BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the c...BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.展开更多
Silicosis,a major persistent occupational disease in China,is a progressive and irreversible pulmonary fibrosis disease with unclear pathogenesis.Cellular senescence,a state of stable cell cycle arrest that is recogni...Silicosis,a major persistent occupational disease in China,is a progressive and irreversible pulmonary fibrosis disease with unclear pathogenesis.Cellular senescence,a state of stable cell cycle arrest that is recognized as a key underlying factor in age-related fibroproliferative disorders,plays an important role in chronic lung diseases,particularly pulmonary fibrosis.We previously reported that SiO2-stimulated mice and alveolar type II epithelial cells develop cellular senescence,which is involved in silicosis formation in alveolar type II epithelial cells[1].Cellular senescence may play an important role in silicosis development;however,the exact underlying mechanisms are not fully understood.展开更多
BACKGROUND Cardiopulmonary changes in noncirrhotic portal hypertension(NCPH)are poorly understood.AIM To investigate cardiopulmonary changes using transthoracic echocardiography(TTE)in NCPH and their correlation with ...BACKGROUND Cardiopulmonary changes in noncirrhotic portal hypertension(NCPH)are poorly understood.AIM To investigate cardiopulmonary changes using transthoracic echocardiography(TTE)in NCPH and their correlation with clinical features.METHODS Prospective cohort including 10 preclinical NCPH[without portal hypertension(PH)]and 32 NCPH subjects who underwent TTE with agitated saline injection and comprehensive clinical evaluation were assessed.PH was defined by presence of either varices,ascites or portosystemic shunting.Intrapulmonary vascular dilatation(IPVD)is defined as appearance of microbubbles in the left atrium after three heartbeats.Right ventricular systolic pressure(RVSP)>38 mmHg was used to identify possible porto-pulmonary hypertension.Cardiomyopathy is defined using cirrhotic cardiomyopathy consortium criteria.RESULTS Among 42 subjects,17(40%)had IPVD,4(9.5%)had RVSP>38 mmHg,and 6(14%)had cardiomyopathy.Aspartate aminotransferase to alanine aminotransferase(AST/ALT)(1.3 vs 1,P=0.04)and liver stiffness measurement(LSM)(12.4 kPa vs 7.1 kPa,P=0.03)were higher in those with IPVD.Presence of either LSM>10 or AST/ALT>1.2 aided in identifying subjects with IPVD-sensitivity,specificity,and accuracy of 76%.RVSP correlated with oxygen saturation(r=-0.33),and free right hepatic vein pressure(r=0.43).Those with PH had higher left atrial volume(LAV)(62 mL vs 48 mL,P<0.01),and LAV index(LAVI)(35 m^(2) vs 23 m^(2),P<0.01)compared to those without PH.Total bile acids,especially primary bile acids positively correlated with LAV(r=0.36),and LAVI(r=0.41).CONCLUSION Similar to cirrhotic patients,cardiopulmonary changes are prevalent in NCPH,especially among those with PH.In NCPH,cardiopulmonary changes occur despite preserved synthetic function,suggesting the NCPH model's value in understanding cardiopulmonary dysfunction in liver disease.展开更多
OBJECTIVE:To investigate the mechanisms of the effect of Shenji Guben(SJGB)decoction(参吉固本方)on chronic obstructive pulmonary disease(COPD).METHODS:A murine model of COPD was established through lipopolysaccharide(...OBJECTIVE:To investigate the mechanisms of the effect of Shenji Guben(SJGB)decoction(参吉固本方)on chronic obstructive pulmonary disease(COPD).METHODS:A murine model of COPD was established through lipopolysaccharide(LPS)nasal drops and passive smoke exposure,followed by evaluation of SJGB decoction efficacy via lung function tests and histological analysis.Non-targeted liquid chromatography-mass spectrometry(LC-MS)-based metabolomics was used to explore the mechanisms of SJGB decoction in COPD.RESULTS:We found that the SJGB decoction effectively reduced inflammatory cell infiltration in the airways and lungs,and improved lung function in the COPD model mice.LC-MS-based metabolomics identified 86 biomarkers in COPD models.Compared to the model group,SJGB decoction significantly altered 34 metabolites.Prostaglandin E2 and DL-Citrulline were highlighted as two representative differential metabolites.MetaboAnalyst 5.0 highlighted glycerophospholipid and riboflavin metabolisms as key pathways affected by SJGB decoction.CONCLUSION:This study evaluated the protective effect of SJGB decoction against COPD and provided insights into its potential mechanisms in COPD treatment.展开更多
Identifying the cause of respiratory tract infections is important for reducing the burden of diagnosis and treatment.To assess viral etiologies of hospitalized patients with pulmonary infection,bronchoalveolar lavage...Identifying the cause of respiratory tract infections is important for reducing the burden of diagnosis and treatment.To assess viral etiologies of hospitalized patients with pulmonary infection,bronchoalveolar lavage fluid(BALF)specimens were collected from non-COVID-19 adult patients(n=333,including patients with lower respiratory tract infection,tuberculosis,lung cancer,and pulmonary nodules)between November 2020 and November 2021.Multiple common respiratory pathogens were detected using multiplex reverse-transcription polymerase chain reaction.The result showed that at least one virus was identified in 35.44%(118/333)of the cases.Among these,influenza virus was the most commonly identified,followed by the parainfluenza virus,coronavirus,human rhinoviruses,and human respiratory syncytial viruses.The tuberculosis group demonstrated the highest viral detection rate,yet paradoxically exhibited the lowest co-infection rate.In contrast,the highest co-infection frequency was observed in the pulmonary nodules group.Patients with viral infections exhibited more severe clinical symptoms compared to those without detected viral infections.However,this observation was only noted in the lower respiratory tract infection group among the different disease groups.Notably,among patients infected with a specific virus,there were no significant differences in viral load between single and co-infections.Our study identified the major causative agents in hospitalized adult patients with pulmonary infection,offering insights for precise disease diagnosis and the prevention of unnecessary use of antimicrobial drugs.展开更多
Background:Metabolic abnormalities are considered to play a key regulatory role in vascular remodeling of pulmonary arterial hypertension.However,to date,there is a paucity of research documenting the changes in metab...Background:Metabolic abnormalities are considered to play a key regulatory role in vascular remodeling of pulmonary arterial hypertension.However,to date,there is a paucity of research documenting the changes in metabolome profiles within the su-pernatants of pulmonary artery smooth muscle cells(PASMC)during their transition from a contractile to a synthetic phenotype.Methods:CCK-8 and Edu staining assays were used to evaluate the cell viability and proliferation of human PASMCs.IncuCyte ZOOM imaging system was used to continuously and automatically detect the migration of the PASMCs.A targeted me-tabolomics profiling was performed to quantitatively analyze 121 metabolites in the supernatant.Orthogonal partial least squares discriminant analysis was used to dis-criminate between PDGF-BB-induced PASMCs and controls.Metabolite set enrich-ment analysis was adapted to exploit the most disturbed metabolic pathways.Results:Human PASMCs exhibited a transformation from contractile phenotype to synthetic phenotype after PDGF-BB induction,along with a significant increase in cell viability,proliferation,and migration.Metabolites in the supernatants of PASMCs treated with or without PDGF-BB were well profiled.Eleven metabolites were found to be significantly upregulated,whereas seven metabolites were downregulated in the supernatants of PASMCs induced by PDGF-BB compared to the vehicle-treated cells.Fourteen pathways were involved,and pyruvate metabolism pathway was ranked first with the highest enrichment impact followed by glycolysis/gluconeogen-esis and pyrimidine metabolism.Conclusions:Significant and extensive metabolic abnormalities occurred during the phenotypic transformation of PASMCs.Disturbance of pyruvate metabolism pathway might contribute to pulmonary vascular remodeling.展开更多
BACKGROUND Pulmonary arterial hypertension(PAH)is a debilitating and progressive pulmonary pathology that often leads to death.Guidelines recommend the use of palliative care(PC)early in the treatment course to ease t...BACKGROUND Pulmonary arterial hypertension(PAH)is a debilitating and progressive pulmonary pathology that often leads to death.Guidelines recommend the use of palliative care(PC)early in the treatment course to ease the burden of symptoms;however,uptake remains low.AIM To evaluate barriers to PC uptake and determine its association with mortality in patients with PAH.METHODS All studies discussing PC in PAH were selected in our review and analysis.Clinical and cross-sectional studies were included.Barriers were described in a qualitative fashion.A random-effects meta-analysis was also conducted,in which the odds ratio for mortality was pooled and reported,along with 95%confidence intervals.RESULTS A total of 19 studies were included in the review.The most common barriers identified included feeling like the patients were“not sick enough”,belief that PC is only appropriate for end-of-life care,belief that it would burden family members,and general feelings of hopelessness.Physicians identified structural causes,such as a lack of funding and low levels of PC-related knowledge,as barriers to recommending PC.The meta-analysis showed no statistically significant difference in mortality across four included studies(Log odds ratio=0.89,95%confidence intervals:-3.06-1.28).Heterogeneity was high(I2=80.32%).CONCLUSION Uptake of PC in PAH is low due to patient and physician-level barriers,which can be overcome with systematic PC integration.Long-term studies are also needed to investigate the impact of PC on outcomes in PAH,as the current limited data show no significant difference.展开更多
Accurate classification of pulmonary nodules is critical for early diagnosis of lung cancer. However, non-invasive and accurate diagnosis of benign and malignant pulmonary nodules faces great challenges. In this study...Accurate classification of pulmonary nodules is critical for early diagnosis of lung cancer. However, non-invasive and accurate diagnosis of benign and malignant pulmonary nodules faces great challenges. In this study, we develop a nano zero-valent iron(nZVI)-assisted laser desorption/ionization mass spectrometry(LDI MS) platform, which enables ultra-high-throughput acquisition of abundant metabolic fingerprint information of serum in negative ion mode. We further recruit a large-scale multicenter prospective cohort and collect 1099 serum samples from participants with benign and malignant nodules. The accurate machine learning models are built and validated based on n ZVI-assisted LDI MS metabolomics to achieve efficient classification of benign and malignant nodules. Using our established stacking ensemble learning model, the AUC of the ROC curve for benign and malignant lung nodule classification can be as high as 0.9, and the sensitivity can reach 85.5%, which is significantly better than existing clinical models. This work provides an integrated workflow from detection technology to diagnostic models for biomarkerbased pulmonary nodule diagnosis, which would be widely used in rapid and large-scale screening of pulmonary nodules.展开更多
Chronic thromboembolic pulmonary hypertension(CTEPH)is a complex chronic disease in which pulmonary artery stenosis or obstruction caused by organized thrombus can lead to increased pulmonary artery pressure and pulmo...Chronic thromboembolic pulmonary hypertension(CTEPH)is a complex chronic disease in which pulmonary artery stenosis or obstruction caused by organized thrombus can lead to increased pulmonary artery pressure and pulmonary vascular resistance,ultimately triggering progressive right heart failure and death.Currently,its exact mechanism is not fully understood.Pulmonary endarterectomy(PEA)has immediate effects with low perioperative mortality and satisfactory prognosis in experienced expert centers for CTEPH patients with proximal lesions.Nevertheless,37%of patients are deemed unsuitable for PEA surgery due to comorbidities and other factors,and nearly half of the operated patients have residual or recurrent pulmonary hypertension.Riociguat is the only approved drug for CTEPH,although its effect is limited.Balloon pulmonary angioplasty(BPA)is a promising alternative treatment for patients with CTEPH.After more than 30 years of development and refinements,emerging evidence has confirmed its role in patients with inoperable CTEPH or residual/recurrent pulmonary hypertension,with acceptable complications and comparable longterm prognosis to PEA.This review summarizes the pathophysiology of CTEPH,BPA history and development,therapeutic principles,indications and contraindications,interventional procedures,imaging modalities,efficacy and prognosis,complications and management,bridging and hybrid therapies,ongoing clinical trials and future prospects.展开更多
BACKGROUND Pulmonary arterial hypertension(PAH)is a disease of the arterioles resulting in an increased resistance in pulmonary circulation with associated high pressures in the pulmonary arteries,causing irreversible...BACKGROUND Pulmonary arterial hypertension(PAH)is a disease of the arterioles resulting in an increased resistance in pulmonary circulation with associated high pressures in the pulmonary arteries,causing irreversible remodeling of the pulmonary arterial walls.Coronavirus disease 2019(COVID-19)has been associated with development of new onset PAH in the literature leading to symptoms of dyspnea,cough and fatigue that persist in spite of resolution of acute COVID-19 infection.However,the majority of these cases of COVID related PAH were diagnosed using echocardiographic data or via right heart catheterization in mechanically ventilated patients.CASE SUMMARY Our case is the first reported case of COVID related PAH diagnosed by right heart catheterization in a non-mechanically ventilated patient.Right heart catheterization has been the gold standard for diagnosis of pulmonary hypertension.Our patient had right heart catheterization four months after her initial COVID-19 infection due to persistent dyspnea.CONCLUSION This revealed new onset PAH that developed following her infection with COVID-19,an emerging sequela of the infection.展开更多
Background: Cryptococcus neoformans is an opportunistic fungal pathogen that primarily affects immunocompromised individuals. While traditional histologic methods such as hematoxylin and eosin (H&E) staining can s...Background: Cryptococcus neoformans is an opportunistic fungal pathogen that primarily affects immunocompromised individuals. While traditional histologic methods such as hematoxylin and eosin (H&E) staining can sometimes identify fungal organisms, definitive diagnosis typically requires microbiological culture or molecular testing. Stimulated Raman Histology (SRH) is an emerging imaging technology that enables rapid, label-free tissue analysis, potentially improving intraoperative diagnostic workflows. Aim: This case report explores the utility of SRH for the real-time identification of pulmonary cryptococcosis, highlighting its potential to enhance tissue triage and expedite diagnosis. Case Presentation: We report a 44-year-old man with a history of smoking and alcohol use who presented with a right lower lung mass. An ION robotic-assisted bronchoscopy was performed, and SRH was used intraoperatively for real-time tissue evaluation. Within approximately 90 seconds, SRH provided morphologic findings indicative of Cryptococcus neoformans, prompting additional microbiological testing, which confirmed the diagnosis. The patient required a six-week hospitalization with antifungal therapy. Conclusion: This case demonstrates the potential of SRH as a rapid, intraoperative diagnostic tool for detecting fungal infections in pulmonary specimens. By enabling real-time morphological assessment, SRH can optimize biopsy specimen triage, reduce the need for repeat procedures, and improve patient management. Integrating SRH into diagnostic workflows may be particularly beneficial in resource-limited settings, where timely cryptococcosis diagnosis is critical.展开更多
Objective:To investigate the effects of Tongjing xuanfei exercise on clinical symptoms,pulmonary function and exercise endurance of patients with Chronic obstructive pulmonary disease at stable stage.Methods:A total o...Objective:To investigate the effects of Tongjing xuanfei exercise on clinical symptoms,pulmonary function and exercise endurance of patients with Chronic obstructive pulmonary disease at stable stage.Methods:A total of 130 patients with Chronic obstructive pulmonary disease at stable stage from the Department of Pulmonary Diseases,Qingdao Haici Medical Group during September 2018 to September 2020 were collected and randomly divided into a observation group and a control group,with 65 patients in each group.The control group was given routine pulmonary rehabilitation nursing,and the observation group was given Tongjing Xuanfei exercise treatment combined with routine pulmonary rehabilitation nursing,12 months for treatment.The changes of symptoms and pulmonary function index were observed before and after treatment.Results:FEV1,FVC,FEV1%pred,FEV1/FVC,exercise endurance and CAT score,mMRC dyspnea index score and TCM clinical symptom score in the observation group were significantly higher than those in the control group(P<0.05).Conclusion:Tongjing Xuanfei exercise is helpful to improve the clinical symptoms,pulmonary function and exercise endurance of patients with Chronic obstructive pulmonary disease at stable stage.展开更多
Objective:This study aims to investigate the patterns of symptom occurrence in patients experiencing acute exacerbations of chronic obstructive pulmonary disease(AECOPD).It will explore the composition of symptom clus...Objective:This study aims to investigate the patterns of symptom occurrence in patients experiencing acute exacerbations of chronic obstructive pulmonary disease(AECOPD).It will explore the composition of symptom clusters and analyze the correlation between these clusters and health-related quality of life(HRQoL).Methods:A total of 207 patients with AE-COPD were surveyed from a tertiary grade A hospital.Data collection was conducted using three validated instruments:the Basic Information Questionnaire(BIQ),Disease Symptom Survey Questionnaire(MSAS),and Quality of Life Questionnaire(CAT).Statistical software SPSS 22.0 was used to analyze the correlation between symptom clusters and quality of life.Results:Exploratory factor analysis showed that five major symptom clusters existed in the patients,including the psycho-emotional symptom cluster,the sleep-related symptom cluster,the other side effects symptom cluster,the energy deficiency symptom cluster and the cough-loss of appetite symptom cluster,and the severity of the symptom clusters showed a significant negative correlation with the quality of life of the patients(P<0.05).Conclusion:Strengthening the comprehensive management of symptom clusters in patients with AE-COPD can help to effectively reduce the symptom burden of patients,and then significantly improve their quality of life.展开更多
BACKGROUND Gastroesophageal reflux disease has been shown to contribute to allograft injury and rejection outcomes in lung transplantation through a proposed mechanism of aspiration,inflammation,and allograft injury.T...BACKGROUND Gastroesophageal reflux disease has been shown to contribute to allograft injury and rejection outcomes in lung transplantation through a proposed mechanism of aspiration,inflammation,and allograft injury.The value of pre-transplant reflux testing in predicting reduction in pulmonary function after lung transplantation is unclear.We hypothesized that increased reflux burden on pre-transplant reflux testing is associated with pulmonary function decline following lung transplant.AIM To assess the relationship between pre-transplant measures of reflux and pulmonary function decline in lung transplant recipients.METHODS This was a retrospective cohort study of lung transplant recipients who underwent pre-transplant reflux testing with 24-hour pH-impedance off acid suppression at a tertiary center in 2007-2016.Patients with pre-transplant fundoplication were excluded.Time-to-event analysis was performed using Cox proportional hazards models to assess associations between reflux measures and reduction in forced expiratory volume in 1 second(FEV1)of≥20%post-transplant.Patients not meeting endpoint were censored at time of post-transplant fundoplication,last clinic visit,or death,whichever was earliest.RESULTS Seventy subjects(58%men,mean age:56 years)met the inclusion criteria.Interstitial lung disease represented the predominant pulmonary diagnosis(40%).Baseline demographics were similar between groups and were not associated with pulmonary decline.The clinical endpoint(≥20%FEV1 decline)was reached in 18 subjects(26%).In time-to-event univariate analysis,FEV1 decline was associated with increased acid exposure time(AET)[hazard ratio(HR)=3.49,P=0.03]and increased proximal acid reflux(HR=3.34,P=0.04)with confirmation on Kaplan-Meier analysis.Multivariate analysis showed persistent association between pulmonary decline and increased AET(HR=3.37,P=0.04)when controlling for potential confounders including age,body mass index,and sex.Subgroup analysis including only patients with FEV1 decline showed that all subjects with abnormal AET progressed to bronchiolitis obliterans syndrome.CONCLUSION Increased reflux burden on pre-transplant testing was associated with significant pulmonary function decline posttransplant.Pre-transplant reflux assessment may provide clinically relevant information in the prognostication and management of transplant recipients.展开更多
We investigated the expression of heme oxygenase 1 (HO 1) gene and production of endogenous carbon monoxide (CO) in the rat lung tissue at different time points of chronic hypoxic pulmonary hypertension and the effe...We investigated the expression of heme oxygenase 1 (HO 1) gene and production of endogenous carbon monoxide (CO) in the rat lung tissue at different time points of chronic hypoxic pulmonary hypertension and the effect of hemin on the expression of HO 1 gene and pulmonary hypertension. A rat model of hypoxic pulmonary hypertension was recreated by exposure to intermittent normobaric hypoxic environment (10 % O 2). Reverse transcriptase polymerase chain reaction (RT PCR) was performed to determine the level of HO 1 mRNA in the rat lung tissue and double wave length spectrophotometry was used to evaluate the quantity of COHb in arterial blood. Cardiac catheterization was employed to measure the right ventricular systolic pressure (RVSP) and HE staining was performed in dissected lung tissue to observe the pathological changes of the intra acinar pulmonary arteries (IAPA). It was found that (1) There was a low level of HO 1 mRNA in normal rat lung tissue, but the level of HO 1 mRNA increased by 2-4 times in the lung tissue of hypoxic rats ( P <0.01). The quantity of COHb was 2-3 times those of control group ( P <0.01 or P <0.05). These were accompanied by the increased of RVSP and the thickened IAPA; (2) Hemin could keep the HO 1 mRNA and COHb in the hypoxic rat lung tissue at a high level, and partially suppressed the increase of rat RVSP, thereby ameliorating the pathological changes of IAPA. In conclusion, the upregulation of the expression of HO 1 gene and production of CO in the rat lung of hypoxic pulmonary hypertension plays a role of inhibition in the development of hypoxic pulmonary hypertension. Hemin has a therapeutic effect on hypoxic pulmonary hypertension.展开更多
Pulmonary vascular disorders including portopulmonary hypertension(PoPHT) are among the common complications of liver disease and are prognostically significant. Survival is very low without medical treatment and live...Pulmonary vascular disorders including portopulmonary hypertension(PoPHT) are among the common complications of liver disease and are prognostically significant. Survival is very low without medical treatment and liver transplantation. With advances in medical therapy for elevated pulmonary artery pressure(PAP) and liver transplant surgery, survival of patients with Po PHT and advanced liver disease is significantly improved. Because of the prognostic significance of Po PHT and the limited donor pool, a comprehensive preoperative cardio-pulmonary assessment is of great importance in cirrhotic patients prior to transplant surgery. Therefore, a detailed transthoracic Doppler echocardiographic examination must be an essential component of this evaluation. Patients with mild Po PHT can safely undergo liver transplant surgery. In cases of moderate to severe Po PHT, right heart catheterization(RHC) should be performed. In patients with moderate to severe Po PHT on RHC(mean PAP 35-45 mm Hg), vasodilator therapy should be attempted. Liver transplantation should be encouraged in cases that demonstrate a positive response. Bridging therapy with specific pulmonary arterial hypertension treatment agents should be considered until the transplant surgery and should be continued during the peri- and post-operative periods as needed.展开更多
Chronic obstructive pulmonary disease(COPD)is a major chronic disease with high global mortality,and capnography offers a noninvasive method for testing lungs function under natural breathing.Reported here is the best...Chronic obstructive pulmonary disease(COPD)is a major chronic disease with high global mortality,and capnography offers a noninvasive method for testing lungs function under natural breathing.Reported here is the best paradigm for COPD diagnosis and airflow obstruction severity assessment based on capnography as achieved by comparing the performance of five machine learning methods.In this study,1007 subjects underwent capnography and pulmonary function tests,then segment-fitted capnography was used to extract quantitative features.Using a hybrid scoring strategy to identify the head features,XGBoost performed the best,with accuracy,precision,recall,and F1 score of 90.08%,90.33%,90.08%,and 89.72%,respectively.This work shows for the first time the feasibility of using capnography to evaluate ventilation dysfunction in COPD patients.The proposed XGBoost-based method offers support to clinicians for assessing patients’ventilatory function by capnography,which has considerable potential as an alternative to traditional pulmonary function tests for respiratory diseases.展开更多
BACKGROUND Idiopathic pulmonary fibrosis(IPF)is classified under fibrotic interstitial pneumonia,characterized by a chronic and progressive course.The predominant clinical features of IPF include dyspnea and pulmonary...BACKGROUND Idiopathic pulmonary fibrosis(IPF)is classified under fibrotic interstitial pneumonia,characterized by a chronic and progressive course.The predominant clinical features of IPF include dyspnea and pulmonary dysfunction.AIM To assess the effects of pirfenidone in the early treatment of IPF on lung function in patients.METHODS A retrospective analysis was performed on 113 patients with IPF who were treated in our hospital from November 2017 to January 2023.These patients were divided into two groups:control group(n=53)and observation group(n=60).In the control group,patients received routine therapy in combination with methylprednisolone tablets,while those in the observation group received routine therapy together with pirfenidone.After applying these distinct treatment approaches to the two groups,we assessed several parameters,including the overall effectiveness of clinical therapy,the occurrence of adverse reactions(e.g.,nausea,vomiting,and anorexia),symptom severity scores,pulmonary function index levels,inflammatory marker levels,and the 6-min walk distance before and after treatment in both groups.RESULTS The observation group exhibited significantly higher rates than the control group after therapy,with a clear distinction(P<0.05).After treatment,the observation group experienced significantly fewer adverse reactions than the control group,with a noticeable difference(P<0.05).When analyzing the symptom severity scores between the two groups of patients after treatment,the observation group had significantly lower scores than the control group,with a distinct difference(P<0.05).When comparing the pulmonary function index levels between the two groups of patients after therapy,the observation group displayed significantly higher levels than the control group,with a noticeable difference(P<0.05).Evaluating the inflammatory marker data(C-reactive protein,interleukin-2[IL-2],and IL-8)between the two groups of patients after therapy,the observation group exhibited significantly lower levels than the control group,with significant disparities(P<0.05).Comparison of the 6-min walking distance data between the two groups of patients after treatment showed that the observation group achieved significantly greater distances than the control group,with a marked difference(P<0.05).CONCLUSION Prompt initiation of pirfenidone treatment in individuals diagnosed with IPF can enhance pulmonary function,elevate inflammatory factor levels,and increase the distance covered in the 6-min walk test.This intervention is conducive to effectively decreasing the occurrence of adverse reactions in patients.展开更多
Background:Current guidelines for managing pulmonary arterial hypertension(PAH)recommend a risk strati-fication approach.However,the applicability and accuracy of these strategies for PAH associated with congenital he...Background:Current guidelines for managing pulmonary arterial hypertension(PAH)recommend a risk strati-fication approach.However,the applicability and accuracy of these strategies for PAH associated with congenital heart disease(PAH-CHD)require further validation.This study aims to validate the reliability and predictive accuracy of a simplified stratification strategy for PAH-CHD patients over a three-year follow-up.Additionally,new prognostic variables are identified and novel risk stratification methods are developed for assessing and managing PAH-CHD patients.Methods:This retrospective study included 126 PAH-CHD patients.Clinical and biochemical variables across risk groups were assessed using Kruskal-Wallis and Fisher’s exact tests.Indepen-dent risk factors were identified using ordered logistic regression,while Kaplan-Meier and Cox proportional hazards regression analyses evaluated their impact on all-cause mortality.A new stratification model for the PAH-CHD population was constructed based on these analyses.Results:Significant survival differences across stratified risk groups were observed(p<0.001),validating the effectiveness of the simplified risk stratification method in PAH-CHD patients.Prothrombin activity was a strong independent predictor of adverse outcomes of PAH-CHD patients(Hazard ratio 0.95,p<0.001,C-index 0.70).A model combining N-terminal pro-brain natriuretic peptide,prothrombin activity,albumin,and right atrial area achieved an area under the curve of 0.89 and a C-index of 0.85.Conclusions:The simplified risk stratification method is applicable to PAH-CHD patients.Prothrombin activity is a strong independent predictor of adverse outcomes.A comprehensive risk stratification approach,incorporating both established and novel biomarkers,enhances accessibility and offers predictive efficacy during follow-up for PAH-CHD patients,comparable to established models.展开更多
BACKGROUND Pulmonary embolism(PE)requires a high degree of clinical suspicion for its diagnosis and can mimic pneumonia due to its clinical,radiological,and laboratory findings.Co-existence of PE and pneumonia can als...BACKGROUND Pulmonary embolism(PE)requires a high degree of clinical suspicion for its diagnosis and can mimic pneumonia due to its clinical,radiological,and laboratory findings.Co-existence of PE and pneumonia can also occur,which is surprisingly more common than appreciated.CASE SUMMARY Here,we report a case of a young male who initially presented during the peak of the coronavirus disease 2019 pandemic with features of pneumonia.He was kept under observation and was later diagnosed and treated for a right main pulmonary artery embolism without any identifiable source of thrombosis.CONCLUSION PE and pneumonia share common clinical,radiological,and laboratory findings that may delay the diagnosis of PE.Hypoxia disproportionate to the extent of radiological involvement could be an indicator of an underlying PE.展开更多
文摘BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.
文摘Silicosis,a major persistent occupational disease in China,is a progressive and irreversible pulmonary fibrosis disease with unclear pathogenesis.Cellular senescence,a state of stable cell cycle arrest that is recognized as a key underlying factor in age-related fibroproliferative disorders,plays an important role in chronic lung diseases,particularly pulmonary fibrosis.We previously reported that SiO2-stimulated mice and alveolar type II epithelial cells develop cellular senescence,which is involved in silicosis formation in alveolar type II epithelial cells[1].Cellular senescence may play an important role in silicosis development;however,the exact underlying mechanisms are not fully understood.
基金Supported by Division of Intramural Research Program at National Institute of Diabetes and Digestive and Kidney Diseases,No.1ZIADK075008。
文摘BACKGROUND Cardiopulmonary changes in noncirrhotic portal hypertension(NCPH)are poorly understood.AIM To investigate cardiopulmonary changes using transthoracic echocardiography(TTE)in NCPH and their correlation with clinical features.METHODS Prospective cohort including 10 preclinical NCPH[without portal hypertension(PH)]and 32 NCPH subjects who underwent TTE with agitated saline injection and comprehensive clinical evaluation were assessed.PH was defined by presence of either varices,ascites or portosystemic shunting.Intrapulmonary vascular dilatation(IPVD)is defined as appearance of microbubbles in the left atrium after three heartbeats.Right ventricular systolic pressure(RVSP)>38 mmHg was used to identify possible porto-pulmonary hypertension.Cardiomyopathy is defined using cirrhotic cardiomyopathy consortium criteria.RESULTS Among 42 subjects,17(40%)had IPVD,4(9.5%)had RVSP>38 mmHg,and 6(14%)had cardiomyopathy.Aspartate aminotransferase to alanine aminotransferase(AST/ALT)(1.3 vs 1,P=0.04)and liver stiffness measurement(LSM)(12.4 kPa vs 7.1 kPa,P=0.03)were higher in those with IPVD.Presence of either LSM>10 or AST/ALT>1.2 aided in identifying subjects with IPVD-sensitivity,specificity,and accuracy of 76%.RVSP correlated with oxygen saturation(r=-0.33),and free right hepatic vein pressure(r=0.43).Those with PH had higher left atrial volume(LAV)(62 mL vs 48 mL,P<0.01),and LAV index(LAVI)(35 m^(2) vs 23 m^(2),P<0.01)compared to those without PH.Total bile acids,especially primary bile acids positively correlated with LAV(r=0.36),and LAVI(r=0.41).CONCLUSION Similar to cirrhotic patients,cardiopulmonary changes are prevalent in NCPH,especially among those with PH.In NCPH,cardiopulmonary changes occur despite preserved synthetic function,suggesting the NCPH model's value in understanding cardiopulmonary dysfunction in liver disease.
基金Supported by Traditional Chinese Medicine Science and Technology Development Plan of Jiangsu Province (No. MS2021013, ZD202215):Exploring the Efficacy and Mechanism of Professor Cao Shihong's Shenji Guben Decoction in Treating Chronic Obstructive Pulmonary Disease Based on Metabolomicsa Real-World Cohort Study on Traditional Chinese Medicine for the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary DiseaseIntra-hospital Fund of Jiangsu Provincial Hospital of Traditional Chinese Medicine Development (No. Y2021ZR11):Investigating the Mechanism of Shenji Guben Decoction in Treating Chronic Obstructive Pulmonary Disease Based on Metabolomics
文摘OBJECTIVE:To investigate the mechanisms of the effect of Shenji Guben(SJGB)decoction(参吉固本方)on chronic obstructive pulmonary disease(COPD).METHODS:A murine model of COPD was established through lipopolysaccharide(LPS)nasal drops and passive smoke exposure,followed by evaluation of SJGB decoction efficacy via lung function tests and histological analysis.Non-targeted liquid chromatography-mass spectrometry(LC-MS)-based metabolomics was used to explore the mechanisms of SJGB decoction in COPD.RESULTS:We found that the SJGB decoction effectively reduced inflammatory cell infiltration in the airways and lungs,and improved lung function in the COPD model mice.LC-MS-based metabolomics identified 86 biomarkers in COPD models.Compared to the model group,SJGB decoction significantly altered 34 metabolites.Prostaglandin E2 and DL-Citrulline were highlighted as two representative differential metabolites.MetaboAnalyst 5.0 highlighted glycerophospholipid and riboflavin metabolisms as key pathways affected by SJGB decoction.CONCLUSION:This study evaluated the protective effect of SJGB decoction against COPD and provided insights into its potential mechanisms in COPD treatment.
基金supported by The National Natural Science Foundation of China(82370008,32470169)National Key R&D Program of China(2023YFC260550)Major Project of Guangzhou National Laboratory(GZNL2023A01001).
文摘Identifying the cause of respiratory tract infections is important for reducing the burden of diagnosis and treatment.To assess viral etiologies of hospitalized patients with pulmonary infection,bronchoalveolar lavage fluid(BALF)specimens were collected from non-COVID-19 adult patients(n=333,including patients with lower respiratory tract infection,tuberculosis,lung cancer,and pulmonary nodules)between November 2020 and November 2021.Multiple common respiratory pathogens were detected using multiplex reverse-transcription polymerase chain reaction.The result showed that at least one virus was identified in 35.44%(118/333)of the cases.Among these,influenza virus was the most commonly identified,followed by the parainfluenza virus,coronavirus,human rhinoviruses,and human respiratory syncytial viruses.The tuberculosis group demonstrated the highest viral detection rate,yet paradoxically exhibited the lowest co-infection rate.In contrast,the highest co-infection frequency was observed in the pulmonary nodules group.Patients with viral infections exhibited more severe clinical symptoms compared to those without detected viral infections.However,this observation was only noted in the lower respiratory tract infection group among the different disease groups.Notably,among patients infected with a specific virus,there were no significant differences in viral load between single and co-infections.Our study identified the major causative agents in hospitalized adult patients with pulmonary infection,offering insights for precise disease diagnosis and the prevention of unnecessary use of antimicrobial drugs.
基金Joint Fund of Science and Technology R&D Plan of Henan Province,Grant/Award Number:232103810056Special Project for Key R&D and Promotion of Henan Province,Grant/Award Number:232102311233 and 242102311034National Natural Science Foundation of China,Grant/Award Number:82170058 and 82241007。
文摘Background:Metabolic abnormalities are considered to play a key regulatory role in vascular remodeling of pulmonary arterial hypertension.However,to date,there is a paucity of research documenting the changes in metabolome profiles within the su-pernatants of pulmonary artery smooth muscle cells(PASMC)during their transition from a contractile to a synthetic phenotype.Methods:CCK-8 and Edu staining assays were used to evaluate the cell viability and proliferation of human PASMCs.IncuCyte ZOOM imaging system was used to continuously and automatically detect the migration of the PASMCs.A targeted me-tabolomics profiling was performed to quantitatively analyze 121 metabolites in the supernatant.Orthogonal partial least squares discriminant analysis was used to dis-criminate between PDGF-BB-induced PASMCs and controls.Metabolite set enrich-ment analysis was adapted to exploit the most disturbed metabolic pathways.Results:Human PASMCs exhibited a transformation from contractile phenotype to synthetic phenotype after PDGF-BB induction,along with a significant increase in cell viability,proliferation,and migration.Metabolites in the supernatants of PASMCs treated with or without PDGF-BB were well profiled.Eleven metabolites were found to be significantly upregulated,whereas seven metabolites were downregulated in the supernatants of PASMCs induced by PDGF-BB compared to the vehicle-treated cells.Fourteen pathways were involved,and pyruvate metabolism pathway was ranked first with the highest enrichment impact followed by glycolysis/gluconeogen-esis and pyrimidine metabolism.Conclusions:Significant and extensive metabolic abnormalities occurred during the phenotypic transformation of PASMCs.Disturbance of pyruvate metabolism pathway might contribute to pulmonary vascular remodeling.
文摘BACKGROUND Pulmonary arterial hypertension(PAH)is a debilitating and progressive pulmonary pathology that often leads to death.Guidelines recommend the use of palliative care(PC)early in the treatment course to ease the burden of symptoms;however,uptake remains low.AIM To evaluate barriers to PC uptake and determine its association with mortality in patients with PAH.METHODS All studies discussing PC in PAH were selected in our review and analysis.Clinical and cross-sectional studies were included.Barriers were described in a qualitative fashion.A random-effects meta-analysis was also conducted,in which the odds ratio for mortality was pooled and reported,along with 95%confidence intervals.RESULTS A total of 19 studies were included in the review.The most common barriers identified included feeling like the patients were“not sick enough”,belief that PC is only appropriate for end-of-life care,belief that it would burden family members,and general feelings of hopelessness.Physicians identified structural causes,such as a lack of funding and low levels of PC-related knowledge,as barriers to recommending PC.The meta-analysis showed no statistically significant difference in mortality across four included studies(Log odds ratio=0.89,95%confidence intervals:-3.06-1.28).Heterogeneity was high(I2=80.32%).CONCLUSION Uptake of PC in PAH is low due to patient and physician-level barriers,which can be overcome with systematic PC integration.Long-term studies are also needed to investigate the impact of PC on outcomes in PAH,as the current limited data show no significant difference.
基金financially supported by the Fundamental Research Funds for the Central Universities (No. WHU 2042024kf0009)National Key Research and Development Program of China (No. 2021YFC2700700)the National Natural Science Foundation of China (Nos. 22074111, 22004093)。
文摘Accurate classification of pulmonary nodules is critical for early diagnosis of lung cancer. However, non-invasive and accurate diagnosis of benign and malignant pulmonary nodules faces great challenges. In this study, we develop a nano zero-valent iron(nZVI)-assisted laser desorption/ionization mass spectrometry(LDI MS) platform, which enables ultra-high-throughput acquisition of abundant metabolic fingerprint information of serum in negative ion mode. We further recruit a large-scale multicenter prospective cohort and collect 1099 serum samples from participants with benign and malignant nodules. The accurate machine learning models are built and validated based on n ZVI-assisted LDI MS metabolomics to achieve efficient classification of benign and malignant nodules. Using our established stacking ensemble learning model, the AUC of the ROC curve for benign and malignant lung nodule classification can be as high as 0.9, and the sensitivity can reach 85.5%, which is significantly better than existing clinical models. This work provides an integrated workflow from detection technology to diagnostic models for biomarkerbased pulmonary nodule diagnosis, which would be widely used in rapid and large-scale screening of pulmonary nodules.
基金Supported by the National Precision Medical Research Program of China,No.2016YFC0905602.
文摘Chronic thromboembolic pulmonary hypertension(CTEPH)is a complex chronic disease in which pulmonary artery stenosis or obstruction caused by organized thrombus can lead to increased pulmonary artery pressure and pulmonary vascular resistance,ultimately triggering progressive right heart failure and death.Currently,its exact mechanism is not fully understood.Pulmonary endarterectomy(PEA)has immediate effects with low perioperative mortality and satisfactory prognosis in experienced expert centers for CTEPH patients with proximal lesions.Nevertheless,37%of patients are deemed unsuitable for PEA surgery due to comorbidities and other factors,and nearly half of the operated patients have residual or recurrent pulmonary hypertension.Riociguat is the only approved drug for CTEPH,although its effect is limited.Balloon pulmonary angioplasty(BPA)is a promising alternative treatment for patients with CTEPH.After more than 30 years of development and refinements,emerging evidence has confirmed its role in patients with inoperable CTEPH or residual/recurrent pulmonary hypertension,with acceptable complications and comparable longterm prognosis to PEA.This review summarizes the pathophysiology of CTEPH,BPA history and development,therapeutic principles,indications and contraindications,interventional procedures,imaging modalities,efficacy and prognosis,complications and management,bridging and hybrid therapies,ongoing clinical trials and future prospects.
文摘BACKGROUND Pulmonary arterial hypertension(PAH)is a disease of the arterioles resulting in an increased resistance in pulmonary circulation with associated high pressures in the pulmonary arteries,causing irreversible remodeling of the pulmonary arterial walls.Coronavirus disease 2019(COVID-19)has been associated with development of new onset PAH in the literature leading to symptoms of dyspnea,cough and fatigue that persist in spite of resolution of acute COVID-19 infection.However,the majority of these cases of COVID related PAH were diagnosed using echocardiographic data or via right heart catheterization in mechanically ventilated patients.CASE SUMMARY Our case is the first reported case of COVID related PAH diagnosed by right heart catheterization in a non-mechanically ventilated patient.Right heart catheterization has been the gold standard for diagnosis of pulmonary hypertension.Our patient had right heart catheterization four months after her initial COVID-19 infection due to persistent dyspnea.CONCLUSION This revealed new onset PAH that developed following her infection with COVID-19,an emerging sequela of the infection.
文摘Background: Cryptococcus neoformans is an opportunistic fungal pathogen that primarily affects immunocompromised individuals. While traditional histologic methods such as hematoxylin and eosin (H&E) staining can sometimes identify fungal organisms, definitive diagnosis typically requires microbiological culture or molecular testing. Stimulated Raman Histology (SRH) is an emerging imaging technology that enables rapid, label-free tissue analysis, potentially improving intraoperative diagnostic workflows. Aim: This case report explores the utility of SRH for the real-time identification of pulmonary cryptococcosis, highlighting its potential to enhance tissue triage and expedite diagnosis. Case Presentation: We report a 44-year-old man with a history of smoking and alcohol use who presented with a right lower lung mass. An ION robotic-assisted bronchoscopy was performed, and SRH was used intraoperatively for real-time tissue evaluation. Within approximately 90 seconds, SRH provided morphologic findings indicative of Cryptococcus neoformans, prompting additional microbiological testing, which confirmed the diagnosis. The patient required a six-week hospitalization with antifungal therapy. Conclusion: This case demonstrates the potential of SRH as a rapid, intraoperative diagnostic tool for detecting fungal infections in pulmonary specimens. By enabling real-time morphological assessment, SRH can optimize biopsy specimen triage, reduce the need for repeat procedures, and improve patient management. Integrating SRH into diagnostic workflows may be particularly beneficial in resource-limited settings, where timely cryptococcosis diagnosis is critical.
基金This work was supported by the 2019 Qingdao Industry Cultivation Program Science and Technology Benefit to the people special Project(No.19-6-1-12-nsh).
文摘Objective:To investigate the effects of Tongjing xuanfei exercise on clinical symptoms,pulmonary function and exercise endurance of patients with Chronic obstructive pulmonary disease at stable stage.Methods:A total of 130 patients with Chronic obstructive pulmonary disease at stable stage from the Department of Pulmonary Diseases,Qingdao Haici Medical Group during September 2018 to September 2020 were collected and randomly divided into a observation group and a control group,with 65 patients in each group.The control group was given routine pulmonary rehabilitation nursing,and the observation group was given Tongjing Xuanfei exercise treatment combined with routine pulmonary rehabilitation nursing,12 months for treatment.The changes of symptoms and pulmonary function index were observed before and after treatment.Results:FEV1,FVC,FEV1%pred,FEV1/FVC,exercise endurance and CAT score,mMRC dyspnea index score and TCM clinical symptom score in the observation group were significantly higher than those in the control group(P<0.05).Conclusion:Tongjing Xuanfei exercise is helpful to improve the clinical symptoms,pulmonary function and exercise endurance of patients with Chronic obstructive pulmonary disease at stable stage.
文摘Objective:This study aims to investigate the patterns of symptom occurrence in patients experiencing acute exacerbations of chronic obstructive pulmonary disease(AECOPD).It will explore the composition of symptom clusters and analyze the correlation between these clusters and health-related quality of life(HRQoL).Methods:A total of 207 patients with AE-COPD were surveyed from a tertiary grade A hospital.Data collection was conducted using three validated instruments:the Basic Information Questionnaire(BIQ),Disease Symptom Survey Questionnaire(MSAS),and Quality of Life Questionnaire(CAT).Statistical software SPSS 22.0 was used to analyze the correlation between symptom clusters and quality of life.Results:Exploratory factor analysis showed that five major symptom clusters existed in the patients,including the psycho-emotional symptom cluster,the sleep-related symptom cluster,the other side effects symptom cluster,the energy deficiency symptom cluster and the cough-loss of appetite symptom cluster,and the severity of the symptom clusters showed a significant negative correlation with the quality of life of the patients(P<0.05).Conclusion:Strengthening the comprehensive management of symptom clusters in patients with AE-COPD can help to effectively reduce the symptom burden of patients,and then significantly improve their quality of life.
文摘BACKGROUND Gastroesophageal reflux disease has been shown to contribute to allograft injury and rejection outcomes in lung transplantation through a proposed mechanism of aspiration,inflammation,and allograft injury.The value of pre-transplant reflux testing in predicting reduction in pulmonary function after lung transplantation is unclear.We hypothesized that increased reflux burden on pre-transplant reflux testing is associated with pulmonary function decline following lung transplant.AIM To assess the relationship between pre-transplant measures of reflux and pulmonary function decline in lung transplant recipients.METHODS This was a retrospective cohort study of lung transplant recipients who underwent pre-transplant reflux testing with 24-hour pH-impedance off acid suppression at a tertiary center in 2007-2016.Patients with pre-transplant fundoplication were excluded.Time-to-event analysis was performed using Cox proportional hazards models to assess associations between reflux measures and reduction in forced expiratory volume in 1 second(FEV1)of≥20%post-transplant.Patients not meeting endpoint were censored at time of post-transplant fundoplication,last clinic visit,or death,whichever was earliest.RESULTS Seventy subjects(58%men,mean age:56 years)met the inclusion criteria.Interstitial lung disease represented the predominant pulmonary diagnosis(40%).Baseline demographics were similar between groups and were not associated with pulmonary decline.The clinical endpoint(≥20%FEV1 decline)was reached in 18 subjects(26%).In time-to-event univariate analysis,FEV1 decline was associated with increased acid exposure time(AET)[hazard ratio(HR)=3.49,P=0.03]and increased proximal acid reflux(HR=3.34,P=0.04)with confirmation on Kaplan-Meier analysis.Multivariate analysis showed persistent association between pulmonary decline and increased AET(HR=3.37,P=0.04)when controlling for potential confounders including age,body mass index,and sex.Subgroup analysis including only patients with FEV1 decline showed that all subjects with abnormal AET progressed to bronchiolitis obliterans syndrome.CONCLUSION Increased reflux burden on pre-transplant testing was associated with significant pulmonary function decline posttransplant.Pre-transplant reflux assessment may provide clinically relevant information in the prognostication and management of transplant recipients.
文摘We investigated the expression of heme oxygenase 1 (HO 1) gene and production of endogenous carbon monoxide (CO) in the rat lung tissue at different time points of chronic hypoxic pulmonary hypertension and the effect of hemin on the expression of HO 1 gene and pulmonary hypertension. A rat model of hypoxic pulmonary hypertension was recreated by exposure to intermittent normobaric hypoxic environment (10 % O 2). Reverse transcriptase polymerase chain reaction (RT PCR) was performed to determine the level of HO 1 mRNA in the rat lung tissue and double wave length spectrophotometry was used to evaluate the quantity of COHb in arterial blood. Cardiac catheterization was employed to measure the right ventricular systolic pressure (RVSP) and HE staining was performed in dissected lung tissue to observe the pathological changes of the intra acinar pulmonary arteries (IAPA). It was found that (1) There was a low level of HO 1 mRNA in normal rat lung tissue, but the level of HO 1 mRNA increased by 2-4 times in the lung tissue of hypoxic rats ( P <0.01). The quantity of COHb was 2-3 times those of control group ( P <0.01 or P <0.05). These were accompanied by the increased of RVSP and the thickened IAPA; (2) Hemin could keep the HO 1 mRNA and COHb in the hypoxic rat lung tissue at a high level, and partially suppressed the increase of rat RVSP, thereby ameliorating the pathological changes of IAPA. In conclusion, the upregulation of the expression of HO 1 gene and production of CO in the rat lung of hypoxic pulmonary hypertension plays a role of inhibition in the development of hypoxic pulmonary hypertension. Hemin has a therapeutic effect on hypoxic pulmonary hypertension.
文摘Pulmonary vascular disorders including portopulmonary hypertension(PoPHT) are among the common complications of liver disease and are prognostically significant. Survival is very low without medical treatment and liver transplantation. With advances in medical therapy for elevated pulmonary artery pressure(PAP) and liver transplant surgery, survival of patients with Po PHT and advanced liver disease is significantly improved. Because of the prognostic significance of Po PHT and the limited donor pool, a comprehensive preoperative cardio-pulmonary assessment is of great importance in cirrhotic patients prior to transplant surgery. Therefore, a detailed transthoracic Doppler echocardiographic examination must be an essential component of this evaluation. Patients with mild Po PHT can safely undergo liver transplant surgery. In cases of moderate to severe Po PHT, right heart catheterization(RHC) should be performed. In patients with moderate to severe Po PHT on RHC(mean PAP 35-45 mm Hg), vasodilator therapy should be attempted. Liver transplantation should be encouraged in cases that demonstrate a positive response. Bridging therapy with specific pulmonary arterial hypertension treatment agents should be considered until the transplant surgery and should be continued during the peri- and post-operative periods as needed.
基金supported by the National Natural Science Foundation of China(Grant Nos.62331025,62071451,and U21A20447)the National Key Research and Development Project(Grant No.2021YFC3002204)+1 种基金the Special Equipment Scientific Research Key Project(Grant No.LB2020LA060003)the CAMS Innovation Fund for Medical Sciences(Grant No.2019-I2M-5-019).
文摘Chronic obstructive pulmonary disease(COPD)is a major chronic disease with high global mortality,and capnography offers a noninvasive method for testing lungs function under natural breathing.Reported here is the best paradigm for COPD diagnosis and airflow obstruction severity assessment based on capnography as achieved by comparing the performance of five machine learning methods.In this study,1007 subjects underwent capnography and pulmonary function tests,then segment-fitted capnography was used to extract quantitative features.Using a hybrid scoring strategy to identify the head features,XGBoost performed the best,with accuracy,precision,recall,and F1 score of 90.08%,90.33%,90.08%,and 89.72%,respectively.This work shows for the first time the feasibility of using capnography to evaluate ventilation dysfunction in COPD patients.The proposed XGBoost-based method offers support to clinicians for assessing patients’ventilatory function by capnography,which has considerable potential as an alternative to traditional pulmonary function tests for respiratory diseases.
文摘BACKGROUND Idiopathic pulmonary fibrosis(IPF)is classified under fibrotic interstitial pneumonia,characterized by a chronic and progressive course.The predominant clinical features of IPF include dyspnea and pulmonary dysfunction.AIM To assess the effects of pirfenidone in the early treatment of IPF on lung function in patients.METHODS A retrospective analysis was performed on 113 patients with IPF who were treated in our hospital from November 2017 to January 2023.These patients were divided into two groups:control group(n=53)and observation group(n=60).In the control group,patients received routine therapy in combination with methylprednisolone tablets,while those in the observation group received routine therapy together with pirfenidone.After applying these distinct treatment approaches to the two groups,we assessed several parameters,including the overall effectiveness of clinical therapy,the occurrence of adverse reactions(e.g.,nausea,vomiting,and anorexia),symptom severity scores,pulmonary function index levels,inflammatory marker levels,and the 6-min walk distance before and after treatment in both groups.RESULTS The observation group exhibited significantly higher rates than the control group after therapy,with a clear distinction(P<0.05).After treatment,the observation group experienced significantly fewer adverse reactions than the control group,with a noticeable difference(P<0.05).When analyzing the symptom severity scores between the two groups of patients after treatment,the observation group had significantly lower scores than the control group,with a distinct difference(P<0.05).When comparing the pulmonary function index levels between the two groups of patients after therapy,the observation group displayed significantly higher levels than the control group,with a noticeable difference(P<0.05).Evaluating the inflammatory marker data(C-reactive protein,interleukin-2[IL-2],and IL-8)between the two groups of patients after therapy,the observation group exhibited significantly lower levels than the control group,with significant disparities(P<0.05).Comparison of the 6-min walking distance data between the two groups of patients after treatment showed that the observation group achieved significantly greater distances than the control group,with a marked difference(P<0.05).CONCLUSION Prompt initiation of pirfenidone treatment in individuals diagnosed with IPF can enhance pulmonary function,elevate inflammatory factor levels,and increase the distance covered in the 6-min walk test.This intervention is conducive to effectively decreasing the occurrence of adverse reactions in patients.
基金This work was supported by the National Natural Science Foundation of China(82070052)the Joint Funds of the Natural Science Foundation of Gansu Province(23JRRA1544)granted to Yunshan Cao.
文摘Background:Current guidelines for managing pulmonary arterial hypertension(PAH)recommend a risk strati-fication approach.However,the applicability and accuracy of these strategies for PAH associated with congenital heart disease(PAH-CHD)require further validation.This study aims to validate the reliability and predictive accuracy of a simplified stratification strategy for PAH-CHD patients over a three-year follow-up.Additionally,new prognostic variables are identified and novel risk stratification methods are developed for assessing and managing PAH-CHD patients.Methods:This retrospective study included 126 PAH-CHD patients.Clinical and biochemical variables across risk groups were assessed using Kruskal-Wallis and Fisher’s exact tests.Indepen-dent risk factors were identified using ordered logistic regression,while Kaplan-Meier and Cox proportional hazards regression analyses evaluated their impact on all-cause mortality.A new stratification model for the PAH-CHD population was constructed based on these analyses.Results:Significant survival differences across stratified risk groups were observed(p<0.001),validating the effectiveness of the simplified risk stratification method in PAH-CHD patients.Prothrombin activity was a strong independent predictor of adverse outcomes of PAH-CHD patients(Hazard ratio 0.95,p<0.001,C-index 0.70).A model combining N-terminal pro-brain natriuretic peptide,prothrombin activity,albumin,and right atrial area achieved an area under the curve of 0.89 and a C-index of 0.85.Conclusions:The simplified risk stratification method is applicable to PAH-CHD patients.Prothrombin activity is a strong independent predictor of adverse outcomes.A comprehensive risk stratification approach,incorporating both established and novel biomarkers,enhances accessibility and offers predictive efficacy during follow-up for PAH-CHD patients,comparable to established models.
文摘BACKGROUND Pulmonary embolism(PE)requires a high degree of clinical suspicion for its diagnosis and can mimic pneumonia due to its clinical,radiological,and laboratory findings.Co-existence of PE and pneumonia can also occur,which is surprisingly more common than appreciated.CASE SUMMARY Here,we report a case of a young male who initially presented during the peak of the coronavirus disease 2019 pandemic with features of pneumonia.He was kept under observation and was later diagnosed and treated for a right main pulmonary artery embolism without any identifiable source of thrombosis.CONCLUSION PE and pneumonia share common clinical,radiological,and laboratory findings that may delay the diagnosis of PE.Hypoxia disproportionate to the extent of radiological involvement could be an indicator of an underlying PE.
