改良支气管残端闭合法对支气管胸膜瘘的预防

目的通过改良肺切除支气管残端处理方法,减少支气管胸膜瘘(BPF)等并发症的发生。方法我科完成各种肺叶或全肺切除患者239例,分为实验组(163例),采用缝合器+连续往返交叉缝合改良技术,对照组(76例),采用间断缝合,或直线缝合器缝合,或者腔外双重结扎的传统方法,比较两组BPF、脓胸、早期刺激性咳嗽、咳血、术后早期漏气等临床指标。结果实验组163例,发生BPF仅1例(0.61%),对照组76例,发生BPF3例(3.94%),两组比较具有显著的统计学差异(P0.05)。其他并发症发生率较对照组均有明显减少,两组比较具有统计学差异(P0.05)。结论该方法效果明显,简单易行,费用低廉,特别适合基层医院应用。     

不同剂量万托林雾化吸入对急性支气管哮喘患儿心率及疗效的影响

目的观察万托林雾化吸入治疗急性哮喘患儿的疗效与安全性。方法将74例年龄在7～12岁间的急性支气管哮喘患儿分为四组。治疗剂量A组雾化吸入0.3 mL 0.5%万托林;B组采用0.4 mL 0.5%万托林;C组采用0.5 mL 0.5%万托林;对照组吸入硫酸特布他林气雾剂。观察各组症状、体征消失时间、疗效及对心率影响等不良反应。结果 A、B、C组治疗后总有效率分别为73.7%、88.9%、94.4%,B、C组与对照组的总有效率相比,差异有统计学意义（P〈0.05）。C组不良反应有所增加,A、B组未出现明显副作用。结论依据不同剂量万托林总有效率及不良反应情况,B组为急性哮喘患儿的最佳治疗剂量。     

舒利迭联合孟鲁司特钠治疗支气管哮喘的临床研究

目的 探讨舒利迭联合孟鲁司特钠治疗支气管哮喘的疗效.方法 选择2011年1月~2012年1月在我院进行治疗的轻度中度支气管哮喘患儿56例为研究对象,两组均给予舒利迭吸入治疗,治疗组同时联合孟鲁司特钠治疗,治疗12周后判断疗效,并比较两组患儿治疗前与治疗后4周和治疗后12周日间和夜间症状评分.结果 治疗后4周,治疗组的日间症状及夜间症状评分较对照组降低更明显,治疗后12周,治疗组的日间症状及夜间症状评分均较治疗前及治疗后4周明显降低,且治疗组的日间症状及夜间症状评分较对照组降低更明显（P ＜ 0.05）.治疗后12周,治疗组28例患儿治疗后无效2例,对照组无效7例,两组总有效率分别为92.9%、75.0%,治疗组的疗效明显优于对照组（P ＜ 0.05）.结论 舒利迭与孟鲁司特钠联用能明显改善哮喘患儿的呼吸困难、咳嗽、喘息症状,提高临床疗效.     

Genotoxicity of short single-wall and multi-wall carbon nanotubes in human bronchial epithelial and mesothelial cells in vitro

Although some types of carbon nanotubes (CNTs) have been described to induce mesothelioma in rodents and genotoxic effects in various cell systems, there are few previous studies on the genotoxicity of CNTs in mesothelial cells. Here, we examined in vitro DNA damage induction by short multi-wall CNTs (MWCNTs; 10–30 nm × 1–2 μm) and single-wall CNTs (SWCNTs; >50% SWCNTs, ∼40% other CNTs; <2 nm × 1–5 μm) in human mesothelial (MeT-5A) cells and bronchial epithelial (BEAS 2B) cells, using the single cell gel electrophoresis (comet) assay and the immunoslot blot assay for the detection of malondialdehyde (M₁dG) DNA adducts. In BEAS 2B cells, we also studied the induction of micronuclei (MN) by the CNTs using the cytokinesis-block method. The cells were exposed to the CNTs (5–200 μg/cm², corresponding to 19–760 μg/ml) for 24 and 48 h in the comet assay and for 48 and 72 h in the MN and M₁dG assays. Transmission electron microscopy (TEM) showed more MWCNT fibres and SWCNT clusters in BEAS 2B than MeT-5A cells, but no significant differences were seen in intracellular dose expressed as area of SWCNT clusters between TEM sections of the cell lines. In MeT-5A cells, both CNTs caused a dose-dependent induction of DNA damage (% DNA in comet tail) in the 48-h treatment and SWCNTs additionally in the 24-h treatment, with a statistically significant increase at 40 μg/cm² of SWCNTs and (after 48 h) 80 μg/cm² of both CNTs. SWCNTs also elevated the level of M₁dG DNA adducts at 1, 5, 10 and 40 μg/cm² after the 48-h treatment, but both CNTs decreased M₁dG adduct level at several doses after the 72-h treatment. In BEAS 2B cells, SWCNTs induced a statistically significant increase in DNA damage at 80 and 120 μg/cm² after the 24-h treatment and in M₁dG adduct level at 5 μg/cm² after 48 h and 10 and 40 μg/cm² after 72 h; MWCNTs did not affect the level of DNA damage but produced a decrease in M₁dG adducts in the 72-h treatment. The CNTs did not affect the level of MN. In conclusion, MWCNTs and SWCNTs induced DNA damage in MeT-5A cells but showed a lower (SWCNTs) or no (MWCNTs) effect in BEAS 2B cells, suggesting that MeT-5A cells were more sensitive to the DNA-damaging effect of CNTs than BEAS 2B cells, despite the fact that more CNT fibres or clusters were seen in BEAS 2B than MeT-5A cells. M1dG DNA adducts were induced by SWCNTs but decreased after a 3-day exposure to MWCNTs and (in MeT-5A cells) SWCNTs, indicating that CNTs may lead to alterations in oxidative effects within the cells. Neither of the CNTs was able to produce chromosomal damage (MN).     

Exhaled Nitric Oxide in Children with Allergic Rhinitis and/or Asthma: A Relationship with Bronchial Hyperreactivity

Background. Nowadays, the measure of the fractional concentration of exhaled nitric oxide (FeNO) enables to assess airway inflammation during an office visit and there is international consensus on this testing methodology. The aim of this study was to evaluate whether FeNO measurement is predictable for bronchial hyperreactivity (BHR) in children with allergic rhinitis, asthma, or both. Methods. Two hundred and eighty children with allergic rhinitis, allergic asthma, or both were evaluated. Bronchial function (FEV₁ and FEF_25–75), BHR (assessed by methacholine challenge), FeNO, and sensitizations were assessed. Results. Bronchial function, BHR, and FeNO were significantly different in the three groups (p < .001). A strong inverse correlation between FeNO and BHR was found in patients with asthma and with asthma and rhinitis (r?=??0.63 and r?=??0.61, respectively). A cutoff of 32 ppb of FeNO was a predictive factor for BHR. Conclusions. This study highlights the relevance of FeNO as possible marker for BHR in allergic children and underlines the close link between upper and lower airways.     

Sensitivity to Environmental Irritants and Capsaicin Cough Reaction in Patients with a Positive Methacholine Provocation Test before and after Treatment with Inhaled Corticosteroids

Background. Increasing evidence points to a potential role for members of the transient receptor potential family of cation channels on several features of asthmatic disease. The cough sensitivity to inhaled capsaicin is known to reflect the reactivity of these airway sensory nerves. Objective. The aim was to study, among patients having a positive methacholine provocation and diagnosed with asthma, capsaicin cough sensitivity, sensitivity to methacholine, and levels of exhaled nitric oxide before and after treatment with inhaled steroids, and further, to measure the self-reported impact from environmental irritants. Methods. Eighteen steroid-naïve patients with a positive methacholine test underwent capsaicin inhalation provocation on two occasions, before and after regular use of inhaled steroids over at least 3 months. Comparisons were made to 21 healthy controls. Sensitivity to methacholine and levels of exhaled nitric oxide were measured before and after the treatment. The participants also answered a validated questionnaire regarding environmental irritants. Results. The patients displayed higher capsaicin cough sensitivity than the controls before the treatment period, but not afterward. Before treatment, capsaicin cough answer correlated significantly with levels of exhaled nitric oxide, but not with methacholine sensitivity. After treatment with inhaled corticosteroids, the capsaicin cough sensitivity and the inflammatory parameters were normalized. In comparison to the control group, the patients reported more affective reactions to and behavioral disruptions induced by environmental irritants. Conclusions. In steroid-naïve patients with a positive methacholine test, there is a link between that part of the airway inflammation that is reflected by exhaled nitric oxide and that followed by an augmented reactivity of capsaicin-sensitive sensory nerves. This association disappears after steroid treatment.     

A MCh Test Pre-post Esophageal Acidification in Detecting GER-related Asthma

The direct effect of gastro-esophageal reflux (GER) on lung function is still debated. Objective. To investigate the role of esophageal acidification in affecting airway response to MCh in GER-related versus atopic asthmatics and to assess specificity and sensitivity of events. Subjects. A total of 56 never-smoking, mild asthmatics: 27 non-atopic asthmatics and acid GER (GER+ve) and 29 atopic asthmatics without any GER (GER–ve). Methods. Each subject performed an MCh challenge in baseline (MCh_b), and 30 minutes after an acid drink (125 mL at pH = 2; MCh_ac), one day apart. PD₂₀FEV₁ MCh_b and MCh_ac were compared by estimating the area under the ROC curve (AU-ROC). Results. GER+ve and GER-ve subjects (well matched in baseline) had a different duration of esophageal acid contact (24-hour monitoring; pH-24h AU₄), and PD₂₀FEV₁ MCh_ac (both p < 0.001). AU-ROC was 86.3% (76% to 97%, 95%CI). Sensitivity and specificity of changes were 82.8% (72.9% to 92.7%, 95%CI) and 85.2% (75.9% to 94.5%, 95%CI), respectively. The difference in MCh threshold that maximized both the sensitivity and specificity level was 100 μ g. Conclusions. The esophageal acidification identified GER-related asthma with a good level of both sensitivity and specificity by enhancing the MCh response only in the presence of acid GER. Data are supporting the effectiveness of this procedure for clinical purposes.     

Chest tightness is relieved with the use of asthma drugs except bronchodilators

Objective: Many patients with a chief complaint of chest tightness are examined in medical facilities, and a lack of diagnosis is not uncommon. We have reported that these patients often include those with chest tightness relieved with bronchodilator use (CTRB) and those with chest tightness relieved with the use of asthma drugs except bronchodilators (CTRAEB). The purpose of this study was to demonstrate the clinical characteristics of the patients with CTRAEB and compare them with data from patients with CTRB. Methods: Patients with CTRB (n?=?13) and CTRAEB (n?=?7) underwent a bronchodilator test, assessments of airway responsiveness to methacholine, bronchial biopsy, and bronchial lavage under fiberoptic bronchoscopy before receiving treatment. In all, 10 healthy subjects, 11 bronchial biopsy control patients, and 10 asthmatic patients were recruited for comparison. Results: Inhalation of a short-acting ß₂-agonist (SABA) increased the forced expiratory volume in one second (FEV₁) by 5.1%?±?4.0% in patients with CTRB and by 1.3%?±?3.5% in patients with CTRAEB, and the difference was statistically significant (p?=?0.0449). The bronchial biopsy specimens from the patients with CTRB and CTRAEB exhibited significant increases in T cells (p?<?.05) compared with those of the control subjects. The bronchial responsiveness to methacholine was increased in only a minor portion of patients with CTRB and CTRAEB. Conclusions: We hypothesized that the clinical condition of patients with CTRAEB involves chest tightness arising from inflammation alone, and this chest tightness is mostly associated with airway T cells, without constriction of the airways. There is little to distinguish CTRAEB from CTRB aside from the response to bronchodilator treatment.

This clinical trial is registered at www.umin.ac.jp (UMIN13994, 13998, and 16741).     

The Prevalence of Airways Hyperresponsiveness in Members of an Exercise Training Facility

Athletes have a high prevalence (11–50%) of exercise-induced asthma, which may be caused by the hyperventilation accompanying repetitive bouts of strenuous exercise. We hypothesized that recreational exercisers would display a similar trend. Eucapnic voluntary hyperventilation (EVH) bronchoprovocation (breathing 21% O₂, 5% CO₂, and 74% N₂ at 60% of MVV for 5 minutes) was performed to determine the prevalence of airways hyperresponsiveness (AHR) in adults (n = 212, 146 males, mean ± standard deviation, age 32 ± 10 years) who exercised regularly (10 ± 10 years, 31 ± 28% of their lives): none had a previous diagnosis of asthma. AHR was defined by at least a 10%, 20%, or 25% decline in FEV₁, FEF_25–75, or PEFR, respectively, by spirometry at 1, 5, 10, and 15 minutes post-EVH. Forty-one of 212 (19%) tested positive for AHR: 20 of 41 (49%) were positive by FEV₁, 28 of 41 (68%) by FEF_25–75, and 27 of 41 (66%) by PEFR. Comparing responders with nonresponders: pre-EVH lung function was equivalent, except for FEV₁, which was reduced (p<0.05) in responders (96 ± 13 vs. 102 ± 12% predicted). Mean maximal negative deflections for responders were: for FEV₁, –17 ± 7%; FEF_25–75, –31 ± 10%; PEFR, –38 ± 11%. Ranges of decline for responders were: FEV₁, –10 to –33%; FEF_25–75, –20 to –59%; PEFR, –25– to –70%. We conclude that in these regular exercisers, the prevalence of AHR is high and comparable with some athletic populations.     

Correlation of Exhaled Nitric Oxide Levels and Airway Inflammation Markers in Stable Asthmatic Patients

Monitoring of inflammation is an important factor in asthma management. The gold standard for measuring direct airway inflammation is bronchial biopsy specimens taken from proximal airways through a fiberoptic bronchoscope. As a noninvasive procedure, the use of exhaled nitric oxide (Fe_NO) for monitoring airway inflammation has been reported in many studies. The aim of this study was to evaluate the correlation of Fe_NO with direct measurements of airway inflammation in biopsy specimens and pulmonary function tests (PFT). Histopathologic features were observed on bronchial biopsy specimens obtained from nine stable mild-moderate asthmatics. Each subject had measurements of PFT, Fe_NO levels, blood eosinophil count, and bronchoscopy with bronchial biopsies and bronchoalveolar lavage. Five subjects with forced expiratory volume in 1 second >80% had methacholine challenge test. None of the subjects had prior anti-inflammatory therapy for asthma. No correlation was found between PFT, blood eosinophil count, and Fe_NO levels. There was a negative correlation between PC20 and Fe_NO. Though there was no correlation between bronchial biopsy eosinophil, monocyte and lymphocyte counts, and Fe_NO, we found a weak positive correlation between total inflammatory cell count in bronchial biopsies and Fe_NO levels. A negative significant correlation was found between Fe_NO levels and epithelial desquamation (p<0.05, r = ?0.7). These results suggest that, Fe_NO levels reflect the increased number of activated inflammatory cells in airways and the negative correlation with epithelial desquamation reflects the role of epithelium in NO syntheses. Fe_NO should not be interpreted as a specific inflammation marker for asthma.