Effects of ageing on the alveolar pores of Kohn and on the cytoplasmic components of alveolar type II cells in monkey lungs

The effects of ageing on the numbers of alveolar pores of Kohn and on the cytoplasmic components of alveolar type II cells were studied in monkey lungs by scanning and transmission electron microscopy. Lung tissue from 26 female and three male pigtail macaques whose ages ranged from 1 month to 31 years (life span is 35 years) was analysed. From the age of 1 month to 10 years there was a significant increase in the number of alveolar pores (r = 0.85, p less than 0. 001); however, between the ages of 14 years to 31 years there was no significant change. In seven animals ranging in age from 1 month to 4 years (mean 2.4 years) the number of pores was 5.8 +/- 3.9 (mean +/- S.D.), whereas in 10 animals aged 16 to 31 years (mean 20.3 years) the number of pores was 32.7 +/- 17.5 (mean +/- S.D.) per alveolar profile, a significant difference (p less than 0.002). In older animals (15-20 years) there was a significant decrease, both in the number of lamellar bodies per alveolar type II cell (p less than 0.01) and in the volume density of lamellar bodies to cytoplasmic volume (p less than 0.05) compared with young animals (1 month to 4.8 years). In older animals, there was also a significant increase in the volume density of a vacuole-like dilatation of the endoplasmic reticulum in alveolar type II cells (p less than 0.05) compared with young animals. These findings suggest impaired pulmonary surfactant production with aging. Both the increased number of alveolar pores and the postulated decrease of surfactant production could play a role in the pathogenesis of pulmonary emphysema.     

不同临床表型COPD频繁和非频繁发作患者气道巨噬细胞的异质性

目的：比较频繁发作(frequent exacerbator,FE)和非频繁发作(infrequent exacerbator,iFE)的不同临床表型的 慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)患者的临床特征及诱导痰中巨噬细胞的异质性。方法： 分析80例慢性支气管炎(chronic bronchitis,CB)、肺气肿(emphysema,EM)、哮喘-COPD重叠(asthma-COPD overlap, ACO)表型的COPD急性发作住院患者的临床特征;采用流式细胞术检测诱导痰巨噬细胞CCL3和CD163的表达,定 量聚合酶链反应(quantitative PCR,qPCR)检测HIF-1α和Cav-1的表达。结果：FE和iFE患者在年龄,第1 s用力呼气容积 (forced expiratory volume in one second,FEV1)/用力肺活量(forced vital capacity,FVC),痰细菌阳性率,COPD评估测试 (COPD Assessment Test,CAT)评分,改良医学研究委员会(Modifi ed Medical Research Council,mMRC)评分方面的差异 有统计学意义(P<0.05);相对于iFE患者,FE患者诱导痰巨噬细胞上CCL3荧光强度明显降低(P<0.01),而CD163显著增 高(P<0.01),同时HIF-1α和Cav-1 mRNA水平也显著升高(P<0.01)。CB表型的FE患者与iFE患者之间在年龄,痰细菌阳 性率,CAT评分,mMRC评分方面的差异有统计学意义(P<0.05);相对于iFE患者,FE患者诱导痰巨噬细胞上CCL3荧 光强度轻度降低(P>0.05),而CD163显著增高(P<0.01),同时HIF-1α和Cav-1 mRNA水平也显著升高(P<0.01)。EM表型 的FE患者与iFE患者之间在年龄,病程,FEV1/FVC,痰细菌阳性率,CAT评分,mMRC评分方面的差异有统计学意义 (P<0.05);相对于iFE患者,FE患者诱导痰巨噬细胞CCL3荧光强度轻度减低(P>0.05),而CD163轻度升高(P>0.05),同 时HIF-1α水平轻度升高(P>0.05),Cav-1水平则显著增加(P<0.01)。ACO表型的FE与iFE患者所有临床特征差异均无统计 学意义,FE患者诱导痰巨噬细胞CCL3荧光强度明显低于iFE患者(P<0.01),而CD163差异无统计学意义(P>0.05),同 时HIF-1α(P<0.01)和Cav-1(P<0.05)表达也显著增加。全部FE及CB表型FE患者CCL3与HIF-1α和Cav-1均呈显著负相关, CD163仅与HIF-1α呈显著正相关;EM表型FE患者CD163与HIF-1α呈显著正相关;ACO表型FE患者CCL3与HIF-1α呈显 著负相关,而CD163与HIF-1α呈显著正相关。结论：CB,EM,ACO表型FE和iFE患者临床特征差异不一,诱导痰中替 代活化巨噬细胞(M2)在FE患者中占优势,HIF-1α可能在其极化过程中起关键作用。     

Spontaneous compressive orbital emphysema of rhinogenic origin

We report the case of a young patient who developed spontaneous compressive orbital emphysema after an attack of coughing. At admission the patient presented left proptosis, diplopia, vision impairment and headache. Computer tomography showed air in the lateral part of left orbit compressing the eyeball and the optic nerve medially. It also revealed a sphenoid bone dysplasia with hyperpneumatization of the left greater wing and with two dehiscences in its wall. It was very intriguing to discover that this sphenoid dysplasia and the flap of mucosa covering one dehiscence were causing a ball-valve effect, allowing air to enter but not leave the orbit. Endoscopic sinus surgery was successfully used to treat this case. Received: 3 April 2000 / Accepted: 5 September 2000     

肺减容术治疗重度肺气肿临床探讨

目的 研究肺减容术对重度肺气肿的手术适应证和临床疗效。方法 选择２０例重度肺气肿患者,经胸骨正中劈开切口或电视辅助胸腔镜途径,用直线切割缝合器或Ｅｎｄｏ ＧＩＡ,切除因过度膨胀而破坏的、无功能肺组织。每侧肺切除其容量的２０％￣３０％。结果术后呼吸困难明显减轻或消失;９５％患者呼吸困难指数从４￣５级转变为１￣２级。肺功能１秒时间肺活量（ＦＥＶ１）增加４１．４％,残气量（ＲＶ）和肺总量（ＴＬＣ）分别     

肺功能严重减低对肺癌手术的影响

目的 探讨肺功能严重减低对肺癌手术的影响和术前肺功能检测对评估手术风险的价值。方法 回顾性分析285例经手术治疗肺癌患者的临床资料。所有病例分为肺功能严重减低组和肺功能相对正常组。分析两组手术死亡率和术后呼吸系统及相关系统并发症发生率的差别。结果 两组间手术死亡率和术后呼吸系统及相关系统并发症发生率无统计学差别。结论 术前肺通气功能测定尚不能全面准确地预测手术的危险性。对于有严重肺功能减低的肺癌患者应结合其他情况综合考虑，仍应给予手术机会，尽可能争取肺叶切除术，以减少手术风险。     

中药脑肺康对地鼠实验性肺气肿及肺动脉高压的防治作用

目的 观察中药肺康对缺氧性肺动脉高压和肺气肿的防治效果并探讨其作用机制。方法 以弹性蛋白酶溶液滴注入金黄地鼠气管内,正常饲养３０ｄ后,常压下缺氧１５ｄ,分别设立中药脑肺康预防组、治疗组、肺气肿＋缺氧组及正常对照组。于处死动物前,测量平均肺动脉压,取静脉血进行循环内皮细胞计数;处死后测量右心肥大指数,光镜下计数左侧肺支气管肺泡灌洗液内细胞总数,对右侧肺进行光镜图像分析。结果 中药脑肺康预防组和治疗３     

Response to nitric oxide in term and preterm infants

The response to three levels (10 ppm, 20 ppm and 40 ppm) of nitric oxide (NO) was assessed in 30 infants, median gestational age 30 (range 24–42) weeks. All the infants required an inspired oxygen concentration of more than 0.5, despite receiving surfactant where appropriate. All but one infant had a positive response to NO (median reduction in the oxygenation index (OI) was 33%, range −9%–90%), but only 20 infants showed a greater than 20% reduction in the OI. There was no obvious relationship of the optimum NO level (i.e. that associated with the maximum reduction in OI) and either diagnosis (congenital diaphragmatic hernia, meconium aspiration syndrome, respiratory distress syndrome, pulmonary interstitial emphysema (PIE), hydrops and sepsis) or maturity, except that five of six infants with PIE responded best to 40 ppm, as did eight of nine infants less than 28 weeks gestational age. We conclude NO dosage should be individualized and NO levels up to 40 ppm should be considered in very immature infants. Received: 15 March 1996 / Accepted: 5 February 1997     

全反式维甲酸对大鼠肺气肿模型的干预作用及对MMP-9和TIMP-1表达的影响

目的 研究全反式维甲酸（ATRA）对大鼠肺气肿模型的干预作用及其作用机制。方法 建立吸烟肺气肿大鼠模型，将40只雄性Wistar大鼠随机分为健康对照组（A组，10只）和吸烟组（30只），吸烟组再随机分为模型组（B组，10只）、生理盐水对照组（C组，10只）、维甲酸干预组（D组，10只），后两组于吸烟6个月后分别每日子ATRA 20mg／kg（D组）和相同剂量生理盐水（C组）灌胃进行干预，通过苏木精-伊红染色评价ATRA的干预作用，用原位杂交和免疫组化等方法观察肺组织基质金属蛋白酶-9（MMP-9）、金属蛋白酶组织抑制因子-1（TIMP-1）的mRNA及蛋白的表达。用免疫组化法观察Ⅳ型胶原在肺组织的表达。结果 与A组相比，B组肺组织MMP-9、TIMP-1 mRNA和蛋白的表达均明显上升（均P〈0．01）；与B组、C组相比，D组肺组织MMP-9mRNA和蛋白的表达显著减少（均P〈0．01），而TIMP-1表达明显上升（均P〈0．05）；平均肺泡数增加，PaO2、氧饱和度明显改善。结论 ATRA能一定程度上减轻吸烟诱导的大鼠肺气肿，且这种效应可能与ATRA抑制MMP-9和增强TIMP-1表达有关。     

Emphysema induced by elastase enhances acute inflammatory pulmonary response to intraperitoneal LPS in rats

Abnormalities in lungs caused by emphysema might alter their response to sepsis and the occurrence of acute lung injury (ALI). This study compared the extension of ALI in response to intraperitoneal lipopolysaccharide (LPS) injection in Wistar rats with and without emphysema induced by elastase. Adult male Wistar rats were randomized into four groups: control, emphysema without sepsis, normal lung with sepsis and emphysema with sepsis. Sepsis was induced, and 24 h later the rats were euthanised. The following analysis was performed: blood gas measurements, bronchoalveolar lavage (BAL), lung permeability and histology. Animals that received LPS showed significant increase in a lung injury scoring system, inflammatory cells in bronchoalveolar lavage (BAL) and IL‐6, TNF‐α and CXCL2 mRNA expression in lung tissue. Animals with emphysema and sepsis showed increased alveolocapillary membrane permeability, demonstrated by higher BAL/serum albumin ratio. In conclusion, the presence of emphysema induced by elastase increases the inflammatory response in the lungs to a systemic stimulus, represented in this model by the intraperitoneal injection of LPS.     

Massive Subcutaneous Emphysema in Robotic Sacrocolpopexy

The advent of robotic surgery has increased the popularity of laparoscopic sacrocolpopexy. Carbon dioxide insufflation, an essential component of laparoscopy, may rarely cause massive subcutaneous emphysema, which may be coincident with life-threatening situations such as hypercarbia, pneumothorax, and pneumomediastinum. Although the literature contains several reports of massive subcutaneous emphysema after a variety of laparoscopic procedures, we were not able to identify any report of this complication associated with laparoscopic or robotic sacrocolpopexy. Massive subcutaneous emphysema occurred in 3 women after robotic sacrocolpopexy in our practice. The patients had remarkable but reversible physical deformities lasting up to 1 week. A valveless endoscopic dynamic pressure system was used in all 3 of our cases. Our objective is to define the risk of massive subcutaneous emphysema during robotic sacrocolpopexy in light of these cases and discuss probable predisposing factors including the use of valveless endoscopic dynamic pressure trocars.