中药814对地鼠实验性肺气肿的保护作用

目的：进一步探讨慢性阻塞性肺疾病（COPD）的发病机理,寻找防治用药,方法：给药鼠气道内1次滴注猪胰弹性蛋白酶复制肺气肿动物模型,以及附加烟雾吸入,分别用中药814灌胃治疗1个月及3个月。观察肺组织形态,肺动脉压（PAP）,血清a1-抗胰蛋白酶（a1-AT）,丙二醛（MDA）,β－葡萄糖醛酸酶（β-g),肺组织前列腺素类（PGs)的变化,结果：1个月时形成中度肺气肿,PAP、β-g、MDA、PGE2、及TXB2／6－keto-PGF1a均显著升高（P＜0．05或＜0．01）,而3个月时a1-AT下降（P＜0．05）。至3个月时或附加烟雾吸入组,上述指标多元进一步的显著变化,中药814对肺组织形态学改变,PAP,β-g,MDA及TXB2／6－keto-PGF1a的升高以及a1-AT的下降有一定的缓解作用,结论：抗蛋白酶之间的失衡是COPD发病学的关键因素,中药814有一定保护作用。     

Overestimated frequency of a possible emphysema-susceptibility allele when microsomal epoxide hydrolase is genotyped by the conventional polymerase chain reaction-based method

A recent association study suggested that the His113 variant of microsomal epoxide hydrolase (mEPHX) may confer a risk for development of emphysema, presumably by increasing susceptibility to smoking injury. Before considering a possible role of this enzyme in pulmonary disease, we attempted to characterize the genetic polymorphism further. The Tyr/His113 polymorphism within exon 3 of mEPHX was initially examined in 62 healthy individuals by conventional methods involving polymerase chain reaction (PCR)-based determination of a restriction fragment length polymorphism (RFLP). Genomic nucleotide sequences, including the polymorphic site and the downstream primer sequence, were further analyzed in 95 unrelated, healthy Japanese volunteers by single-stranded conformation polymorphism (SSCP) analysis and direct sequencing. Genotyping by the first method (PCR-RFLP) revealed that the allelic distribution in our test population apparently deviated from Hardy-Weinberg equilibrium. Sequence analysis showed that a synonymous nucleotide substitution, AAG to AAA (Lys119), was located just within the published primer site. The AAA at codon 119 was present only in alleles with Tyr113, and its frequency reached 0.31 in our panel of 190 Japanese alleles. This substitution potentially hampered PCR amplification because of the nucleotide mismatch, with the result that the frequency of the Tyr113 variation was underestimated. The frequency of His113, a possible emphysema susceptibility allele of the mEPHX gene, was thus overestimated when human DNA samples were genotyped in the conventional way. Depending on the population(s) tested, this anomaly could represent a pitfall for PCR-based association studies. Received: September 27, 2000 / Accepted: November 10, 2000     

Chemical and nutritional analysis of seeds from purple and white açaí (Euterpe oleracea Mart.)

Seeds from the purple and the white fruit produced by the Amazonian palm, Euterpe oleracea Mart., commonly called “açai”, were analyzed by solid state ¹H-decoupled ¹³C CPMAS and MAS NMR, solution NMR and LC–MS/MS. The goal was to distinguish the seeds from each colored fruit and determine their spectra for the first time. The seeds of each variety contained primarily glycosidic carbons, due to their cellulose and hemicellulose content. They also contained carbons due to CO, CC, as well as aliphatic carbons. The insoluble fiber found in açaí pulp is distinguishable from the seed of the fruit by its unique solid state ¹H-decoupled ¹³C CPMAS NMR spectra. The seed also contains fats (0.22–0.33%) not previously reported. The seed contains a mixture of saturated and unsaturated fats. There are also 3.38–4.70% total methanolic extractables, with no detectable cyanidin 3-O-glucoside or cyanidin 3-O-rutinoside, unlike the pulp which contains both cyanidins. When the NMR spectra of the white and purple açaí seeds are compared, it was possible to observe differences between these two açaí varieties, as well as differences between the composition of pulp of the fruit and its seed.     

Cribado de cáncer de pulmón: catorce años de experiencia del Programa Internacional de Detección Precoz de Cáncer de Pulmón con TBDR de Pamplona (P-IELCAP)

Introduction and objectivesEuropean experience regarding lung cancer screening using low-dose chest CT (LDCT) is available. However, there is limited data on the Spanish experience in this matter. Our aim is to present the results from the longest ongoing screening program in Spain.MethodologyThe Pamplona International Early Lung Cancer Detection Program (P-IELCAP) is actively screening participants for lung cancer using LDCT since year 2000 following the IELCAP protocol, including spirometric assessments. Men and women, ≥ 40 years of age, current or former smokers with a tobacco history of ≥ 10 pack-years are included. Results are compared to those from other European trials.ResultsA total of 2989 participants were screened until March 2014 (73% male). A median of 2 (IQR 1-3) annual screening rounds were performed. Sixty lung cancers were detected in 53 participants (73% in Stage I). Adenocarcinoma was the most frequent. The lung cancer prevalence and incidence proportion was 1.0% and 1.4%, respectively, with an annual detection rate of 0.41. The estimated 10-year survival rate among individuals with lung cancer was 70%. Chronic obstructive pulmonary disease and emphysema are important lung cancer predictors.ConclusionsThe experience in Spain's longest lung cancer screening program is comparable to what has been described in the rest of Europe, and confirms the feasibility and efficacy of lung cancer screening using LDCT.     

特发性肺间质纤维化是否合并肺气肿患者的临床特征对比分析

目的 探讨特发性肺间质纤维化（IPF）是否合并肺气肿患者的临床特点、肺功能、影像学及其预后的差异.方法 选择IPF且符合肺纤维化合并肺气肿（CPFE）诊断的患者43例（观察组）,选择同期确诊的单纯IPF未合并肺气肿患者40例（对照组）,对比分析两组患者的临床资料、肺功能、血氧分压、支气管肺泡灌洗液（BALF）细胞成分及生存时间的差异.结果 观察组吸烟指数为（29±17）包年,明显高于对照组的（17± 15）包年,差异有统计学意义（P＜0.05）.观察组第1秒用力呼气容积（FEV1）/用力肺活量（FVC）占预计值百分比为（70±6）％,明显低于对照组的（84±9）％,差异有统计学意义（P＜0.05）;观察组一氧化碳弥散量（DLCO）占预计值百分比为（43±11）％,明显低于对照组的（55±17）％,差异有统计学意义（P＜0.05）.观察组肺总量占预计值百分比（78±12）％,明显高于对照组的（63±11）％,差异有统计学意义（P＜0.05）,两组肺活量占预计值百分比及静息状态下动脉血氧分压比较差异无统计学意义（P＞0.05）.两组BALF细胞总数、巨噬细胞、中性粒细胞、淋巴细胞及嗜酸粒细胞百分率比较差异无统计学意义（P＞0.05）.结论 吸烟为IPF合并肺气肿的重要危险因素,合并肺气肿不影响IPF患者的预后.     

肺气肿的无创影像学测量进展

肺气肿为呼吸系统常见病,是一种以终末细支气管远端气腔永久性扩大,伴肺泡壁破坏及肺弹性收缩功能障碍为特点的进行性损坏性疾病。因而早期诊断对于肺气肿的治疗及预后均有着极其重要的意义,本文将从影像学角度分别以X线胸片、胸部CT及核磁共振成像三方面对比研究肺气肿的影像学表现及诊断。     

A new experimental model of cigarette smoke-induced emphysema in Wistar rats,

OBJECTIVE:

To describe a new murine model of cigarette smoke-induced emphysema.

METHODS:

Twenty-four male Wistar rats were divided into two groups: the cigarette smoke group, comprising 12 rats exposed to smoke from 12 commercial filter cigarettes three times a day (a total of 36 cigarettes per day) every day for 30 weeks; and the control group, comprising 12 rats exposed to room air three times a day every day for 30 weeks. Lung function was assessed by mechanical ventilation, and emphysema was morphometrically assessed by measurement of the mean linear intercept (Lm).

RESULTS:

The mean weight gain was significantly (approximately ten times) lower in the cigarette smoke group than in the control group. The Lm was 25.0% higher in the cigarette smoke group. There was a trend toward worsening of lung function parameters in the cigarette smoke group.

CONCLUSIONS:

The new murine model of cigarette smoke-induced emphysema and the methodology employed in the present study are effective and reproducible, representing a promising and economically viable option for use in studies investigating the pathophysiology of and therapeutic approaches to COPD.     

Combined pulmonary fibrosis and emphysema: an increasingly recognized condition

Combined pulmonary fibrosis and emphysema (CPFE) has been increasingly recognized in the literature. Patients with CPFE are usually heavy smokers or former smokers with concomitant lower lobe fibrosis and upper lobe emphysema on chest HRCT scans. They commonly present with severe breathlessness and low DLCO, despite spirometry showing relatively preserved lung volumes. Moderate to severe pulmonary arterial hypertension is common in such patients, who are also at an increased risk of developing lung cancer. Unfortunately, there is currently no effective treatment for CPFE. In this review, we discuss the current knowledge of the pathogenesis, clinical characteristics, and prognostic factors of CPFE. Given that most of the published data on CPFE are based on retrospective analysis, more studies are needed in order to address the role of emphysema and its subtypes; the progression of fibrosis/emphysema and its correlation with inflammation; treatment options; and prognosis.     

胸腔镜手术治疗老年肺气肿自发性气胸43例

目的探讨胸腔镜手术治疗老年肺气肿自发性气胸的适应证和手术方法。方法1994年9月～2011年12月,胸腔镜手术治疗43例老年肺气肿自发性气胸。单发或成簇大疱者行完全胸腔镜手术（video－assisted thoracosc opiesurgery,VATS）,多发肺大疱和经济较困难者行胸腔镜辅助小切口手术（video－assisted minithoracotomy,VAMT）,中重度肺气肿肺大疱切除或肺减容者行胸腔镜辅助小切口管状奈维垫片手术（VAMT＋Neoveiｌ）。结果VATS组16例,VAMT组15例,VAMT＋Neoveil组12例。术后持续漏气超过15天8例,无其他并发症,均治愈出院,无死亡。随访1年5例,2～4年38例,复发2例,经胸腔闭式引流术治愈。结论电视胸腔镜手术是治疗老年肺气肿自发性气胸有效的治疗方法,直线切割缝合器加管状奈维垫片切除肺气肿肺大疱术后胸腔引流时间和住院时间短,并发症少,且操作简单,安全确切,扩大肺气肿自发性气胸手术适应证。     

血管内皮生长因子与慢性阻塞性肺疾病

慢性阻塞性肺疾病是一个发病率和死亡率都很高的慢性疾病，其发病机制涉及肺内细胞的凋亡，肺实质细胞的减少，炎性细胞的浸润和气道、血管的重构。血管内皮生长因子作为一个可特异作用于内皮细胞，调节血管内皮细胞生长、分化、修复及发挥功能的重要因子，与慢性阻塞性肺疾病的发生有着密切的联系。