Increasing awareness of recognition of chronic obstructive pulmonary disease

The medical community should, by now, be well aware of the importance of chronic obstructive pulmonary disease （COPD）, an increasingly common condition with high morbidity and mortality. In modern terms, COPD has come to signify concurrent chronic bronchitis, asthmatic bronchitis and emphysema. Cigarette smoking has long been recognized as the predominant aetiological agent. Arterial hypoxaemia, a frequent complication of COPD, can lead to pulmonary hypertension and cor pulmonale. COPD affects over 5% of the adult population and is the only major cause of death whose morbidity and mortality are increasing in several countries. In China, it is difficult to quantify how many people are affected with COPD. However, a recent epidemiological survey indicated that COPD prevalence was 8.2% in China. COPD prevalence in men was significantly higher than in women （12.4% cf 5.1%）. The prevalence in rural areas was higher than that in urban areas （8.8% cf 7.8%）. Of patients with COPD, 61.5% were smokers. The report also stated that COPD is the major cause of death in rural areas in China and the fourth leading cause of death in urban areas, rising to the third leading cause of death by 2020. The prevalence of the disease increases with age with highest rates seen in people over the age of 70 years. COPD is the only major cause of mortality with a rising incidence and prevalence worldwide, rendering it an increasingly worrisome.     

Corticosteroid resistance in chronic obstructive pulmonary disease: new uses of theophylline

Chronic obstructive pulmonary disease (COPD) is a major global health problem with a rising morbidity and mortality,which is expected to account for about 27％ of tobacco related deaths and is anticipated to move from the fifth to the fourth leading cause of death worldwide from 2002 to 2030.1 COPD is characterized by the abnormal and chronic inflammation induced by cigarette smoking and other inflammatory insults in both small airway and lung parenchyma.2,3 Glucocorticosteroids (also called glucocorticoids,corticosteroids or steroids) are the most effective anti-inflammatory drugs available for the treatment of many chronic inflammatory and immune diseases.4 However,corticosteroids have limited benefit in treating stable COPD5 defined as (relative) steroid insensitivity or resistance6 and may be characteristic of all phenotypes of COPD.Although anti-inflammatory treatments are expected to effectively treat inflammation of COPD,almost all anti-inflammatory approaches risk increasing the extent of infection by blunting host defence mechanisms.Their effectiveness in humans has been limited by various side effects.5 Therefore,it is important to develop a treatment to enhance corticosteroid anti-inflammatory action in COPD.     

Loeffler endocarditis: magnetic resonance imaging features of pre- and post-operation

Loeffier endocarditis is clinically presented as restrictive cardiomyopathy, which is the least common of the three major categories of cardiomyopathic disorders.1 The endomyocardial fibrosis was considered as its main pathophysiologic changes.24 Generally speaking, the characteristics include thickening of the apex and inflow tracts of one or both ventricles, and the papillary muscle and chordae tendineae also can be involved in some cases.     

Combined inhibition of proteasome and autophagy：A novel cancer therapeutic approach

1 Proteasome inhibitors in cancer therapy The ubiquitin-proteasome system is a major degradation system for short-lived proteins. Proteins to be degraded are labeled with ubiquitin, and the ubiquitinated proteins are degraded by the 26S proteasome complex. The degradation is thus specifically targeted to a fraction of proteins. Prompt removal of these proteins is critical to the precise and timely regulation of intracellular signaling involved in multiple cellular processes, including cell proliferation and cell death.     

A dangerous combination: tuberculosis and chronic obstructive pulmonary disease

Both chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis are leading causes of morbidity and mortality,and therefore the most important challenges to public health in China.A large,populationbased survey showed that the prevalence of COPD was 8.2％ (men,12.4％;women,5.1％) in adults 40 years of age or older,1 and even higher in Chinese rural areas where biomass fuels are the main sources of energy for cooking,heating,and other household needs in poorly ventilated dwellings.2 Under-diagnosis and under-treatment of COPD in these areas was another serious concern.2 It is also notable that pulmonary tuberculosis is highly prevalent in rural areas,which may share common risk factors with COPD.A systemic review by Lin et al3 showed that smoking was also an independent risk factor for tuberculosis and suggested a positive association between indoor air pollution and the disease.Cigarette smoking is the leading risk factor for COPD,but the prevalence of COPD in non-smokers is as high as 6.6％,and it is estimated that 25％-45％ COPD patients are neversmokers.4 Biomass fuel and occupational exposure are two major risk factors in never-smokers,and accumulating evidence suggests that tuberculosis is another significant risk factor for COPD.Facing the colliding epidemics of tuberculosis,tobacco smoking and COPD in developing countries,5 it is of urgent need to address the impact of tuberculosis on COPD,as well as the risk of tuberculosis in COPD patients.     

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.     

Rational radical neck dissection for oral cancer

Lymphatic metastasis is the most commonly seen route for the spread of malignant epithelial tumors. Oral cancers derived from epithelial tissue occur more often in the head and neck regions with a high lymphatic metastasis rate. According to reports from Chinese researchers, the lymphatic metastasis rate of oral cancer could be as high as 40%, and clearing those involved lymph nodes in neck is one of the most important methods to treat the disease.     

Rational radical neck dissection for oral cancer

Lymphatic metastasis is the most commonly seen route for the spread of malignant epithelial tumors. Oral cancers derived from epithelial tissue occur more often in the head and neck regions with a high lymphatic metastasis rate.According to reports from Chinese researchers, the lymphatic metastasis rate of oral cancer could be as high as 40%, and clearing those involved lymph nodes in neck is one of the most important methods to treat the disease.     

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.     

A case of isolated hepatic actinomycosis causing right pulmonary empyema

The clinical picture of actinomycosis was first described in 1878.Actinomycosis agents are found in the natural flora of the oral cavity, upper gastrointestinal system and female genital systems. Actinomyces israelii is usually responsible for the infections and causes chronic suppurative and granulomatous infections. The most common disease form is cervicofascial infection. Liver is involved in 5% of all actinomycosis infections. Liver involvement secondary to any primary infection site in the abdomen frequently occurs. In 15% of abdominal infections the liver is also involved. However, in very rare cases, a primary focus cannot be found, and these cases are called primary or isolated hepatic actinomycosis （IHA）. IHA which is frequently seen as a solitary abscess can be confused with a malignancy both clinically and radiologically.     

Detection of plasmodium falciparum lactate dehydrogenase. A promising approach to quick diagnosis of malaria.

To establish a quick and applicable diagnostic method has been a major target in immunological research on malaria. Of all approaches studied, circulating antigen (CAg) detection seems to be the most promising. Scientists have encountered tough difficulties in the analysis and purification of malaria parasite antigen because of its high complexity. Studies showed that plasmadium falciparum (P.f) lactate dehydrogenase (pLDH), as a specific CAg of malaria parasite. is apparently different from that of human erythrocytes (rLDH) both in their physical and biochemical characteristics. and is very easy to be identifed. Consequently, pLDH detection has a great potential to be developed into a method for assessing parasitemia. This paper reviewed the methods for the purification. separation, identification of pLDH and the prospect of its clinical applications as an ideal detector of the presence of malaria parasite in order to speed up this research.     

Inflammation: an important mechanism for different clinical entities of coronary artery diseases

Although atherosclerosis has been considered to be multi-factorial disease in which genetic, environmental, metabolic factors have been implicated, the gaps remain in our knowledge of the etiopathogenesis of atherosclerosis. There is mounting evidence that inflammation plays an important role in the initiation, development as well as evolution of atherosclerosis, suggesting that atherosclerosis is an inflammation disease.1,2 Although triggers and pathways of inflammation are probably multiple and different in different clinical settings, the data from animals as well as humans including our groups indicated that an inflammatory process was involved in all stages of atherosclerosis appeared in different clinical entities.     

Progress in the Diagnosis and Management of Chorea-acanthocytosis

Chorea-acanthocytosis (ChAc) is the most common subtype of neuroacanthocytosis syndrome, characterized by the presence of acanthocytes and neurological disorders.It is thought to be caused by VPS13A mutations. Characteristic movement disorders in ChAc is choreiform movements affecting both trunk and extremities and prominent orolingual dyskinesia is pathognomonic. Acanthocytosis in peripheral blood smear, elevated serum creatine kinase and atrophy of heads of caudate nuclei and dilation of the anterior horn of the lateral ventricles in magnetic resonance imaging could assist the diagnosis of ChAc. Botulinum toxin injection is a possible treatment for the typical orofacial dystonia. Deep brain stimulation is a novel surgical treatment modality. Most cases chose globus pallidus internus as target. Patients with dystonia as a major manifestation will benefit more from high-frequency stimulation and those with major findings of chorea and dysarthria are suitable for low-frequency stimulation. More evidence of long-term outcomes is warranted.     

Antioxidants in Food and Chronic Degenerative Diseases

Both preventive and chain breaking antioxidants have a role in the limitation of free radical damage.Some of these may be rdgarded as “classical“,like vitamins E and C but others are more recently discovered, such as the flavonoids,widespread in plant tissues, and the muscle constituents anserine and carnosine.The major conditions in which the role of antioxidants is under intense investigation include coronary artery disease, cancer and diabetes.There are theoretical underpinnings for the efficacy of antioxidants in each of these,with the protection of low density lipoprotein (in respect of the first) being exceptionally persuasive.Much attentinon is now being focused on the flavonoids, which are surprisingly pleiotropic in their effects.For one of them, quercetin ,over a dozen seemingly independent biological effects can be listed, including the inhibition of low density lipoprotein oxidation.Flavonoids also inhibit peroxidation in foodstuffs,as opposed to tissues.There is much controversy over antioxidant supplementation policies,some authorities recommending a massive programme of supplementation for all ages and classes,others stressing the value of the traditional mixed diet.This matter is unlikely to be resolved soon, but in the meantimesensible supplementation policies should be continued for those most vulnerable ,that is,babies and the aged.     

REVIEW Risk Assessment of the Mycotoxin Ochratoxin A

Ochratoxin A (OA) is a mycotoxin which has been found to occur in foods of plant origin, in edible animal tissues, as well as in human blood sera and tissues. The ability of OA to move up the food chain is aided by its long half-life in certain edible animal species. In this report, an evaluation of the health risks to Canadians due to the presence of OA in food products is presented. The first part of the report deals with the physicochemical aspects, mycology, laboratory production, analytical methods, and natural occurrence in plant products, animal products, and human tissues. The stability of OA in foods and feeds, the effects of food processing, and the removal from foods and feeds by physicochemical means are also discussed. From these data, the worst case estimate for the daily exposure of Canadians to OA, from the consumption of pork-based food products and cereal foods, is approximately 5 ng OA/kg body wt (mean of eaters) for young children, the highest consumption group on a body weight basis. The second part of the report deals with the metabolic disposition as well as the available toxicity database for OA in laboratory animals, farm animals, and humans. The major target for OA toxicity in all mammalian species tested is the kidney, and endemic nephropathies affecting livestock as well as humans have been attributed to OA. OA is also teratogenic, and in the fetus the major target is the developing central nervous system. Recent studies have provided "clear evidence" of the carcinogenicity of OA in two rodent species. OA was found to be nonmutagenic in various microbial and mammalian gene mutation assays, but weak genotoxic activity to mammalian cells was noted. In addition, OA was found to suppress immune function. Based on the NTP carcinogenicity study with OA in rats, the estimated tolerable daily intake in humans ranges from 0.2 to 4.2 ng OA/kg body wt, depending on the method of extrapolation used. In view of the toxic properties of OA, it is recommended that exposure to OA be kept to a minimum. In Canada, further monitoring programs are required to better define the overall residue profile of OA in cereal grains, animal feeds, animal food products, and human blood. Such data are required to better assess dietary exposure and to ascertain the need for regulatory controls or other control mechanisms. (c)1989 Academic Press, Inc.     

Selective fusion in adolescent idiopathic scoliosis

Despite the continual evolution in the surgical treatment of adolescent idiopathic scoliosis （AIS）,the goals of surgery remain to correct and stabilize the deformity in three dimensions, to maintain equilibrium of the shoulders and trunk, and to leave as many mobile spinal segments as possible. The essence is to fuse the smallest possible number of vertebrae to maintain maximum residual mobility, but end with corrected and well-balanced spine. Selective fusion is termed when both the main thoracic and thoracolumbar/lumbar （TL/L） curves deviate completely from the midline （Figure 1）, but only the major curve （the largest Cobb measurement） is fused, leaving the minor curve unfused and mobile. For the single curve, such as thoracic, thoracolumbar, or lumbar curve, there are fewer differences of opinion amongst spinal surgeons regarding the selection of the fusion level than the surgical approach. However, the choice of fusion levels in some types of curves, such as double curves and triple controversy issue. If the fusion is incorrect, it curvature deterioration, curves remains a difficult and decision to perform selective may result in postoperative shoulder imbalance, trunk decompensation, or even produce new deformity, an early revision by extending the fusion or reducing the correction may need. The non-selective approach rarely leads to early troubles that require a second procedure and is often perceived as being safer in the short-term. But it may be more difficult in the long-term as distal degeneration is more likely. This raises the question： ＂Is it better to be safe in the short-term or take a chance avoiding later degenerative problems with a shorter motion-sparing fusion？＂ Thus, the aim of selective fusion is to identify the compensatory curves （minor curve） that will straighten spontaneously after correcting and fusing the major curve, thereby avoid the fusion of these flexible compensatory curves.     

Morphogenetic Action of Neurotransmitters on Regenerating Planarians—A Review

Planarians can be used as invertebrate bioassays to evaluate the role of neurotransmitters on regenerating cells.The influence of the nervous system is crucial to regenerate a normal complete animal.The neurotrophic action of the nervous system has been attributed to the major neurohormones present throughout the animal kingdom.The same type of transmitters found in mammals have been extensively found in many invertebrates,including planarians,but their tole in regeneration is unclear.Neurotransmitters and drugs which act on neurohumoral transmission have been used to determine the role of each neurohormone on regenerating planarians.Biochemical and pharmacological mechanisms of neurohormones on regenerative planarians are reviewed,as is their putative role on regeneration.Correlation with the roles of neurotransmitters in the central nervous system of higher organisms are also addressed.     

Effect of smoking cessation on airway inflammation of rats with chronic bronchitis

Background Smoking is the major cause of airway inflammation in chronic obstructive pulmonary disease （COPD）, and smoking cessation is regarded as one of the important strategies for prevention and treatment of the inflammation. The inflammation of the chronic airway may be present and deteriorated even if the COPD patients stop smoking. Whether and how early smoking cessation affects the progress of inflammation is still obscure. This study was conducted to find the appropriate time for smoking cessation to terminate the airway inflammation in rats with smoke-induced chronic bronchitis. Methods A rat model of COPD was established by passively inhaling smoke mixture. Fifty-four young male Sprague-Dawley rats were randomly divided into 9 groups with different periods of smoke exposure and different time points of cessation. The inflammation markers to be detected included inflammatory cells in the bronchoalveolar lavage fluid （BALF）, the myeloperoxidose （MPO） activity, the morphologic changes and the expression of ICAM-1 on the airway epithelium. Results When smoking was terminated at early stage, the inflammatory markers and related indexes were different from those of the typical chronic bronchitis group （group M7） （P〈0.01）. The pathologic score of group SC7 （2 weeks of smoking cessation after occurrence of typical chronic bronchitis ） was not different from that of group M7, and the level of ICAM-1 was still up-regulated （compared to group M7, P〉0.05）. Meanwhile, most of inflammatory cells in BALF were neutrophils compared to other groups （P〈0.01）.When smoking was terminated, the MPO activity was significantly lower than that of group M7 （P〈0.01）. Conclusions Smoking cessation at early stage can effectively inhibit the inflammatory reaction of COPD. Once chronic bronchitis occurs, little could be improved by smoking cessation.     

Evolving role of systemic inflammation in comorbidities of chronic obstructive pulmonary disease

The number of individuals affected by chronic obstructive pulmonary disease （COPD） has been increasing in the last decades. As a consequence, COPD is expected to become the third most frequent cause of death worldwide by 2020.1 Exacerbations of COPD is a major cause of morbidity. In particular, they greatly contribute to decline of health-related quality of life,increase in symptoms and breathlessness, Progression of the disease, and increased risk of mortality.2     

Fibromyalgia after severe acute respiratory syndrome: a case report

Since November 2002, an infectious disease with unknown cause occurred in China and many countries had been involved. Cases were reported in 28 countries and more than 5050 individuals had been infected.1 Lung is the most frequently involved organ and can be fatal in severe cases. At the end of February 2003, it was defined as Severe Acute Respiratory Syndrome (SARS) by World Health Organization. China had a SARS epidemic in the spring of 2003. More than 1000 patients were infected and some patients died of respiratory failure.Finally, a new variant of coronavirus was suspected to be the pathogen although the pathogenesis was still unclear. Since it is a new disease and we have very limited knowledge about its clinical sequela, we followed the survived patients closely in order to understand it in depth. During the follow up, we discovered an interesting patient who was finally diagnosed as fibromyalgia. We report this case herein to share our experience with clinicians who may see patients with SARS or fibromyalgia.