[Nontuberculous mycobacteria infection and pulmonary alveolar proteinosis in a patient with hematopoietic defects].

A 28-year-old male with a history of leukopenia was admitted with complaints of fever, cough, and dyspnea for 3 months. Initial work-up identified reduced circulating levels of granulocytes, monocytes, lymphocytes, and NK cells. Computed tomography revealed bilateral reticulonodular opacities and mediastinal lymph node enlargement. Peripheral blood culture and mediastinal lymph node aspiration yielded Mycobacterium avium. Genetic testing revealed a heterozygous germline GATA2 mutation (c.1187G>A, R396Q). Despite standard anti-mycobacterial therapy, the patient's dyspnea worsened and subsequent imaging studies revealed diffuse ground-glass opacification. A transbronchial lung biopsy confirmed the development of pulmonary alveolar proteinosis. Bone marrow transplantation had not been performed due to the unavailability of suitable donors. The disease progressed after whole lung lavage, and the patient died at the age of 31 years from respiratory failure. The current case report emphasized the importance of raising awareness about the rare GATA2 deficiency, which is characterized by hematologic abnormalities, primary immunodeficiency, and pulmonary alveolar proteinosis.

[Retrospective analysis of clinical pathology status of minor differentiated thyroid cancer].

Objective: To analyze the clinical pathology status of minor differentiated thyroid cancer (DTC). Methods: The clinical pathology data of 107 cases of DTC patients aging≤18 years old who accepted operations at Department of General Surgery, Peking Union Medical College Hospital from January 2000 to December 2016 were collected. There were 27 males and 80 females, aged (15.4±2.7) years (range: 6 to 18 years). And a randomly selected sample's data was collected as control group, concluded 110 adult DTC patients. There were 35 males and 75 females, aged (43.2±11.8) years (range: 21 to 77 years). The clinical and pathological data of the two groups were retrospectively analyzed. The t test, Mann-Whitney U test, χ(2) test and Fisher exact test was used to analyze the data, respectively. Results: The minor patients had larger diameter of tumors ((16.5±9.9) mm vs. (8.7±5.1) mm, t=7.369, P=0.000), higher rate of lymph node metastasis (68.2% vs. 50.0%, χ(2)=7.446, P=0.006) and higher rate of lateral lymph node metastasis (36.4% vs. 11.8%, χ(2)=18.059, P=0.000) than adult patients. The rate of lateral lymph node metastasis was significantly higher when minor presented multiple fociin primary lesions (54.3% vs. 27.8%, χ(2)=7.144, P=0.008) than those with single foci lesions. Adult patients presented more capsular invasion than minor patients in primary lesions (55.6% vs. 19.2%, χ(2)=28.942, P=0.000). Conclusions: The minor DTC patients present more progress disease status when they receive operations compared with the adult DTC patients. Minor DTC patients appeared as multiple foci should be alert to lateral lymph node metastasis.

[Effects of lateral and medial points of thoracic paravertebral nerve block by ultrasound for rapid recovery after laparoscopic cholecystectomy].

Objective: To investigate the effects of ultrasound-guided lateral and medial point blocks of thoracic paravertebral space on the rapid recovery of laparoscopic cholecystectomy. Methods: A total of 90 patients of either sex, aged 18-67 years, weighted 45.10-91.80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective laparoscopic cholecystectomy were divided into two groups (n=45) using a random number table: lateral point group of thoracic paravertebral space (group A) and medial point group of thoracic paravertebral space (group B). Ultrasound-guided thoracic paravertebral nerve block was performed before induction of general anesthesia. The puncture point of group A was positioned as the intercostal block of the thoracic paravertebral space of the right side of T(6)-T(11), and the puncture point of the group B was positioned as the thoracic paravertebral body of the right side of T(6)-T(11) thoracic paravertebral space. The thoracic paravertebral block was performed with 2 ml of 0.75% ropivacaine per injection for a total of 10 ml. The visual analog scale (VAS) scores of resting pain and active pain at 4, 8, 12 and 24 h after operation were observed. The anus recovery time after surgery and perioperative hypotension were also recorded. Results: The blood pressures in group A were significantly higher than those in group B at 4, 8, 12 and 24 h after operation, which were(73±7) vs (70±7), (78±7) vs (74±7),(82±7) vs (79±7),and (87±7) vs (83±7) mmHg,and the differences were statistically significant (t=2.29, 2.54, 2.33, 2.37, all P<0.05). The VAS scores of resting pain and active pain in group A were significantly higher than those in group B, and the differences were statistically significant (Z=-2.29, -2.51, -2.21, -2.39, -2.53, -2.25, -2.30, -2.24, all P<0.05). The postoperative anal exhaust recovery time of the patients in group A was (21.8±1.9) min that was obvious lower than that in group B which was (22.7±1.9) min with statistically significant difference (t=2.12, P<0.05). There was no significant difference in the incidence of postoperative dizziness, nausea, vomiting, and pruritus (χ(2)=0.28, 0.72, 0.45, 0.21,all P>0.05). Conclusions: In the procedure of thoracic paravertebral block under the guidance of ultrasound, the closer blocking points are to the central axis of the spine, the better the postoperative analgesic effect, but the more obvious the postoperative blood pressure reduction and the longer the anal recovery exhaust time. The further away from the central axis of the spine, the more analgesic effect decreases, but the blood pressure decreases and the anal recovery time is relatively rapid.

[Construction and mechanical analysis of finite element model for bending property of controlled memory wire nickel-titanium rotary file].

OBJECTIVE: To construct a model for a controlled memory (CM) nickel-titanium (NiTi) file and another M-wire NiTi file with the same geometry by using finite element analysis. To evaluate the flexibility of a CM NiTi file by using three dimensional finite element method and to compare its mechanical responses with that M-wire NiTi. METHODS: Based on the reverse engineering, the 21 mm long, 25#/08 taper Hyflex NT NiTi file and Hyflex CM NiTi file were fixed by the cantilever bending model at a distance of 9.5 mm from the tip of the file. The mechanical tester's indenter was loaded/unloaded at a distance of 3 mm from the tip of the file. The maximum displacement was 3 mm, the load displacement curve was obtained. Subsequently, by using a micro-CT to scan (layer spacing of 8 µm) NiTi files, and ABAQUS (6.10) was introduced to construct a geometric model. Hyflex NT was considered as a shapememory alloy constitutive model, Hyflex CM was considered as a power-hardening plastic constitutive model, respectively. Comparing the load-displacement curve of cantilever bending in the three-dimensional finite element model with the load-displacement curve in the experiment. RESULTS: Two tetrahedral element models were constructed, the total number of nodes was 99 353 and the total number of cells was 63 744. When the loading displacement was 1 mm, the stress distribution of the cross section at 6.1 mm from the tip of the file was observed. The upper and lower surfaces were subjected to the maximum bending stress and entered the phase transformation yield stage. The finite element simulation could clearly show the deformation of the file. Various information such as deformation characteristics and stress distribution in the process were well fitted to the actual experimental curve. CONCLUSION: The constitutive behavior of the material has a significant effect on the mechanical behavior of NiTi file. The finite element model established for the NiTi file of the CM wire can accurately capture the characteristics of various deformation processes of the NiTi root canal file, and it has a good fit with the actual experimental curve. The finite element model can be used for study on bending properties of CM wire.

[Surface microstructure and cyclic fatigue resistance of electro discharged machining nickel-titanium endodontic instrument].

OBJECTIVE: To compare the surface microstructures and cyclic fatigue resistance of HyFlex EDM with HyFlex CM and HyFlex NT. METHODS: Twelve 25 mm-long 25#/- HyFlex EDM and twelve 25 mm-long 25#/0.06 taper HyFlex CM or HyFlex NT were selected. The surface microstructure of the 2 instruments which were randomly selected from each group was observed by using scanning electron microscope (SEM). The remaining 10 instruments from each group were submitted to the cyclic fatigue test by using a simulated stainless steel root canal with 60° angle of curvature and curvature radius of 3.5 mm. The time till fracture was recorded, the number of cyclic fatigue (NCF) was calculated, the length of fracture fragment was evaluated, and the topographic features were analyzed by using SEM. The data were analyzed by using one-way analysis via SPSS 23.0 software. The statistical significance level was set at 0.05. RESULTS: SEM observation of the surface and microstructural characterization revealed peculiar melting appearance and evenly distributed micropores on the surface of HyFlex EDM while observations of the surface of both HyFlex CM and HyFlex NT demonstrated machining grooves and irregularities. The NCF of HyFlex EDM was 838±223, which was significantly higher than not only that of HyFlex CM (582±99), but also that of HyFlex NT (81±20) (P<0.05), and the difference between the latter two groups was significant, as well (P<0.05). The length of fractured fragments of HyFlex EDM was (7.27±0.28) mm, which was significantly longer than the HyFlex CM and HyFlex NT, with values of (6.72±0.26) mm and (6.62±0.37) mm, respectively (P<0.05). Topographic features demonstrated typical cyclic fatigue for all the three groups while the region of crack origins was more for HyFlex EDM and HyFlex CM than that of HyFlex NT. As far as the dimple area was concerned, that of HyFlex EDM was deeper and larger than that of HyFlex CM and HyFlex NT. CONCLUSION: Within the limitations of this study, electro-discharge machining leads to peculiar melting appearance with micropores instead of machining grooves and irregularities on the surface of HyFlex EDM, which may be the reason why HyFlex EDM exhibits significantly better cyclicfatigue resistance than HyFlex CM and HyFlex NT.

[Effect of autoclave on surface microstructure and cyclic fatigue resistance of R-phase rotary instruments].

OBJECTIVE: To compare the effects of autoclave on surface microstructure and cyclic fatigue resistance of K3XF and K3. METHODS: Forty-eight size 25, 0.06 taper 25 mm-long K3XF or K3 were randomly divided into 4 groups (n=12). The instruments from group 1 were not autoclaved, and the groups 2 to 4 underwent autoclave for 10 cycles, 20 cycles, and 30 cycles, respectively. The surface microstructure of two instruments randomly selected from each group was observed using scanning electron microscope (SEM). The remaining 10 instruments were submitted to the cyclic fatigue test by using a simulated metal root canal with curvature of 60° and radius 3.5 mm. The time till fracture was recorded, the number of cyclic fatigue (NCF) calculated, the fragment length evaluated, and the topographic features were analyzed using SEM. The data were analyzed using the two-way ANOVA analysis by SAS 9.3 software at a significance level of P<0.05. RESULTS: SEM observation identified rough features on the surface of K3XF with micropores existing evenly. K3 was characterized by machining grooves, which located specifically in the flute, leaving a smooth cutting edge. After autoclave, SEM observation indicated that the micropores in the surface of K3XF became larger and more, whereas the machining grooves in the surface of K3 were squeezed, out of shape and flaking. As far as the NCF was concerned, new K3XF was 210±59, and no significant difference was found after 10, 20, and 30 cycles of autoclave for K3XF, values being 178±37, 208±48, and 227±43, respectively (P>0.05). For K3, the new one was 145±38, and no significant difference in NCF was demonstrated after 10 and 20 cycles of autoclave, with the values of 128±43 and 124±46, respectively (P>0.05). However, after 30 cycles of autoclave of K3, significant increase to 216±38 was identified (P<0.05). Topographic features demonstrated typical cyclic fatigue for all the groups. CONCLUSION: The surface roughness of K3XF was increased after autoclave, while the cyclic resistance remained stable after up to 30 cycles.

[Metallurgic behavior and mechanical property of nickel-titanium endodontic files made by 3 heat treatment techniques].

Objective: To compare the phase transformation behavior, bending property and cyclic fatigue resistance of CM-wire, R-phase and M-wire nickel-titanium endodontic files treated by 3 heat treatment techniques. Methods: Hyflex CM (25 mm, 25#/0.06) made from CM wire, TF (25 mm, 25#/0.06) made from R-phase heat treatment, ProTaper Next X2 (25 mm, tip size 25#/0.06) made from M-wire, Mtwo (25 mm, 25#/0.06) and ProTaper F2 (25 mm, tip size 25#/0.08) made from conventional nickel-titanium wire were chosen. Five of each files were chosen for differential scanning calorimetric (DSC) evaluation (n=5). The specimens were prepared from adjacent portions of the shaft. The weight and length were typically (20±1) mg and 2-3 mm. Another eight of the 5 nickel-titanium files were undergone cantilever-bending test, respectively (n=8). Further ten of the 5 instruments were submitted to the cyclic fatigue test by using a simulated metal root canal (n=10). The data of M(s), M(f), A(s), A(f), ΔH, bending load, number of cyclic fatigue (NCF), fragment length were analyzed using one-way analysis of variance at a significance level of P<0.05. Results: The A(f) of Hyflex CM [(60.27±0.94) ℃] and ProTaper Next [(51.40±0.32) ℃] were higher than body temperature of 37 ℃. The bending load values at 3.0 mm deflection of Hyflex CM [(0.867±0.074) N], TF [(1.275±0.146) N], Mtwo [(2.281±0.426) N], ProTaper Next [(3.104±0.252) N] and ProTaper [(4.227±0.483) N] increased gradually and significantly. The NCF of Hyflex CM (582±99), TF (427±85), ProTaper Next (158±22), Mtwo (129±32) and ProTaper (65±20) decreased gradually. Conclusions: The 3 heat treatment techniques exert tremendous influence on the phase transformation behavior and mechanical characteristics of the files, which demonstrate improved bending property and cyclic fatigue resistance than the conventional ones.

[Glide path management of rotary nickel-titanium instruments in simulated root canals].

OBJECTIVE: To compare the shaping ability of ProGlider, HyFlex EDM Glidepath File and RaCe ISO 10 with that of PathFile and stainless steel K-file hand instruments in simulated root canals. METHODS: A total of 60 simulated resin blocks were divided randomly into five groups (n=12), each group prepared with each instrument, respectively. Preparation time was recorded. Pre- and post-operative images were obtained using a scanner and superimposed using Photoshop. The material removal from the inner and outer canal walls beginning from 0 mm at the end point of the canal were measured using ImageJ. Centering ability was determined, accordingly. The data were analyzed using the One-Way ANOVA at a significance level of P<0.05. RESULTS: Preparation time for ProGlider was (61.018±5.020) s, significantly the fastest (P < 0.05), that for SS K-file (111.100±6.987) s, the slowest (P<0.05), and the differences among the other 3 groups were not significant (P>0.05). The removal of resin from the outer wall at the apical portion was significantly lower for HyFlex EDM Glidepath File than for ProGlider (P<0.05), both of them were significantly lower than the other 3 groups (P<0.05). For the removal from the inner wall at the curvature portion, ProGlider was the least whilst SS K-file the most (P<0.05). At the straight portion, RaCe ISO 10 removed the most not only from the inner but also the outer wall (P<0.05), HyFlex EDM Glidepath File the second most, and the other 3 groups among the same levels. As far as the centering ability was concerned, at the apical portion, HyFlex EDM Glidepath File was the best, ProGlider the second best, no significant difference identified among the other 3 groups. At the curvature portion, ProGlider and HyFlex EDM Glidepath File were the best, PathFile the second, RaCe ISO 10 the third, the worst was the SS K-file. At the straight portion, the difference amongt the 5 groups was not significant. CONCLUSION: The shaping abilities of ProGlider, HyFlex EDM Glidepath File and RaCe ISO 10 were better or comparable to that of PathFile, while the preparation time for ProGlider reduced significantly, and HyFlex EDM Glidepath File and RaCe ISO 10 removed significantly more resin at the straight portion of the canal.

[Effects of different techniques on removal of vapor lock in the apical region of curved canals: a cone-beam computed tomography study].

OBJECTIVE: To compare the effect of four different techniques on removal of vapor lock in the apical region of curved root canals. METHODS: Forty simulated resin root canals with 45° curvature were prepared using WaveOne Primary, then the apical foramen were sealed with soft wax. The teeth were divided randomly into 4 groups thereafter (n=10). Contract solution was injected into the canals using a 30 G side-vented needle and scanned with cone-beam CT (CBCT) to identify the volume of the vapor lock. Four different techniques including photon-induced photoacoustic streaming (PIPS) laser-activated irrigation, gutta-percha cone technique, ultrasonic irrigation, and sonic irrigation were used to remove the vapor locks in the root canals. The residual volume of the vapor lock was identified again using CBCT scanning data. Accordingly, the reduction rates of the vapor lock were calculated. Furthermore, the initial and residual vapor lock length was calculated. The data were analyzed by using the One-way ANOVA analysis and Kruskal-Wallis H test at a significance level of P<0.05. RESULTS: There was no significant difference in the initial vapor lock volume (P>0.05). Residual volume of the vapor lock for PIPS laser-activated irrigation was 0 mm(3), and that for gutta-percha cone technique was (0.02±0.07) mm3, significantly lower than those of ultrasonic and sonic irrigation, the values being (0.20±0.09) mm(3) and (0.23±0.06) mm(3) (P<0.001), respectively. The reduction rates of the vapor lock of PIPS laser-activated irrigation and gutta-percha cone technique were 100.00% (100.00%, 100.00%) and 100.00% (77.66%, 100.00%), respectively, significantly higher than those of ultrasonic irrigation [70.37% (56.41%, 91.43%)] and sonic irrigation [63.54% (51.47%, 74.00%), P<0.001]. The length of the residual vapor lock for PIPS laser-activated irrigation was 0 mm, and that for gutta-percha cone technique was (0.15±0.47) mm, significantly lower than those of ultrasonic and sonic irrigation, values being (2.21±0.09) mm and (2.34±0.08) mm (P<0.001), respectively. The length of the residual vapor locks in the ultrasonic and sonic group remained approximately the same as the distance between the working tip and the apical foramen. CONCLUSION: PIPS laser activated irrigation and gutta-percha cone technique could remove the vapor lock from the apical region of curved canals effectively.

[The analysis of systemic concomitant disease in sudden deafness patients].

Objective:To investigate the clinical characteristics of patients with underlying disease in sudden deafness.Method:One hundred and seventy-three inpatients suffered from sudden deafness were included in this study. We analyzed the underlying disease of these patients retrospectively.Result:The underlying disease of sudden deafness patients mainly include atherosclerosis risk factors (hypertension, diabetes, hyperlipemia, hyperhomocystinemia, hyperuricemia) 79.8%, cervical vertebra disease 26.6%, ear disease 19.1%, thyroid disease 13.9%.Conclusion:The characteristics of underlying disease may plays a crucial role in pathogenesis and treatment in sudden deafness patients.

Effect of functional nuclear factor-kappaB genetic polymorphisms on hepatitis B virus persistence and their interactions with viral mutations on the risk of hepatocellular carcinoma.

BACKGROUND: Nonresolving inflammation and viral mutations are important in hepatitis B virus (HBV)-induced hepatocarcinogenesis. However, the effects of genetic polymorphisms affecting nuclear factor-kappaB (NF-κB) on HBV persistence and generation of hepatocellular carcinoma (HCC)-related HBV mutations remain unknown. PATIENTS AND METHODS: rs28362491 (NFKB1 -94Ins > Del), rs2233406 (NFKBIA -826C > T), rs3138053 (NFKBIA -881A > G), and rs696 (NFKBIA +2758G > A) were genotyped in 1342 healthy controls, 327 HBV-clearance subjects, and 3976 HBV-positive subjects including 1495 HCC patients, using quantitative PCR. HBV mutations were determined by sequencing. The NFKBIA promoter activity was assessed by transient transfection. Multiplicative interactions of the polymorphisms and viral mutations were assessed by multivariate logistic regression. RESULTS: Compared with HBV-clearance subjects, rs2233406 (CT versus CC) and rs3138053 (AG or AG + GG versus AA) significantly decreased HBV persistence, especially in the genotype B HBV-infected subjects. In the genotype C HBV-infected subjects, rs2233406 variant genotypes were significantly associated with an increased risk of HCC [CT versus CC: age-, gender-adjusted odds ratio (AOR), 1.33; 95% confidence interval (CI) 1.01-1.75 in training set and AOR, 1.59; 95% CI 1.01-2.52 in validation set] compared with HCC-free HBV-infected subjects and significantly increased the frequencies of HCC-related HBV mutations (A1762T/G1764A, T1753V, preS1 start codon mutation, and preS deletion); rs28362491 (Del/Del or Ins/Del + Del/Del versus Ins/Ins) significantly increased the frequency of A1762T/G1764A and reduced the frequency of preS2 start codon mutation. The variant genotypes impaired NFKBIA promoter activity in hepatic cells. The interaction of rs2233406 variant genotypes (CT + TT versus CC) with A1762T/G1764A significantly increased HCC risk in genotype C HBV-infected subjects, with AOR of 2.61 (95% CI 1.09-6.26). CONCLUSION: Genetic polymorphisms improving NF-κB activity contribute to genotype B HBV clearance. The rs2233406 variant genotypes significantly increase HCC risk, possibly via facilitating immune selection of the HBV mutations. The host-virus interactions are important in identifying HBV-infected subjects who are more likely to develop HCC.

An increase in hyaluronan by lung fibroblasts: a biomarker for intensity and activity of interstitial pulmonary fibrosis?

The purpose of the present study was to clarify the roles of hyaluronan (HA) production of lung fibroblasts in the pathogenesis of pulmonary fibrosis. Quantitative and comparative assessments of the HA levels in bronchoalveolar lavage fluid (BALF) and lung fibroblast-conditioned media (F-CM) were made at various stages during the development of bleomycin-induced pulmonary fibrosis in rats. In bleomycin-treated animals, the HA levels in F-CM increased significantly (P < 0.01) on day 1 after bleomycin treatment, peaked on day 3, and then gradually declined and returned to control values on days 14-28. The HA concentrations of BALF in the bleomycin group were significantly increased (P < 0.01) on day 3, were maximal on day 7, and thereafter gradually decreased, remaining significantly above normal values (P < 0.01) on day 14, but returning to control values by day 28. In the bleomycin group, the HA levels both in BALF and in F-CM were significantly correlated with the cell components in BALF and there was a significant correlation between the HA concentration in BALF and in the F-CM. Lung fibroblasts were activated and produced increased HA which resulted in excessive accumulation of HA in the lung in the early stage of pulmonary fibrosis; the increased HA synthesis of lung fibroblasts and enhanced HA concentrations of BALF might reflect the intensity of alveolitis and the disease activity.

Ameliorating effect of erythromycin on bleomycin-induced pulmonary fibrosis: role of alveolar macrophage activation and cytokine release.

The objective of this study was to evaluate the effectiveness of erythromycin (EM) on bleomycin-induced pulmonary fibrosis in rats and its possible mechanisms. Seventy-five rats were divided into three groups. Alveolar macrophages (AM) were harvested through bronchalveolar lavage (BAL) and consecutive changes of tumour necrosis factor-alpha (TNF-alpha) and platelet-derived growth factor (PDGF) in AM supernatant and bronchoalveolar lavage fluid (BALF) were assayed with ELISA and bioassay, respectively. The AM-derived TNF-alpha was elevated on day 3, peaked day 7 and then decreased but remained at higher level until day 28. The AM-derived PDGF was increased on day 3, peaked on day 7 then decreased to non-statistically significant higher level. The TNF-alpha in BALF was increased significantly on day 3 then decreased to normal level; the peak preceded that of AM-derived TNF-alpha. The PDGF in BALF was increased on day 3, peaked on day 7, and then decreased to normal, which exhibited a consecutive change similar to that of AM-derived PDGF. The EM significantly suppressed TNF-alpha and PDGF release by AM, markedly decreased TNF-alpha and PDGF levels in BALF. The EM also lessened the collagen deposition, the lung hydroxyproline comprised 75.44%, 72.72% and 56.24% that of bleomycin-treated group on day 7, 14 and 28, respectively. In conclusion, EM can ameliorate bleomycin-induced pulmonary fibrosis possibly through suppression of TNF-alpha and PDGF as well as the inhibition on accumulation of inflammatory cells in the lung.

[Correlation between bronchoalveolar lavage fluid angiotensin converting enzyme levels and T cell subsets in patients with sarcoidosis].

BALF ACE levels were assayed in patients with sarcoidosis, and their correlation with lymphocyte percentage and TH/Ts ratio in BALF were analysed. The results showed a positive correlation (r = 0.4453, P < 0.05; r = 0.7085, P < 0.01). BALF ACE level was decreased as patients with active sarcoidosis improved clinically, indicating that BALF ACE level may be a sensitive biological parameter in the diagnosis and disease activity assessment of sarcoidosis.

[Immunoenzymatic labeling of monoclonal antibodies for surface antigens of T-cells using immune complexes of APAAP in patients with interstitial lung disease].

The use of unlabeled antibody bridging technique with alkaline phosphatase monoclonal anti-alkaline phosphatase (APAAP) complexes makes it possible to solve the problem of short durability of immunofluorescent staining and the problem of nonspecific endogenous enzyme interference of blood cells with immunoperoxidase method. The technique of APAAP allows satisfactorily to demonstrate the cytoplasmic and surface membrane antigens of T-cells both in peripheral blood and bronchoalveolar lavage fluid (BALF). With the technique studied, the subsets of T-lymphocytes simultaneously in both peripheral blood and BALF of 26 patients with interstitial lung disease and of 16 apparently healthy subjects. The results showed: (1) In patients with interstitial pulmonary fibrosis (IPF) CD8 cells in BALF were higher in number than those in peripheral blood and BALF of normal subjects (P < 0.01). It is suggested that abnormalities of T-Lymphocytes might also play a role in the pathogenesis of IPF. (2) CD4 cells in BALF of patients with sarcoidosis were significantly higher in number than those in other groups (P < 0.01). However, CD8 cells in BALF of patients with sarcoidosis were lower in number than those in others (P < 0.01). The higher ratio of CD4/CD8 was found in sarcoidosis patients during active stage. The findings suggested that change of the ratio of CD4/CD8, as an immunoregulatory abnormalities in lung, could be regarded as one of parameters in assessing the activity in patients with sarcoidosis.

[Cytological examination of bronchoalveolar lavage fluid and its clinical significance in patients with diffuse interstitial lung diseases].

Cytological examination of bronchoalveolar lavage fluid (BALF) was carried out in 48 patients with diffuse interstitial lung diseases based on chest roentgenography. 7 cases manifested with respiratory symptoms but without any abnormality on both chest roentgenogram and fibroptic bronchoscopy served as controls. The total cell counts of BALF in the study group were all higher than those of the control group (3.1 x 10(5)/ml) and the differential count of the cells showed that neutrophilic granulocytes was found in patients with fibrosing alveolitis, Neutrophilic granulocytes accounted for 21.3 +/- 2.4% of all the cells and the percentage was significantly higher than that of the control group (1.8 +/- 0.5% P less than 0.01). On the contrary, lymphocytosis was found in patients with allergic alveolitis and sarcoidosis; lymphocytes accounted for 30.8 +/- 5.3% and 29.0 +/- 1.1% of all the cells in these two diseases respectively and the percentage was also higher than that of the control group (3.0 +/- 0.6% P less than 0.01). However, the differential cell count of BALF in alveolar carcinoma showed no significant difference with that of the control group (P greater than 0.05). The factors influencing the quality control of both BAL and cytological examination were evaluated and the clinical significance of these results was discussed.