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Incidence and Clinical Characteristics of pulmonary Hypertension in Patients with Idiopathic pulmonary Fibrosis

Chinese Medical Journal 2015年第7期128卷 896-901页

作者： Wei Yan Li-Ying Peng Cheng-Jun Ban Xue-Feng Xu Min Zhu Yan Liu Shu Zhang Zhen-Guo Zhai Chen Wang Hua-Ping Dai Department of respiratory and Critical Care Medicine Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China Beijing Key Laboratory of Respiratory and Pulmonary Circulation Beijing Institute of Respiratory Medicine Beijing 100020 China

Background： pulmonary hypertension （PH） frequently complicates the course of idiopathic pulmonary fibrosis （IPF） patients and is associated with significantly worse outcomes. The aim of the present study was to investigate the incidence of PH in IPF patients and evaluate the correlation between clinical parameters and systolic pulmonary artery pressure （sPAP）. Methods： Hospitalized patients with IPF, who were evaluated for sPAP by Doppler echocardiography from January 2004 to December 2011, were enrolled in our study. Patients were defined as PH by an estimated sPAP 〉 50 mmHg and graded as PH likely, PH possible and PH unlikely, based on the 2009 European Society of Cardiology/European respiratory Society PH Guidelines. The correlations between clinical parameters and sPAP were analyzed by multiple linear regression. Results： Totally, 119 IPF patients were enrolled in our study and 28 （23.5%）, 20 （16.8%） and 71 （59.7%） patients were PH likely, PH possible and PH unlikely, respectively. Borg dyspnea score was positively correlated with sPAP, r = 0.467, P 〈 0.001. Oxygen saturation was negatively correlated with sPAP, r = -0.416, P 〈 0.001. Diffusing capacity of the lung for carbon monoxide percentage predicted was negatively correlated with sPAP, r = -0.424, P = 0.003. N-terminal fragment of pro-brain natriuretic peptide and pulmonary artery width was positively correlated with sPAP, r = 0.452, P = 0.011 and r= 0.513, P 〈 0.001, respectively. Conclusions： The incidence of PH in IPF patients was 23.5% in a single center of China. PH may worsen the dyspnea, right heart dysfunction and decrease the life quality of the patients with IPF.

关键词： Idiopathic pulmonary Fibrosis： Incidence pulmonary Hypertension

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Combined laparoscopic and thoracoscopic Ivor Lewis esophagectomy for esophageal cancer： initial experience from China

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Chinese Medical Journal 2012年第8期125卷 1376-1380页

作者： LI Hui HU Bin YOU Bin MIAO Jin-bai FU Yi-li CHEN Qi-rui Department of Thoracic Surgery Beijing Chao-Yang HospitalCapital Medical UniversityBeijing Key Laboratory of Respiratory and Pulmonary CirculationBeijing Institute of Respiratory MedicineBeijing 100020China

Background Minimally invasive Ivor Lewis esophagectomy was usually performed with either hand-sewn or circular stapler anastomosis through a small thoracotomy or using a side-to-side stapler anastomotic technique. This study aimed to present our initial results of Ivor Lewis esophagectomy using a circular-stapled anastomosis with transoral anvil technique. Methods Six patients with esophageal cancer underwent minimally invasive Ivor Lewis esophagectomy with an intrathoracic circular-stapled end-to-end anastomosis. The abdominal portion was operated on laparoscopically, and the thoracic portion was done using thoracoscopic techniques. A 25 mm anvil connected to a 90 cm long delivery tube was introduced transorally to the esophageal stump in a tilted position, the anvil head was then connected to circular stapler. The anastomosis was completed under direct thoracoscopic view. Results A total of six patients in this report successfully underwent total laparoscopic and thoracoscopic Ivor Lewis esophagectomy with a circular-stapled anastomosis using a transoral anvil. They were five male and one female patients, and had a mean age of 55 years （range, 38-69 years）. The thoracic and abdominal operations were successfully performed without any intraoperative complications or conversion to laparotomy or thoracotomy. The passage of the anvil head was technically easy and successful in all six cases. The mean overall operative time was （260_＋42） minutes （range, 220-300 minutes）, and the mean estimated blood loss was （520_＋160） ml （range, 130-800 ml）. Patients resumed a liquid oral diet on postoperative day seven. The median length of hospital stay was 17 days （range, 9-25 days）. The postoperative pathological diagnosis was esophageal squamous cell carcinoma in five patients and esophageal small cell carcinoma in one patient. Tumors were staged as T2NoMo in three cases, T2N1M0 in one case, and T3NoM0 in two cases. During the mean follow-up of 2.5 months （range, 2-4 months）, there were no intraoperative technical failure of t

关键词： thoracoscopy laparoscopy Ivor Lewis esophagectomy esophagogastric anastomosis Orvil^TM system

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Rapamycin in fibrotic diseases： beneficial or detrimental agent？

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Chinese Medical Journal 2013年第7期126卷 1364-1369页

作者： XU Xue-feng Department of respiratory and Critical Care Medicine Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders Beijing Institute of Respiratory Medicine Beijing 100020 China

apamvcin was first isolated from a strain of Sreptomyces hygroscopicus in the early 1970s froma soil sample taken on Easter Island. Because the antiproliferative effects of rapamycin on yeast cell, as well as B and T lymphocytes, it was first identified as an antimicrobial agent with potent immunosuppressive activity and has been used in antirejection therapy.

关键词： fibrotic disease rapamycin mammalian target of rapaymycin negative feedback loop antifibrogenesis

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Strengthen national action for the prevention and control of chronic respiratory diseases

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Chinese Medical Journal 2014年第1期127卷 1-3页

作者： Huang Kewu Department of pulmonary and Critical Care Medicine Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China beijing Institute of respiratory Medicine Beijing Key Laboratory ofRespiratory and Pulmonary Circulation Disorders Beijing 100020China Institute of respiratory Medicine Beijing Hospital Beijing 100730China

Chronic respiratory diseases are chronic diseases of the airways and other structures of the lung.Some of the most common are asthma,chronic obstructive pulmonary disease （COPD）,respiratory allergies,occupational lung diseases and pulmonary hypertension.Hundreds of millions of people suffer every day from chronic respiratory diseases.COPD is one of the most representative chronic respiratory diseases.A population-based,cross-sectional survey of COPD conducted between 2003 and 2004 showed that the overall prevalence of the disease in people aged above 40 years was 8.2%,1 which would result in a COPD patient population of over 43 million.

关键词： chronic respiratory diseases prevention control

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Type 2 epithelial mesenchymal transition in vivo： truth or pitfalls？

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Chinese Medical Journal 2012年第18期125卷 3312-3317页

作者： XU Xue-feng DAI Hua-ping Beijing Key Laboratory of Respiratory and Pulmonary Circulation Beijing Institute of Respiratory Medicine Faculty of respiratoryMedicine Capital Medical University Department of respiratoryand Critical Care Medicine Beijing Chao-Yang Hospital CapitalMedical University China Beijing 100020

Epithelial-mesenchymal transition （EMT） is a process by which fully differentiated epithelial cells undergo a phenotypic conversion and assume a mesenchymal cell phenotype, including elongated morphology, enhanced migratory and invasiveness capacity, and greatly increased production of extracellular matrix （ECM） components. The EMTs associated with wound healing, tissue regeneration, and organ fibrosis are termed as type 2 EMT. Over the past two decades, emerging evidence suggested that injured epithelial cells, via type 2 EMT, may serve as important sources of fibroblasts and contribute to organ fibrosis, such as kidney, liver, lung and eyes. There is perhaps no doubt that adult epithelial cells can undergo EMT in vitro in response to transforming growth factor （TGF）-131 and other inflammatory or pro-fibrotic stimuli. However, whether type 2 EMT really occurs in vivo, whethers it is actually a source of functional and activated interstitial fibroblasts and whether it contributes to tissue fibrosis have already been the subjects of heated debate. In this review, we will describe the main features of EMT, the major findings of type 2 EMT in vitro, the evidences for and against type 2 EMT in vivo and discuss the heterogeneity and pitfalls of the techniques used to detect EMT during fibrotic diseases. We suggest that in order to ascertain the existence of type 2 EMT in vivo, different proper phenotype markers of epithelial and mesenchymal cells should be jointly used and cell lineage tracking techniques should be standardized and avoid false positives. Finally, we believe that if EMT really occurs and contributes to tissue fibrosis, efforts should be made to block or reverse EMT to attenuate fibrotic process.

关键词： epithelial mesenchymal transition tissue fibrosis fibroblast

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3-Bromopyruvate alleviates the development of monocrotalineinduced rat pulmonary arterial hypertension by decreasing aerobic glycolysis,inducing apoptosis,and suppressing inflammation

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Chinese Medical Journal 2020年第1期133卷 49-60页

作者： Jie Liu Wang Wang Lei Wang Xian-Mei Qi Yu-Hui Sha Ting Yang Department of Immunology Capital Medical UniversityBeijing 100069China Department of Physiology and Pathophysiology Capital Medical UniversityBeijing 100069China Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders Capital Medical UniversityBeijing 100069China Department of respiratory and Critical Care Medicine China-Japan Friendship HospitalBeijing 100029China

Background:pulmonary arterial hypertension(PH)is a progressive disease with limited therapeutic options,ultimately leading to right heart failure and death.Recent findings indicate the role of the Warburg effect(aerobic glycolysis)in the development of PH.However,the effect of the glycolysis inhibitor 3-bromopyruvate(3-BrPA)on the pathogenesis of PH has not been well investigated.This study aimed to determine whether 3-BrPA inhibits PH and its possible mechanism.Methods:PH was induced in adult Sprague-Dawley rats by a single intraperitoneal injection of monocrotaline(MCT).3-BrPA,or phosphate-buffered saline(PBS)was administered via intraperitoneal injection every other day from the first day of MCT-injection to 4 weeks of follow-up,and indices such as right ventricular systolic pressure(RVSP),right ventricular hypertrophy index(RVHI),pulmonary arteriolar remodeling indicated by percent media thickness(%MT),lactate levels and glucose consumption,were evaluated.pulmonary arteriolar remodeling and right ventricular hypertrophy were observed in hematoxylin-eosin-stained lung sections.Western blotting,immunohistochemistry,and/or immunofluorescence analyses were used to measure the expression of relevant proteins.A cytochrome C release apoptosis assay and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling staining were used to measure cell apoptosis.Results:MCT-induced PH showed a significant increase in glucose consumption(0 vs.4 weeks:0.87±0.23 vs.2.94±0.47,P=0.0042)and lactate production(0 vs.4 weeks:4.19±0.34 vs.8.06±0.67,P=0.0004).Treatment with 3-BrPA resulted in a concomitant reduction in glucose consumption(1.10±0.35 vs.3.25±0.47,P=0.0063),lactate production(5.09±0.55 vs.8.06±0.67,P=0.0065),MCT-induced increase in RVSP(39.70±2.94 vs.58.85±2.32,P=0.0004),pulmonary vascular remodeling(%MT,43.45%±1.41%vs.63.66%±1.78%,P<0.0001),and right ventricular hypertrophy(RVHI,38.57%±2.69%vs.62.61%±1.57%,P<0.0001)when compared with those of the PBS-treated group.3-BrPA,a hexokinase 2 inhibitor,exerte

关键词： pulmonary arterial hypertension Monocrotaline 3-Bromopyruvate Aerobic glycolysis

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Significance of Aspergillus spp. isolation from lower respiratory tract samples for the diagnosis and prognosis of invasive pulmonary aspergillosis in chronic obstructive pulmonary disease

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Chinese Medical Journal 2012年第17期125卷 2973-2978页

作者： HE Hang-yong CHANG Shuo DING Lin SUN Bing LI Fang ZHAN Qing-yuan Department of respiratory and Critical Care Medicine Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders Beijing Institute of Respiratory Medicine Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China Department of Infectious Diseases and Clinical Microbiology Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders Beijing Institute of Respiratory Medicine Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China Cardiac Surgery 'Center -Fuwai Hospital National Center for Cardiovascular Disease State Key Laboratory of Cardiovascular Disease Chinese Academy of Medical Science and Peking Union Medical College Beijing 100037 China

Background Chronic obstructive pulmonary diseases （COPD） is an emerging population at risk for invasive infection of Aspergillus. Isolation of Aspergillus from lower respiratory tract （LRT） samples is important for the diagnosis of invasive pulmonary aspergillosis （IPA）. The purpose of this study was to investigate the value of Aspergillus isolation from LRT samples for the diagnosis and prognosis of IPA in COPD population. Methods Clinical record with Aspergillus spp. isolation in COPD and immunocompromised patients was reviewed in a retrospective study. Patients were categorized and compared according to their severity of illness （admitted to general ward or ICU） and immunological function （COPD or immunocompromised）. Results Multivariate statistical analysis showed that, combined with Aspergillus spp. isolation, APACHE II scores 〉18, high cumulative doses of corticosteroids （〉350 mg prednisone or equivalent dose） and more than four kinds of broad-spectrum antibiotics received in hospital may be predictors of IPA in COPD （0R=9.076, P=0.001; 0R=4.073, P=-0.026; OR=4.448, P=-0.021, respectively）. The incidence of IPA, overall mortality, mortality of patients with IPA and mortality of patients with Aspergillus spp. colonization were higher in COPD patients in ICU than in general ward, but were similar between COPD and immunocompromised patients. Conclusions Aspergillus spp. isolation from LRT in COPD may be of similar importance as in immunocompromised patients, and may indicate an increased diagnosis possibility of IPA and worse prognosis when these patients received corticosteroids, antibiotics, and need to admit to ICU. Aspergillus spp. isolation from LRT samples combined with certain risk factors mav be useful in differentiating colonization from IPA and evaluating the prognosis of IPA in COPD patients.

关键词： Aspergillus invasive pulmonary aspergillosis chronic obstructive pulmonary disease lower respiratory tract samples immunocompromised

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Determinants of health-related quality of life worsening in patients with chronic obstructive pulmonary disease at one year

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Chinese Medical Journal 2014年第1期127卷 4-10页

作者： Liang Lirong Lin Yingxiang Yang Ting Zhang Hong Li Jie Wang Chen Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders Beijing Chao-Yang Hospital Capital Medical University Beijing100020 China beijing Institute of respiratory Medicine Department of Respiratory and Critical Care MedicineBeijing Chao-Yang Hospital Capital Medical University Beijing100020 China beijing Hospital of the Ministry of Health Beijing 100730 China

Background Chronic obstructive pulmonary disease （COPD） is a major cause of morbidity and mortality worldwide and has been the leading cause of death in China.Patients with COPD have significant decrements in their health-related quality of life （HRQL）.It is necessary to identify the factors involved in worsening HRQL in order to improve the HRQL of COPD patients.However,evidence from longitudinal studies is limited.The aim of the study was to evaluate the determinants of the deterioration of HRQL in patients with COPD.Methods At baseline,a total of 491 patients with stable COPD received comprehensive assessments,including psychosocial and clinical variables,six minutes walk distance （6MWD）,dyspnea grade measured by the 5-grade Medical Research Council （MRC） dyspnea scale,anxiety and depression measured by the hospital anxiety and depression scale and HRQL measured by St.George＇s respiratory Questionnaire （SGRQ）.Patients were then monitored monthly for 12 months to document COPD exacerbations.At the end of the study period,the SGRQ values were reassessed.A 1-year change in SGRQ total score ≥4 was defined as a deterioration of the HRQL and as the outcome.A total of 450 patients completed the 12-month follow-up and were analyzed in the present study.Results The age （mean±SD） was （65.0±10.6） years and 68.7％ of subjects were men.The deterioration of the HRQL was 26.4％.In multivariate Logistic regression,independent and graded associations were found between the baseline MRC dyspnoea grade and the deterioration of HRQL （P=0.012）,OR 3.03 （95％ CI 1.11-8.24） for patients with MRC dyspnoea grade ≥4 versus patients with MRC dyspnoea grade =1.Similarly,the number of exacerbations during the follow-up was independently and gradually increased with the deterioration of HRQL （P ＜0.001）,OR 3.03 （95％ CI 1.9-5.6） for the participants with exacerbations ≥3 versus participants with no exacerbation.The 6MWD evaluated by quartiles was negatively associated with the deterioration of HRQL with borderline statistical significance.Conclu

关键词： chronic obstructive pulmonary disease health-related quality of life risk factors exacerbation dyspnea

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Foreign Body Aspiration-induced Unusual Exacerbation o Chronic Obstructive pulmonary Disease

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Chinese Medical Journal 2016年第6期129卷 755-756页

作者： Xiao-Xia Ren Yan Liu Ting Yang Hua-Ping Dai Department of pulmonary and Critical Care Medicine China-Japan Friendship Hospital Beijing 100029 China Department of pulmonary and Critical Care Medicine Beijing Institute of Respiratory Medicine Beijing Key Laboratory of Respiratory and Puimonary Circulation Disorders Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China

To the Editor： Chronic obstructive puhnonary disease （COPD） is a common preventable and treatable disease, characterized by persistent and progressive airflow limitation due to abnormal inflammation in the airways and lung to noxious particles or gases. Exacerbation of COPD is rarely induced by foreign body aspiration. In the present report, we described a male patient with acute exacerbation of COPD caused by foreign body aspiration.

关键词：肺肺疾病慢性阻塞性炎症胰岛素男(雄)性

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Extracorporeal blood therapy in sepsis and acute respiratory distress syndrome： the ＂purifying dream＂

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Chinese Medical Journal 2014年第24期127卷 4263-4270页

作者： Xu Xuefeng Dai Huaping Jia Chun'e Wang Chen National Clinical Research Centre for respiratory Medicine Beijing Hospital Beijing 100730 China Department of respiratory and Critical Care Medicine B eijing Chao- Yang Hospital Capital Medical University Beijing 100020 China Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders Beijing Institute of Respiratory Medicine Capital Medical University Beijing 100020 China

Objective To discuss the rationale, hypothesis, modality of extracorporeal blood purification （EBP） techniques for the critically ill animal models or patients, and to summarize the experimental and clinical studies with inconsistent data which explored the EBP＇s efficacy in the areas of critical care medicine. Data sources Articles referred in this review were collected from the database of PubMed published in English up to June 2014. Study selection We had done a literature search by using the term ＂（sepsis OR acute lung injury OR acute respiratory distress syndrome） AND （extracorporeal blood purification OR hemofiltretion OR hemoperfusion OR plasma exchange OR plasmapheresis OR adsorpiton）＂. Related original or review articles were included and carefully analyzed. Results Acute cellular and humoral immune disturbances occur in both sepsis and acute respiratory distress syndrome （ARDS）. Treatments aimed at targeting one single pro-/anti-inflammatory mediator have largely failed with no proven clinical benefits. Such failure shifts the therapeutic rationale to the nonspecific, broad-spectrum methods for modulating the over-activated inflammatory and anti-inflammatory response. Therefore, EBP techniques have become the potential weapons with high promise for removing the circulating pro-/anti-inflammatory mediators and promoting immune reconstitution. Over the years, multiple extracorporeal techniques for the critically ill animal models or patients have been developed, including hemoflltration （HF）, high-volume hemofiltration （HVHF）, high-cutoff hemofiltration （HCO-HF）, hemo-perfusion or -adsorption （HP/HA）, coupled plasma filtration adsorption （CPFA）, and plasma exchange （PE）. These previous studies showed that EBP therapy was feasible and safe for the critically ill animal models or patients. However, data on their efficacy （especially on the clinical benefits, such as mortality） were inconsistent. Conclusions It is not now to conclude that EBP intervention can purify septic or ARDS patients with high clinical

关键词： acute lung injury acute respiratory distress syndrome extracorporeal blood purification sepsis

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