Congenital lobar emphysema

Summary Congenital lobar emphysema is reported occurring in a 10 day old, low birth weight infant. Following resection, gross examination of the affected lobe revealed collapsed but unobstructed bronchi, suggesting a cartilaginous defect. The specimen was insufflated with formalin and the bronchial tree dissected out. Histological study including comparison with a normal pulmonary lobe, confirms that abnormalities of cartilage may be important in the pathogenesis of congenital lobar emphysema.     

Endoscopic lung volume reduction coils for patients with severe emphysema—a single-centre retrospective analysis

 Open in a separate windowOBJECTIVESPatients with chronic obstructive pulmonary disease and lung emphysema may benefit from surgical or endoscopic lung volume reduction (ELVR). Previously reported outcomes of nitinol coil-based ELVR techniques have been ambiguous. The analysis was done to analyse outcomes of ELVR with nitinol coils in patients with severe pulmonary emphysema.METHODSFrom September 2013 to November 2014, our centre performed a total of 41 coil implantations on 29 patients with severe emphysema. Coils were bronchoscopically placed during general anaesthesia. Twelve out of 29 patients received staged contralateral treatments up to 112 days later to avoid bilateral pneumothorax. Lung function and 6-min walking distance were assessed 1 week prior, 1 week after as well as 6–12 months after the procedure. Patients were followed up to 48 months after ELVR and overall mortality was compared to a historic cohort.RESULTSWhile coil-based ELVR led to significant short-term improvement of vital capacity (VC, +0.14 ± 0.39 l, P = 0.032) and hyperinflation (Δ residual volume/total lung capacity −2.32% ± 6.24%, P = 0.022), no significant changes were observed in 6-min walking distance or forced expiratory volume in 1 s. Benefits were short-lived, with only 15.4% and 14.3% of patients showing sustained improvements in forced expiratory volume in 1 s or residual volume after 6 months. Adverse events included haemoptysis (40%) and pneumothorax (3.4%), major complications occurred in 6.9% of cases. Overall survival without lung transplant was 63.8% after 48 months following ELVR, differing insignificantly from what BODE indices of patients would have predicted as median 4-year survival (57%) at the time of ELVR treatment.CONCLUSIONSELVR with coils can achieve small and short-lived benefits in lung function at the cost of major complications in a highly morbid cohort. Treatment failed to improve 4-year overall survival. ELVR coils are not worthwhile the risk for most patients with severe emphysema.     

中医治疗肺气肿的思路与方法

肺气肿的中医病机主要是正虚而痰瘀互结,阻滞肺脏,累及脾肾。治疗当以益肺宣肺、活血化浊气为法。发作期标实为急,当宣肺散邪;缓解期以本虚为主,治疗当以扶正为主,佐化痰降浊。     

New therapies for chronic obstructive pulmonary disease,lung regeneration

Chronic obstructive pulmonary disease (COPD) is characterized by the presence of airflow limitations that are not fully reversible and is a major cause of chronic morbidity and mortality worldwide. Although there has been extensive research examining the molecular mechanisms underlying the development of COPD, there is no proven clinically effective treatment for promoting recovery from established COPD. At present, regeneration is the only hope for a cure in patients with COPD. In this article, we review current treatments for COPD, focusing particularly on recent advances in lung regeneration based on two major approaches: regeneration-promoting agents and cell therapy. Retinoic acids are the major focus among regeneration-promoting agents, while mesenchymal stem cells are the main topic in the field of cell-based therapy. This article aims to provide valuable information for developing new therapies for COPD.     

骨髓间充质干细胞移植治疗肺气肿：静脉和气管途径谁更有优势？

背景：骨髓间充质干细胞移植可以抑制肺气肿炎症反应及细胞凋亡,治疗肺功能严重损害已经得到实验证实。目的：探讨不同途径移植骨髓间充质干细胞对实验性肺气肿炎症反应及细胞凋亡的抑制作用。方法：Wistar雌性大鼠随机分对照组、静脉组及气管组,均用烟熏加气管内滴注猪胰弹性蛋白酶法建立肺气肿模型。静脉组和气管组经尾静脉及气管途径移植雄性大鼠骨髓间充质干细胞,对照组尾静脉和气管内注射PBS,移植后14 d观察大鼠肺组织病理学变化,检测肺泡壁细胞凋亡指数,支气管肺泡灌洗液肿瘤坏死因子α水平。结果与结论：与对照组相比,静脉组及气管组均能减轻肺气肿病理改变,降低肿瘤坏死因子α水平及凋亡指数,差异有显著性意义(P < 0.01);但是静脉组与气管组比较,肺气肿病理改变、肿瘤坏死因子α水平及凋亡指数差异无显著性意义(P > 0.05)。结果表明两种途径移植骨髓间充质干细胞对肺气肿均有明显的治疗作用,从方便易行的角度考虑经静脉移植骨髓间充质干细胞治疗肺气肿较为有优势。中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程全文链接：     

李氏清暑益气汤临床新用

李庭凯教授在多年的临床诊疗过程中,总结了丰富的经验,形成了独特的理论辩证体系.笔者从师待诊观察到导师临床应用清暑益气汤加减治疗疑难杂症取得了较好的疗效,导师所用清暑益气汤是李东垣清暑益气汤出自〈脾胃论〉,方由黄芪、人参、甘草、当归、麦冬、五味子、青皮、陈皮、神曲、黄柏、葛根、苍术、白术、升麻、泽泻等药味组成.本方证是治疗夏季伤暑,四肢困倦,胸脘满闷,汗出口渴,小便赤,大便溏等气阴两虚证.导师在临床运用中谨守病机,灵活变通,现举几例略述之.     

Prevalence of obstructive lung disease in HIV population: a cross sectional study

Background

Observational studies have suggested an association between HIV infection and emphysema.

Aims

The primary aim of this study was to estimate the prevalence of obstructive lung disease in HIV-infected patients seen in an outpatient infectious disease clinic. The secondary aim was to estimate the prevalence of Obstructive Lung Disease (OLD) in smokers and non smokers in this population.

Methods

This was a prospective cross-sectional study. Consecutive patients who were seen for routine HIV care underwent spirometry and answered the St. George’s Respiratory Questionnaire (SGRQ). Further, we collected information from the charts on demographics, co-morbidities, CD4 cell count, and HIV viral load (current, baseline, etc).

Results

This study included 98 HIV-infected patients with mean age of 45 years, (SD: 11) and 84% male. They were seen from November 2008 to May 2009 at Thomas Jefferson University in Philadelphia. According to established criteria, spirometry results were classified as normal in 69% and obstructive in 16.3%. Among those who never smoked, the prevalence of obstructive lung disease on spirometry was 13.6%. The prevalence of obstruction in HIV patients with a history of smoking was 18.5%. Current and ever smokers comprised 21.4% and 55% of the patients respectively. The mean SGRQ total score was 7. The mean SGRQ score in active smokers was 17 and 15 in those subjects with a prior history of smoking. The mean SGRQ score among patients with obstruction in spiromerty was 27.7 in patients with obstruction on spirometry.

Conclusion

This urban population of HIV-infected persons has a relatively high prevalence of obstructive lung disease as assessed by spirometry. Furthermore, the high prevalence of obstructive lung disease in never smokers may suggest a possible association between HIV infection and emphysema. In addition the SGRQ total score was comparatively higher in patients with obstruction on spirometry. Our data suggests that potentially all patients with HIV should be screened a for OLD.     

全反式维甲酸治疗对大鼠肺气肿动脉血气变化的研究

目的观察研究不同浓度全反式维甲酸（ATRA）对猪胰蛋白酶（PPE）构建的大鼠肺气肿动脉血气变化的情况。方法 60只Wistar大鼠随机分为对照组（N）和模型组（E）,棉籽油组（C）,小剂量ATRA治疗组（L）,中剂量ATRA治疗组（M）,大剂量ATRA治疗组（H）,每组各10只,一次性气管内注入PPE构建大鼠肺气肿模型后,用大、中、小剂量ATRA和棉籽油注入大鼠腹腔内进行治疗。30天后测量大鼠体重,动脉血气分析。结果 L组大鼠动脉血气分析较E组有显著改善（P〈0.05）,接近N组水平;C、M、H组动脉血气未见明显效果,且有缺氧明显趋势。结论低剂量ATRA治疗大鼠肺气肿对改善动脉血气具有较好的效果。