Angiotensin converting enzyme inhibitors mitigate collagen synthesis induced by a single dose of radiation to the whole thorax

Our long-term goal is to use angiotensin converting enzyme (ACE) inhibitors to mitigate the increase in lung collagen synthesis that is induced by irradiation to the lung, which could result from accidental exposure or radiological terrorism. Rats (WAG/RijCmcr) were given a single dose of 13 Gy (dose rate of 1.43 Gy/min) of X-irradiation to the thorax. Three structurally-different ACE inhibitors, captopril, enalapril and fosinopril were provided in drinking water beginning 1 week after irradiation. Rats that survived acute pneumonitis (at 6-12 weeks) were evaluated monthly for synthesis of lung collagen. Other endpoints included breathing rate, wet to dry lung weight ratio, and analysis of lung structure. Treatment with captopril (145-207 mg/m(2)/day) or enalapril (19-28 mg/m(2)/day), but not fosinopril (19-28 mg/m(2)/day), decreased morbidity from acute pneumonitis. Lung collagen in the surviving irradiated rats was increased over that of controls by 7 months after irradiation. This increase in collagen synthesis was not observed in rats treated with any of the three ACE inhibitors. Analysis of the lung morphology at 7 months supports the efficacy of ACE inhibitors against radiation-induced fibrosis. The effectiveness of fosinopril against fibrosis, but not against acute pneumonitis, suggests that pulmonary fibrosis may not be a simple consequence of injury during acute pneumonitis. In summary, three structurally-different ACE inhibitors mitigate the increase in collagen synthesis 7 months following irradiation of the whole thorax and do so, even when therapy is started one week after irradiation.     

Pulmonary function in patients with pleural effusion of varying magnitude and fibrothorax

Pulmonary function was studied in sixty patients with pleural effusion and seventy patients with fibrothorax. The patients with pleural effusion were divided into three groups according to the extent of the effusion. The patients were submitted to spirometry and arterial blood gas analysis. The effects of pleural effusion on pulmonary function is evaluated with regards to the size of effusion. Small-size pleural effusion little affects arterial oxygen tension. Pleural effusion and fibrothorax have a similar pattern of pulmonary function.     

Pleural amyloidosis as a cause of excessive pleural effusions

A 83-year-old woman known with a stable disease multiple myeloma was hospitalized frequently with dyspnoea caused by copious bilateral pleural effusions. Thoracentesis was performed repeatedly but pleural effusions returned. Extensive laboratory and radiological examinations failed to reveal the cause of the pleural effusions. Finally, after pleural biopsy the diagnosis of amyloidosis of the pleura could be made. The patient died in hospital from a stroke. Pleural amyloidosis is rarely reported and is accompanied by large uni- or bilateral pleural effusions even without amyloidosis of the heart.     

肺癌患者三维适形放疗前后肺功能的动态变化及与放射性肺炎发生的关系研究

目的探讨非小细胞肺癌三维适形放疗前后肺功能的动态变化及其与放射性肺炎发生率的关系。方法68例未手术的肺癌患者,男42例,女26例,中位年龄52岁,KPS评分≥80分,均行三维适形放疗,放疗前及放疗后1、3个月检查肺功能主要参数用力肺活量（FVC）、1S用力呼气量（FEV1）、肺一氧化碳弥散量（CLCO）,同时观察放射性肺炎的发生率及程度。结果所有患者均完成放疗,剂量为60～70Gy。24例患者发生不同程度放射性肺炎,其中I级11例,Ⅱ级7例,Ⅲ级3例,Ⅳ级3例,无V级病例。FVC放疗前与放疗后3个月0级（n=44）和I＋Ⅱ＋Ⅲ＋Ⅳ级（n：24）放射性肺炎者比较,差异无统计学意义（P〉0．05）,而FEVl．0和DLCO放疗前与放疗后3个月的0级（n=44）和I＋Ⅱ＋Ⅲ级＋Ⅳ级（n=24）放射性肺炎者比较,差异有统计学意义（P〈0．05）。V20,V30及MLD平均值越大,放射性肺炎程度越高：结论非小细胞肺癌放疗后DLCO水平显著降低,放射性肺炎患者FEVl和DLCO放疗后显著降低。V20,V30,及MLD可预测放射性肺炎发生。     

Lung tumor response to inhaled Pu and its implications for radiation protection

Multistage models of cancer induction have been accepted in chemical and radiation carcinogenesis for many years. Most models assume that both initiating and promoting events are required for greatest expression of tumor incidence. The sequence of events is important in determining the shape of the dose-response curve. A total of 1058 female, SPF, Wistar, sham-exposed rats and 2134 rats given a single inhalation to 169Yb, 239PuO2 are being studied for lung tumor formation in a life-span study. Histopathological analyses have been completed on 1149 rats. Similar dose-response curves are seen for pulmonary fibrosis pulmonary metaplasia and lung tumor formation. Lung tumor incidences were: 0.6% (0 Gy), 0.5% (0.06 Gy), 0% (0.11 Gy), 0% (0.23 Gy), 4.5% (0.46 Gy), 0% (0.84 Gy), 13.8% (1.9 Gy), 18.6% (3.5 Gy), 72.5% (7.4 Gy), and 84.9% (15 Gy). The dose lung-tumor curve was best fit by a quadratic function and was not well fit by a linear function. It is proposed that the low-dose portion of the quadratic curve represents promotion event(s) due to increasing 239PuO2 particle clustering in subpleural regions, leading to a cellular evolution of focally intense inflammation, fibrosis, epithelial metaplasia and carcinoma formation. A defined, practical threshold dose may be useful with respect to setting radiation protection guidelines for lung tumor induction.     

心力衰竭患者脑钠肽水平与左室舒张充盈类型及肺动脉收缩压的关系

目的研究收缩性心力衰竭患者左室舒张充盈类型及肺动脉收缩压与血浆脑钠肽(BNP)水平的相关性。方法61例收缩性心力衰竭患者(左室射血分数<50%)进行超声心动图检查,根据肺静脉血流和二尖瓣口舒张期血流评价左室舒张充盈类型,根据连续多普勒超声心动图收缩期三尖瓣口返流血液的峰值流速测肺动脉收缩压,同时进行血浆BNP水平的检测。结果多元线性回归分析表明,在收缩性心力衰竭患者中,左室舒张充盈类型及肺动脉收缩压对血浆BNP有显著影响。Spearman相关分析表明,血浆BNP水平与左室舒张充盈类型及肺动脉收缩压均有明显的相关性(P<0.01)。当左室舒张充盈类型由正常型到限制型逐渐递增时,血浆BNP水平也相应增高,且血浆BNP水平随着肺动脉收缩压的升高而增高。结论收缩性心力衰竭患者中,肺动脉收缩压及左室舒张充盈类型与血浆BNP水平密切相关,在实际工作中运用超声心动图判断心功能时除常规的指标外,还需考虑舒张充盈类型和肺动脉收缩压,以全面评价患者的心功能状态。     

The development of classically and alternatively activated macrophages has different effects on the varied stages of radiation-induced pulmonary injury in mice

The classical and alternative activation of macrophages has been proposed to play a role in radiation-induced pneumonitis and fibrosis, respectively. To test this hypothesis, the thoraces of C57BL/6 mice were irradiated with 12 Gy X-rays, and irradiated and control mice were euthanized at 1, 8, 12, 24 and 72 hours, and 2, 4, 8, 16 and 24 weeks after irradiation. The expression of inducible nitric oxide synthase (iNOS) and arginase type 1 (Arg-1) was evaluated at the mRNA and protein levels at different stages post-irradiation. We demonstrated that the enhanced mRNA and protein expression of iNOS occurred within the pneumonic stage, whereas the high levels of Arg-1 expression occurred within the fibrotic phase. Immunohistochemistry revealed that iNOS and Arg-1 were mainly expressed in macrophages. The expression of iNOS and Arg-1 may be associated with acute radiation pneumonitis and the development of radiation fibrosis, respectively. Although the function of macrophages cannot explain the whole process of radiation-induced pulmonary injury development, it may play an important regulatory role during this process.     

Pericardial and pleural effusions after definitive radiotherapy for esophageal cancer

Purpose: We investigated the incidences of pericardial and pleural effusions after definitive radiotherapy with or without concurrent chemotherapy were analyzed retrospectively. Methods: One hundred and forty-seven patients with esophageal cancer received definitive radiotherapy or concurrent chemoradiotherapy (CCR). Follow-up chest Computed Tomography scans were reviewed to detect pericardial and pleural effusions. Adverse events were graded according to the Radiation Therapy Oncology Group Common Toxicity Criteria. Results: The median follow-up was 34 (range, 6 to 84) months. Numbers of eligible patients evaluated for pericardial and pleural effusions were 107 and 101, respectively. Pericardial effusions exceeding grade 1 and grade 2 toxicities were observed in 46 (43%) and 15 (14%) patients, respectively. The corresponding numbers for pleural effusions were 44 (44%) and 18 (18%). Onset of effusion ranged from 1 to 65 months after treatment. Multivariate analysis identified radiation field width of the mediastinum exceeding 8 cm as a significant risk factor for both pericardial and pleural effusions. Age and field length exceeding 20 cm were identified as independent risk factors for pleural effusion. Conclusions: Pericardial and pleural effusions after radiotherapy or CCR are occasionally recognized as adverse events in patients with esophageal cancer. The mediastinal radiation field width can be a simple indicator for predicting those adverse events.     

血清及胸水p53抗体检测对肺癌的临床诊断意义

目的通过对肺癌患者血清及胸水p53抗体水平的检测,探讨p53抗体对肺癌诊断价值和临床意义。方法采用酶联免疫吸附法(ELISA)检测26例肺癌未治疗患者,19例经手术或化疗治疗后的肺癌患者血清p53抗体,并以20例良性疾病患者作对照,其中5例肺癌患者同时检测胸水p53抗体,以6例良性胸水作对照。结果肺癌未治疗组血清阳性率为50.0%,p53抗体水平为(4.054±6.308)IU/mL,高于对照组(0.177±0.085)IU/mL,差异有统计学意义(P<0.01),肺癌治疗组阳性率为31.6%,血清p53抗体水平为(1.660±3.591)IU/mL,与对照组和肺癌未治疗组差异无统计学意义(P>0.05),良性对照组胸水p53抗体水平为(0.398±0.443)IU/mL,结果略高于血清,差异无统计学意义(P>0.05);肺癌组血清p53抗体检测阳性率为60.0%,胸水阳性率为80.0%,肺癌组胸水p53抗体水平为(15.510±8.813)IU/mL,高于其血清中含量和良性对照组胸水中含量,且差异有统计学意义(P<0.01)。结论检测血清及胸水p53抗体水平有助于肺部良恶性疾病的诊断及鉴别诊断,是一种简便、...     

Pleural effusions in acute pancreatitis

BACKGROUND: Acute pancreatitis ranks third among the inflammatory diseases causing acute abdomen; it accounts for about 2% of all cases of acute surgical abdomen. The clinical course of the disease is characterised by a number of local and systemic complications, the most frequent being respiratory disorders. METHODS: In the present study we review our experience with the management of acute pancreatitis in 75 patients complicated by pleural effusions in some of them. The patients were allocated into two groups depending on the severity of the disease: group I included patients with mild pancreatitis and group II--with severe acute pancreatitis. RESULTS: Pleural effusions were found in 4.7% of the patients in group I and in 24.2% in group II. They were given conservative treatment; it included puncture in three patients. CONCLUSIONS: Pleural effusions, which are indicators of poor prognosis, are observed most often in severe acute pancreatitis.     

腺苷脱氨酶测定在良恶性胸腔积液鉴别中的应用

目的：探讨腺苷脱氨酶活性测定在良恶性胸腔积液鉴别中的应用。方法：对156例结核性胸腔积液和60例恶性胸腔积液标本进行腺苷脱氨酶测定,同时测定血清腺苷脱氨酶活性。结果：结核性胸腔积液患者的腺苷脱氨酶活性（91．2±22．4）U／L明显高于血清（21．8±5．8）U／L,也明显高于恶性胸腔积液（22．2±5．6）U／L,两者比较差别有显著意义（P〈0．01）。结论：胸腔积液腺苷脱氨酶活性测定可以作为鉴别良恶性胸腔积液的指标,尤其在结核性胸膜炎中有临床诊断价值。     

高原低压低氧环境对心肺结构与功能的影响研究进展

该文结合近年来国内外高原医学相关研究进展,对高原低压低氧环境对心肺结构与功能的影响进行综述。主要包括高原低压低氧环境对心肌结构与心脏功能的影响,对肺动脉结构与肺功能的影响,以及相关分子生物学机制的介绍和初步探讨;提出可通过测量、对比平原世居者高原暴露前后的每搏输出量(SV)和静息状态下左室扭转率来综合评价其运动能力,通过区分功能代偿与失代偿来分类研究急慢性低压低氧环境对肺功能的影响更有意义。     

CD44 and Bak expression in IL-6 or TNF-alpha gene knockout mice after whole lung irradiation

To understand the molecular mechanisms that underlie radiation pneumonitis, we examined whether knockout of the TNF or the IL-6 gene could give mice an inherent resistance to radiation in the acute phase of alveolar damage after thoracic irradiation. The temporal expression of inflammation (CD44) and apoptosis (Bak) markers in lung after thoracic irradiation was measured to determine the degree of alveolar damage. At 4 weeks post-irradiation (10 Gy), small inflammatory foci were observed in all mice, but there were no obvious histological differences between control (C57BL/6JSlc), TNF-alpha knockout (TNF KO), and IL-6 knockout (IL-6 KO) mice. However, immunohistochemical analysis of CD44 and Bak expression over a time course of 2 weeks highlighted significant differences between the three groups. C57BL/6JSlc and TNF KO mice had increased numbers of both CD44-positive and Bak-positive cells after irradiation, while the IL-6 KO mice showed stable levels of CD44 and Bak. In conclusion, the radioresistant status of IL-6 KO mice in the acute phase of alveolar damage after irradiation suggested an important role for IL-6 in radiation pneumonitis.     

CA125在鉴别结核性和癌性胸腔积液中的价值分析

目的探讨血清和胸水中CA125在结核性和癌性胸水的鉴别诊断意义。方法回顾性分析90例结核性胸水患者(结核组)和68例癌性胸水患者(肺癌组)的血清和胸水CA125测定值及二者比值,应用受试者工作曲线(ROC曲线)确定胸水和血清CA125比值对两组鉴别的临界值。结果肺癌组胸水CA125测定值和胸水血清CA125比值分别为(796.95±394.37)U/ml和13.69±5.34,明显高于结核组(281.33±272.13)U/ml和5.83±6.67,差异均有统计学意义(t分别为9.42和7.95,均P﹤0.01),但两组血清CA125测定值差异无统计学意义(t=1.69,P=0.09)。p-CA125/s-CA125﹥10在两组中的比率差异有统计学意义(P=0.00),应用ROC曲线确定的p-CA125/s-CA125比值临界值为10,对癌性胸水的敏感度为82.4%,特异度为75.6%。结论血清和胸水中CA125对于结核性和癌性胸水的鉴别意义不大,但是用胸水和血清CA125比值来鉴别结核性和癌性胸水有一定价值。     

Pulmonary complications after radiotherapy in lung cancer

The appearance of the pulmonary injury after irradiation using 60Co-gamma-ray was investigated for 574 cases with carcinoma of the lung. In 437 patients these (76.2% of the total cases) radiation pneumonitis was seen, and the late radiation fibrosis was observed in 197 cases (29.1%). In cases which more than 50 Gy was irradiated for the treatment of more than 75 cm2, the frequency and the grade of pulmonary complications increased rapidly.     

Cardiac responses of rats submitted to postnatal protein restriction

Undernutrition during critical stages of development and childhood has important effects on cardiovascular homeostasis. The present study was undertaken to evaluate the in vivo and ex vivo cardiac function of rats submitted to postnatal protein restriction. Male Wistar rats (28 days old) were fed a regular (20%) or low-protein (6%) diet over 5 weeks. After this period, cardiac function was analyzed by echocardiography and isolated heart preparation. Furthermore, the density of cardiac noradrenergic fibers and hematological profile were evaluated. We found that malnourished rats exhibited elevated arterial blood pressure, increased fractional shortening (echocardiography), increased systolic tension, increased ±dT/dt (isolated heart technique), impaired diastolic function characterized by a slight increase in the left ventricular end-diastolic diameter (echocardiography) and decreased diastolic tension (isolated heart technique), and cardiac hypertrophy evidenced by augmentation of the posterior left ventricular wall and discrete hematological changes. In addition, malnourished rats exhibited increased noradrenergic fiber density in their hearts (0.08% ± 0.02% area in control rats vs. 0.17% ± 0.03% area in malnourished rats). Our current data demonstrate that postnatal protein restriction causes cardiac adaptation characterized by an early overworking heart. This is at least in part mediated by an increase in the efferent sympathetic fibers to the heart. These findings provide important information for efforts to prevent and manage the consequences of undernutrition in the human population.     

Roentgenographic manifestations and pulmonary function effects of asbestos-induced pleural thickening.

Pleural thickening is the most common roentgenographic manifestation of past asbestos exposure. In addition to pleural thickening serving as a specific market of exposure, discrete (plaques) and diffuse pleural fibrosis are important abnormalities because they have been found to be associated with increased risk for other asbestos-related sequelae and to themselves have an adverse effect on pulmonary function. We review here the results of an evaluation of a cohort of asbestos-exposed workers, plumbers and pipefitters, who were consecutively enrolled in a large cross-sectional prevalence study. Among the 681 male participants, pleural abnormalities were associated with decreased values of forced vital capacity, an effect independent of ILO profusion grade. The risk for pleural disease was unexplained by smoking status. Diffuse pleural thickening was more common and was associated with greater decrements in function than was discrete thickening.     

Effects of asbestos-related pleural disease on pulmonary function

The relationship between loss of pulmonary function and the presence of asbestos-related pleural disease was evaluated for 913 Minnesota asbestos workers. Asbestos-related pleural disease was categorized as circumscribed plaques or diffuse thickening. Compared with workers with normal pleura, workers with plaques had a decreased mean percentage for predicted forced vital capacity (FVC) and predicted forced expiratory volume in 1 s (FEV1.0). Diffuse thickening was associated with more profound decreases in FVC and FEV1.0. No relationship was seen between FEV % [(100 x FEV1.0)/FVC)] and either type of pleural disease. Dyspnea was associated with diffuse thickening more so than plaques. These results remained after control for pack-years of smoking, extent of parenchymal disease, and the presence of pulmonary disease history. Pleural plaques and diffuse pleural thickening were considered independent risk factors for the loss of lung function.