subgroup analysis showed that the levels of homocysteine and hydrogen sulfide,and the expression of CSE and MTHFR between patients with dynamic and obstructive PH were significantly different （all P ＜0.05）.Based on the ROC curve,homocysteine had the best sensitivity and specificity to predict obstructive PH （P=0.032）,while CSE had the most significant sensitivity and specificity to predict the dynamic PH （P=0.008）.Conclusions Increased levels of homocysteine and decreased levels of hydrogen sulfide were significantly negatively correlated in PH associated with CHD.The underlying mechanism involved the decreased expression of MTHFR and CSE along with vitamin B12 deficiency.Homocysteine and hydrogen sulfide are potential biomarkers to predict PH.     

Basic and clinical research into chronic obstructive pulmonary

Chronic obstructive pulmonary disease （COPD）, one of the most common public health problemsworldwide, is the fourth leading cause of death in the world. In China, respiratory diseases （of which COPD is a major component） are the third leading cause of death in rural areas and the fourth leading cause of death in urban area, accounting for 1 million deaths and over 5 million disabilities each year. COPD ranks first among the burdens in China.1 Hence, medical workers and governments at different levels pay close attention to this disease~ The Respiratory Group under the Chinese Medical Association published the Guidelines for Diagnosis and Management of COPD in 2002^2 and the revised version in 2007^3. This publication serves as a milestone of the development of basic and clinical investigation in China. The guidelines are likely to affect the way for the treatment of COPD in addition to reflect the current knowledge about the underlying causes of COPD and recommend the proper diagnosis and management of COPD.     

Correlation of D-dimer level with the radiological severity indexes of pulmonary embolism on computed tomography pulmonary angiography

Background It is known that the main role of D-dimer has been as an exclusionary test in patients with suspected venous thromboembolism.However,the D-dimer is increasingly beginning to find clinical utility as a marker in the evaluation of the extent of the embolic disease.The aim of the study was to determine whether D-dimer levels predict the radiological markers of pulmonary embolism （PE） severity using Mastora score.Methods This prospective study involved 69 patients with acute PE proved by computed tomography pulmonary angiography （CTPA）.The D-dimer level was noted.A pulmonary artery obstruction index （PAOI; Mastora score） ≥21.3% indicated severe obstruction of PE.A right ventricle/left ventricle （RV/LV） ratio 〉0.9 indicated RV dysfunction.Results The median D-dimer level and PAOI were 765 μg/L （95% C/：750-1 205 μg/L） and 16.77% （95% CI：16.32%-23.06%）,respectively.The D-dimer level was positively correlated with PAOI （r=0.417,P 〈0.000 1）.PAOI ≥21.3% was associated with high D-dimer levels （median,993 μg/L （95% C/：856-1 841 μg/L）,Z=-2.991,P=0.003）.The D-dimer level was correlated with the RV/LV ratio （r=0.272,P=0.024）.RV/LV ratios 〉0.9 were associated with high D-dimer levels （median,880 μg/L （95% CI：764-1 360 μg/L）,Z=-2.070,P=0.038）.PAOI was positively correlated with the RV/LV ratio （r =0.390,P=0.001）.After three months,both the PAOI and D-dimer levels decreased （Z=-7.009,P 〈0.000 1; Z=-6.976,P〈0.000 1,respectively）.Conclusion D-dimer levels are positively correlated with PE burden and right ventricle dysfunction on CTPA,and can help monitor the therapeutic response.     

Unique association of adiponectin isoforms with serum cytokines and redox molecules in patients with chronic obstructive pulmonary disease

In serum,adiponectin can exist as either full-length form that can form trimers,hexamers and high molecular weight (HMW) multimers,or as globular adiponectin (gAd).Adiponectin-deficiency leads to an increase in proinflammatory mediators and an emphysemalike phenotype,1 also protects against tobacco-induced inflammation and the increased emphysema.2 The mechanism underlying this apparent paradox remains unclear.We therefore analyzed serum levels of adiponectin isoforms,thioredoxin (Trx)/thioredoxin reductase (TrxR) activity,tumor necrosis factor (TNF)-α,IL-6and 4-hydroxynonenal (4-HNE) in patients with chronic obstructive pulmonary disease (COPD) and in control individuals.     

Symptomatic pulmonary lipiodol embolism after transarterial chemoembolization for hepatic malignant tumor: clinical presentation and chest imaging findings

Background Pulmonary lipiodol embolism after transarterial chemoembolization （TACE） was rare and life-threatening,occasionally reported in previous literatures.We aimed to review the records of 11 patients with pulmonary oily embolism and analyze their characteristics of radiographic findings and risk factors.Methods Records of 478 consecutive patients who underwent 1 026 percutaneous TACE procedures were retrospectively analyzed.Eleven cases with respiratory symptoms were identified as having symptomatic pulmonary lipiodol embolism after TACE.Data of these patients,including clinical presentation,techniques of TACE,imaging features of tumor and chest imaging findings,were assessed.Results Eleven （2.3%） of 478 consecutive patients who underwent percutaneous TACE procedures had a pulmonary oily embolism after procedures.The mean size of target tumors embolized was （13.6＆#177;2.0） cm.All were hyper-vascular.The mean volume of lipiodol was （21.8＆#177;8.2） ml.Pulmonary oily embolisms were revealed within 12-48 hours after TACE.The most severe respiratory symptoms and imaging abnormalities of the eight patients who survived presented between 2 and 5 days after TACE,becoming normal between 12 and 35 days after TACE.Three patients died.Chest CT revealed retention of radiopaque lipiodol in lungs.Conclusions Pulmonary lipiodol embolism occurs easily in patients who have large hyper-vascular hepatic malignant tumor.The high-density lipiodol deposition in the lung field can be used as diagnostic feature.     

Interleukin-32, not reduced by salmeterol/fluticasone propionate in smokers with chronic obstructive pulmonary disease

Background The interleukin （IL）-32/tumor necrosis factor （TNF） a pathway is supposed to play a key role in the amplification of the immune response in chronic obstructive pulmonary disease （COPD） inflammation. Inhaled corticosteroids （ICS） in combination with long-acting I]2-agonists （LABA） have shown airway anti-inflammatory effects in recent studies, but the mechanism is still uncertain. Methods Patients were treated in a randomized, open-labeled, parallel group clinical trial with either a combination of salmeterol xinafoate/fluticasone propionate （SF; Seretide, GlaxoSmithKline） Diskus （50/500 pg twice daily） or ipratropium bromide/salbutamol （IS; Combivent, Boehringer Ingelheim） MDI （42 IJg/240 IJg quartic daily） for 12 weeks. At the start and the end of treatment, induced sputum was collected and the concentration of IL-32 and TNF-a, the number of neutrophUs and eosinophils were measured. Results Following 12 weeks of treatment, a statistically significant fall from baseline in the concentration of TNF-a in sputum （P=0.004） was seen after treatment with SF but not with IS. However, neither treatment had significant effects on the concentration of IL-32 in sputum. There was a decrease from baseline in the number of sputum neutrophils with SF that approached statistical significance （P=0.028） but not with IS, while the number of sputum eosinophils did not change significantly from baseline in either treatment group. There was a statistically significant decline from baseline in the quality of life as assessed by the St George＇s respiratory questionnaire in both the SF （P=0.004） and IS （P=0.030） treatment groups, but no evidence of improvement in lung function was observed in either group. Conclusion The sputum TNF-a and neutrophils, but not IL-32 and macrophages, could be reduced by ICS/LABA treatment, suggesting that IL-32 could be involved in the corticosteroid resistance of COPD inflammation.     

Determinants of health-related quality of life worsening in patients with chronic obstructive pulmonary disease at one year

Background Chronic obstructive pulmonary disease （COPD） is a major cause of morbidity and mortality worldwide and has been the leading cause of death in China.Patients with COPD have significant decrements in their health-related quality of life （HRQL）.It is necessary to identify the factors involved in worsening HRQL in order to improve the HRQL of COPD patients.However,evidence from longitudinal studies is limited.The aim of the study was to evaluate the determinants of the deterioration of HRQL in patients with COPD.Methods At baseline,a total of 491 patients with stable COPD received comprehensive assessments,including psychosocial and clinical variables,six minutes walk distance （6MWD）,dyspnea grade measured by the 5-grade Medical Research Council （MRC） dyspnea scale,anxiety and depression measured by the hospital anxiety and depression scale and HRQL measured by St.George＇s Respiratory Questionnaire （SGRQ）.Patients were then monitored monthly for 12 months to document COPD exacerbations.At the end of the study period,the SGRQ values were reassessed.A 1-year change in SGRQ total score ≥4 was defined as a deterioration of the HRQL and as the outcome.A total of 450 patients completed the 12-month follow-up and were analyzed in the present study.Results The age （mean±SD） was （65.0±10.6） years and 68.7％ of subjects were men.The deterioration of the HRQL was 26.4％.In multivariate Logistic regression,independent and graded associations were found between the baseline MRC dyspnoea grade and the deterioration of HRQL （P=0.012）,OR 3.03 （95％ CI 1.11-8.24） for patients with MRC dyspnoea grade ≥4 versus patients with MRC dyspnoea grade =1.Similarly,the number of exacerbations during the follow-up was independently and gradually increased with the deterioration of HRQL （P ＜0.001）,OR 3.03 （95％ CI 1.9-5.6） for the participants with exacerbations ≥3 versus participants with no exacerbation.The 6MWD evaluated by quartiles was negatively associated with the deterioration of HRQL with borderline statistical significance.Conclusion MRC dyspnea grade and the number of exacerbations impair the HRQL of patients with COPD.     

Association between body mass index and pulmonary function of patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease （COPD） is a major cause of chronic morbidity and mortality throughout the world. It is a preventable and treatable disease with significant extra pulmonary effects that may contribute to the severity in individual patients. It is characterized by airflow limitation that is not fully reversible. The diagnosis of COPD should be confirmed by spirometry. Body mass index （BMI） is an important indicator that can well reflect nutritional status of patients, and low BMI is an independent risk factor for mortality in patients with COPD.