肺癌肺叶切除患者术前存在气道定植菌与术后肺炎的发生有相关性吗?

背景与目的 外科手术是目前治疗肺癌的主要手段,肺癌患者围术期死亡的主要原因仍是术后肺炎.已有的研究结果显示致病性气道定植菌被认为是术后肺部并发症的一个独立危险因素,本研究旨在探讨术前致病性气道定植菌的存在与术后发生肺炎的关系及其危险因素.方法 横断面调查2014年5月至2015年1月连续收治于成都市6家三级甲等医院胸外科行手术治疗的125例非小细胞肺癌患者,术前经纤维支气管镜取气管及支气管内液细菌学标本,并检测术前血清肺表面活性蛋白D(surfactant protein D,SP-D)水平,术后肺部相关并发症进行分析.结果 肺癌患者术前合并致病性气道定植菌的发生率为15.2％(19/125),以革兰氏阴性菌为主(19/22,86.36％);肺癌患者术前合并致病性气道定植菌的高危因素为:高龄(≥75岁)和长期吸烟史(吸烟指数≥≥400支/年);术后肺部相关并发症和术后肺炎发生率在肺癌合并致病性气道定植菌组(42.11％,26.32％)均显著高于非合并组(16.04％,6.60％)(P=0.021,P=0.019).术前血清SP-D浓度在肺癌合并致病性气道定植菌(31.25±6.09)显著高于非合并组(28.17±5.23)(P=0.023).并发术后肺炎患者中气道致病性定值菌发生率为41.67％(5/12),其发生率是无手术后肺炎患者的3.4倍(OR=3.363,95％CI:1.467-7.711).结论 肺癌患者合并致病性气道定植菌与术后肺炎发生密切相关,且高危险因素是高龄和长期吸烟史.     

肺癌患者外周血中表面活性蛋白DmRNA的表达及临床意义

背景与目的 : 循环癌细胞的灵敏检测对于肺癌患者的预后及选择合适的治疗方法很 重要. 为此,我们建立了利用表面活性蛋白 D(surfactant protein D, SP-D)作为基因标志 的 RT-PCR方法,检测肺癌患者外周血中的癌细胞,并初步探讨其临床意义. 方法 : 采用优化 的套式 RT-PCR方法,对 26例伴肺外转移肺癌患者,37例无转移肺癌患者,15例良性肺疾病患 者及 15例健康志愿者外周血中 SP-D mRNA的表达进行分析. 结果 : 1)该方法灵敏度可达 1× 10- 6, 特异性强 ; 2)采用此方法,伴肺外转移和无转移肺癌患者外周血中 SP-D mRNA的检出 率分别为 92.3% (24/26)和 24.3% ( 9/ 37),所有良性肺疾病患者和健康对照外周血中均未 见 SP-D mRNA 的表达. 结论 : SP-D mRNA可能是检测肺癌患者外周血中是否存在癌细胞的一 个有价值的指标,对肺癌的转移倾向有一定的提示作用,并有可能为制定治疗方案和评估预 后提供重要的参考依据.     

Severe interstitial pneumonia associated with anti-PD-1 immune checkpoint antibody after talc slurry pleurodesis

A 70-year-old Japanese man with recurrent squamous cell carcinoma of the head and neck presented with severe interstitial pneumonia associated with nivolumab, after talc slurry pleurodesis. Following the development of malignant pleural effusion, he underwent chest drainage and was administered intrathoracic talc as a pleurodesis. Two weeks later, we administered nivolumab (3 mg/kg) to be repeated every 2 weeks. However, on day 12, chest computed tomography scan demonstrated diffuse non-segmental ground-glass opacity and mild bronchiectasis. We diagnosed interstitial pneumonia associated with nivolumab. Although corticosteroid pulse therapy was initiated, the patient died of respiratory failure on day 14.     

The safety and efficacy of weekly paclitaxel in combination with carboplatin for advanced non-small cell lung cancer with idiopathic interstitial pneumonias

Background

Idiopathic interstitial pneumonias (IIPs) are one of the most common complications in patients with lung cancer. In lung cancer patients with IIP, the most serious toxicity is acute exacerbation of IIP caused by anticancer treatment in Japan. However, there has been no consensus and no evidence presented, regarding optimal treatment for advanced lung cancer with IIP.

Patients and methods

Chemotherapy-naïve patients of inoperable stage, or post-operative recurrent non-small cell lung cancer (NSCLC) with IIPs were enrolled. Patients received paclitaxel at a dose of 100 mg/m² on Days 1, 8, 15, and carboplatin every 28 days at a target dose of area under the curve (AUC) 5.0 on Day 1.

Results

Between May 2004 and October 2008, 18 patients, including 6 with idiopathic pulmonary fibrosis (IPF), were enrolled and treated for a median of four cycles (range, 1-6). One patient (5.6%; 95% confidence interval (CI), 0-17%) with histologically confirmed IPF had acute exacerbation of IIPs associated with the treatment. The overall response rate was 61% (95% CI, 36-86%). The median progression-free survival, median survival time, and 1-year survival rate were 5.3 months, 10.6 months, and 22%, respectively.

Conclusion

This is the first report indicating that advanced NSCLC patients with IIP may benefit from chemotherapy. Weekly paclitaxel and carboplatin combination chemotherapy was as effective as conventional regimens in advanced NSCLC patients without IIP and was safer than previously reported for NSCLC patients with IIP. The results from this study would support, on ethical grounds, the conduct of a large-scale study to confirm the feasibility of this regimen.     

不同染尘剂量对大鼠血清硅元素、克拉拉细胞蛋白及表面活性蛋白-D表达影响

目的 探讨大鼠矽肺模型不同染尘剂量与血清硅元素水平、克拉拉细胞蛋白(CC16)和表面活性蛋白D(SPD)之间的剂量-反应关系并进行比较.方法 145只雄性Wistar大鼠按不同染尘剂量(10、30、50、70 g/L)及不同时间点(染尘后1、3、5、7、14、21和28 d)分为对照组及28个染尘组.取大鼠血液及肺组织,采用电感耦合等离子体质谱仪(ICP-MS)检测矽肺模型大鼠血清中硅元素水平,酶联免疫吸附测定法(ELISA法)定量测定大鼠血清中CC16和SP-D水平.结果 随着染尘剂量的增加和时间的延长,模型组大鼠血清硅元素的水平呈现逐渐增高的趋势;CC16水平于造模后即开始降低,自第7天开始与对照组比较,差异有统计学意义(P<0.05),并随着时间的延长和染尘剂量的增加水平不断减少;SP-D水平于造模后即开始增加,与对照组比较,在第5天差异有统计学意义(P<0.05),在第14天最高,21 d起开始逐渐下降.结论 矽肺模型大鼠血清硅元素水平在早期低剂量染尘时即明显升高,且旱于CC16和SP-D的变化,三者水平均随染尘剂量和时间的不同而变化,提示血清硅元素、CC16和SP-D水平变化可能为矽肺的早期诊断提供生物学指标,具有一定的意义及价值.     

Analysis of pulmonary surfactant in rat lungs after intratracheal instillation of short and long multi-walled carbon nanotubes

Abstract

Multi-walled carbon nanotubes (MWCNTs) are interesting new materials, but there is some concern about their harmfulness due to their fibrous nature. To determine the difference in the biological effects of MWCMTs by fiber length, we prepared two MWCNT samples from one bulk sample. One consisted of cut up short fibers (Short; average length?=?0.94?µm) and the other was just dispersed (Long; average length?=?3.4?µm). The samples were administered to male Wistar rats by intratracheal instillation at doses of 0.2?mg and 1?mg/animal (Short) and 0.2?mg and 0.6?mg/animal (Long). The animals were sacrificed at time points from 3?d to 12 months after administration. Bronchoalveolar lavage fluid (BALF) was taken from the lungs and pathological specimens were prepared. The concentrations of phospholipids, total protein and surfactant protein D (SP-D) in the pulmonary surfactant of the BALF were determined, the surface tension of BALF was measured, and the inflammation score was determined by the point-counting method to assess pulmonary tissue inflammation. The present study suggests that inflammatory response in the lung was slightly higher for long MWCNTs than for short MWCNTs when compared at the same mass dose. The correlation between pulmonary surfactant components and BALF surface tension was also evaluated. The Spearman’s rank correlation coefficients obtained for the phospholipid, total protein and SP-D concentrations were ?0.068 (p?=?0.605), ?0.360 (p?=?0.005) and ?0.673 (p?=?0.000), respectively. Surface tension, measured by a simple method, should be reflected in the change of a surfactant protein, such as SP-D.     

Factors associated with the relapse of cryptogenic and secondary organizing pneumonia

Background

Organizing pneumonia (OP) is a histopathological response pattern to lung inflammation. It is clinically classified into cryptogenic OP and secondary OP, which is associated with various clinical conditions. Rapid resolution with corticosteroids and frequent relapses are common in OP. However, few studies have investigated the factors associated with OP relapse.

A case of interstitial pneumonia caused by bucillamine: a study using serological markers

Abstract

The patient was a 61-year-old man diagnosed with rheumatoid arthritis (RA) in 2001. He initially received treatment at a nearby clinic, but his condition could not be satisfactorily controlled. He subsequently consulted our hospital during the same year. Although his symptoms improved in response to treatment at our hospital, slight fever, cough, and then high fever and dyspnea subsequently developed. A diagnosis of interstitial pneumonia was made on the basis of findings of diagnostic imaging. The time course of changes in serological markers, including surfactant protein A (SP-A), surfactant protein D (SP-D), and KL-6, as well as markers of inflammatory reaction and lactate dehydrogenase was examined to determine the clinical significance of serological markers in the management of interstitial pneumonia.     

The genetics of neonatal respiratory disease

This chapter reviews some of the genetic predispositions that may govern the presence or severity of neonatal respiratory disorders. Respiratory disease is common in the neonatal period, and genetic factors have been implicated in some rare and common respiratory diseases. Among the most common respiratory diseases are respiratory distress syndrome of the newborn and transient tachypnoea of the newborn, whereas less common ones are cystic fibrosis, congenital alveolar proteinosis and primary ciliary dyskinesias. A common complication of neonatal respiratory distress syndrome is bronchopulmonary dysplasia or neonatal chronic lung disease. This review examines the evidence linking known genetic contributions to these diseases. The value and success of neonatal screening for cystic fibrosis is reviewed, and the recently characterised contribution of polymorphisms and mutations in the surfactant protein genes to neonatal respiratory disease is evaluated. The evidence that known variability in the expression of surfactant protein genes may contribute to the risk of development of neonatal chronic lung disease or bronchopulmonary dysplasia is examined.