[Advances in chest imaging in early chronic obstructive pulmonary disease].

Chronic obstructive pulmonary disease(COPD)is a heterogeneous and complex disease, and is characterized by exertional dyspnea and chronic cough. For many years, lung function testing have been used to diagnose COPD, but the sensitivity of lung function testing is low, so there is an urgent need for more sensitive diagnostic methods that show early changes in pathology. In recent years, with the rapid development of HRCT, quantitative CT, new magnetic resonance imaging technology, optical coherence tomography (OCT), artificial intelligence, electrical impedance tomography, etc, it provides a basis for the early diagnosis of COPD. This article reviewed the progress in imaging studies of early COPD in recent years.

[Clinical characteristics of 288 cases of pathologically confirmed benign pulmonary nodules post-surgery].

Objective: To analyze retrospectively the clinical characteristics of pathologically confirmed benign pulmonary nodules post-surgery, and therefore to provide evidence for the diagnosis of benign pulmonary nodules. Methods: 288 cases of pulmonary nodules were selected in the Ruijin Hospital from 1st January 2017 to 31st October 2019. All the lesions of these patients were confirmed by surgery and had definite pathological diagnosis. The clinical data were collected, including demography, clinical data, radiological features. Features that indicated benign pulmonary nodules were summarized. Results: The main etiologies of benign pulmonary nodules were granulomas, hamartomas, cryptococcus infection, organizing pneumonia and non-specific inflammation. In our cohort, we found that the radiological characteristics of benign nodules were single, solid, less than 10 mm in average diameter, with well-defined margins, absence of vacuole sign or vascular convergence , and negative functional imaging. Conclusion: The most common etiologies of post-surgical benign nodules were granulomas, hamartomas, and cryptococcus infection, characterized by being single, solid and with well-defined margins. Caution should be taken before considering surgery for such nodules.

[Experts consensus for the diagnosis, treatment, and prevention of coronavirus disease 2019 in the elderly].

Coronavirus disease 2019 (COVID-19) can cause great damage to the elderly patients and lead to high mortality. The clinical presentations and auxiliary examinations of the elderly patients with COVID-19 are atypical, due to the physiological ageing deterioration and basal pathological state. The treatment strategy for the elderly patients has its own characteristics and treatment protocol should be considered accordingly. To improve the diagnosis, treatment, and prevention of COVID-19 in the elderly, the Expert Committee of Geriatric Respiratory and Critical Care Medicine, China Society of Geriatrics established the "Expert consensus for the diagnosis, treatment, and prevention of coronavirus disease 2019 in the elderly" . We focused on the clinical characteristics and key points for better treatment and prevention of COVID-19 in the elderly. (1) For diagnosis, atypical clinical presentation of COVID-19 in the elderly should be emphasized, which may be complicated by underlying disease. (2) For treatment, strategy of multiple disciplinary team (mainly the respiratory and critical care medicine) should be adopted and multiple systemic functions should be considered. (3) For prevention, health care model about integrated management of acute and chronic diseases, in and out of hospital should be applied.

[The mobilization effect of IL-25 on eosinophil progenitor cells in allergic asthma].

Objective: Eosinophil progenitor cells (EoP) play a critical role in allergic airway inflammation in asthma. Previous studies have revealed that the expression of IL-25 receptor subunits (IL-17RA and IL-17RB) are increased on eosinophils (Eos) from allergic asthmatics upon allergen inhalation but few study has explored the role of IL-25 on EoP. Thus, in this research we examined the possible role of IL-25 on EoP in allergic asthmatics challenged by allergen, as well as in animal models where we verified the changes of newly produced Eos after IL-25 knockout. Methods: Asthmatics (n=14, during 2017-2018) who developed allergen-induced early and late responses were enrolled in this study. Blood was collected at pre-and 24 h post-challenge. Surface expression of IL-17RA and IL-17RB were evaluated by flow cytometry on EoP. In vitro migration assay was used to examine migrational responses of EoP and hematopoietic cells (HPC) from these subjects. In animal models, mice were grouped according to whether IL-25 was knock-out and whether mice were sensitized and challenged by ovalbumin (OVA) into asthmatic, control, knockout asthmatic and knockout control groups. Lung tissues, bronchoalveolar lavage flow (BALF) and bone marrow tissues of these mice were collected in order to evaluate airway inflammation and amount of newly produced (Brdu positive) and mature Eos. Results: EoP expressing IL-17RB were significantly increased after allergen inhalation in allergic asthmatics [(514±138) vs. (1146±450)/10(6) cells, pre-and post-challenge, F=6.819, P=0.022]. Pre-exposure to IL-25 primed the migrational responsiveness of EoP to stromal cell-derived factor (SDF)1α [(39.0±10.1)% vs. (73.0±7.9)%, control and IL-25 exposure groups respectively, P=0.021, 95% CI 5.19%~58.45%]. In OVA sensitized mice, knockout of IL-25 significantly reduced Eos and newly produced Eos percentage in the BALF [Eos, (7.8±2.0)% vs. (3.1±0.6)%, asthmatic and knockout asthmatic group respectively, P=0.002, 95% CI-7.57% to -1.98%; Brdu positive Eos, (50.0±7.6)% vs. (8.6±4.3)%, asthmatic and knockout asthmatic group respectively, P=0.011, 95% CI-72.41% to -10.27%], and newly produced Eos were also reduced in the bone marrow [(70.8±6.1)% vs. (1.3±1.3)%, asthmatic and knockout asthmatic group respectively, P=0.000, 95% CI -94.88% to -44.18%]. Conclusion: These results suggest an important role of IL-25 in allergen-induced EoP migration, local differentiation and eosinophilia in the airways.

[Smoking abstinence rate and its associated factors between abrupt and gradual smoking cessation].

Objective: To analyze and compare the abstinence rate of smoking quitting methods and its associated factors between abrupt and gradual smoking cessation in smokers with drug-based therapy. Methods: A prospective clinical study was conducted in patients undergoing quitting smoking intervention in Ruijin Hospital smoking cessation clinic between June 2013 and May 2016. All the subjects were randomized in a 1∶1 ratio into the abrupt smoking cessation group (smoking as usual over 3 weeks before a planned quit day, and then stopping smoking abruptly) and the gradual smoking cessation group (gradually reducing tobacco use over 3 weeks before a planned quit day, and then stopping smoking totally). The primary outcome was the complete abstinence rate, and the secondary outcomes included 1-month, 3-month and 6 month 7-day point prevalence of abstinence rates and 3 month sustained abstinence rates. Changes of body weight and drug adverse events were also compared. Results: A total of 314 moderate to severe nicotine-dependent patients were admitted in the study, including 157 patients in the abrupt smoking cessation and 157 patients in the gradual smoking cessation group. Fourteen patients fell off during the follow-up. For the complete abstinence rate, the gradual smoking cessation group was higher than the abrupt smoking cessation group(55.0% vs. 36.9%, χ(2)=9.841, P=0.002) .For 7-d smoking abstinence rate in the 1st, 3rd, 6th month, there was no significant difference between the 2 groups (all P>0.05). As for the 3-month sustained abstinence rate, a higher smoking quitting rate was seen in the gradual smoking cessation group compared to the abrupt smoking cessation group in the 6-month follow-up (17.9% vs.8.7%, χ(2)=5.441, P=0.020). The adverse drug reaction incidence was higher in the abrupt smoking cessation group than the gradual smoking cessation group (Gastrointestinal discomfort: 39.2% vs. 17.7%, χ(2)=12.336, P=0.000; Dreaminess: 40.2% vs. 13.3%, χ(2)=20.172, P=0.000). Conclusions: For moderate to severe nicotine-dependent patients, the gradual smoking cessation could serve to enhance the abstinence rate and mitigate the withdrawal symptoms.

Expression level of NSE, S100B and NPY in children with acute miliary phthisis and secondary tubercular meningitis.

OBJECTIVE: To explore the expression level of neuron-specific enolase (NSE), S100B and neuropeptide Y (NPY) in children with acute miliary tuberculosis and secondary tubercular meningitis. PATIENTS AND METHODS: 28 children diagnosed with acute miliary tuberculosis and secondary tubercular meningitis were included into group A, 25 children diagnosed with pure acute miliary tuberculosis were included into group B and 23 children diagnosed with suspected meningitis were included into group C. The levels of NSE, S100B and NPY in cerebrospinal fluid and serum were detected. RESULTS: The levels of NSE, S100B and NPY in cerebrospinal fluid and serum of group A were significantly higher than the levels in the other two groups, differences were statistically significant (p<0.05). A multifactor retrospective analysis suggested that secondary tubercular meningitis was significantly correlated with the high expression of S100B, NPY and NSE in cerebrospinal fluid and serum. CONCLUSIONS: Early detection of the expression levels of NSE, S100B and NPY in cerebrospinal fluid and serum was of great value for the diagnosis of tubercular meningitis secondary to acute miliary tuberculosis.

Correlation between genetic susceptibility of tuberculosis and macrophage migration inhibitory factor.

This paper aims to study the relationship between genetic susceptibility of tuberculosis and macrophage migration inhibitory factor (MIF) and provide theoretical basis and foundation for further studies on pathogenesis and treatment of tuberculosis. Enzyme Linked Immuno Sorbent Assay (ELISA) was applied to detect the difference of MIF protein expression level in peripheral serum of the test subjects, and analyze the difference of MIF protein expression levels of different genotypes and alleles at -794CATT locus and -173G/C locus. The results showed that MIF protein expression level in serum of patients in the tuberculosis group was higher than that of the healthy control group (p < 0.05). The MIF protein expression level of genotype (5/5+5/6+6/6) and (7/X+8/X) at -794CATT locus of the tuberculosis group was higher than that of the healthy control group (p < 0.05), and MIF protein expression level of genotype GG and (GC+CC) at -173G/C locus of the tuberculosis group was higher than that of the healthy control group (p < 0.05). Therefore, macrophage migration inhibitory factor is an important cell factor which plays a regulating role in the immune system, as it can inhibit macrophage migration and promote the gathering, infiltration and proliferation of macrophages at inflammatory sites. Furthermore, it can secrete some cell factors which play a central role in immunological regulation.

[Gene typing and antibiotic resistance of methicillin-resistant Staphylococcus aureus isolated from lower respiratory tract at two hospitals in Shanghai].

OBJECTIVE: To study the genotyping characteristics and antibiotic resistance of methicillin-resistant Staphylococcus aureus(MRSA) isolated from lower respiratory tract at 2 different level hospitals in Shanghai. METHODS: The subjects included 155 patients at Ruijin Hospital and Tongren Hospital between January 2013 and June 2014, including 108 males and 47 females, with a mean age of 67.8±16.5. The 155 MRSA strains were isolated from lower respiratory tract specimens and multilocus sequence typing (MLST) and spa typing were analyzed by the PCR method. The antimicrobial resistance of MRSA was tested by VITEK-32. Fisher's exact test was used for statistical analysis. RESULTS: Among the 155 strains, 28 MLST-spa molecular types were identified, of which ST764-t002(41.29%), ST239-t037(17.42%) and ST239-t030(10.32%) were the most predominant types. The MRSA strains were susceptible to linezolid, vancomycin and teicoplanin, and also had a lower resistance to trimethoprim-sulfamethoxazole and rifampin, with a susceptible rate of 83.9% and 83.2% respectively, but were highly resistant to other antibiotics. The resistance rate of ST239-t037 to trimethoprim-sulfamethoxazole was higher than that of other types, and the resistance rate of ST239-t030 to rifampin was higher than that of other types, the differences being significant(P<0.001). The mean length of hospital stay of the 155 patients was (97±84) days, and mechanical ventilation were used in 78(50.3%) patients, while 108(69.7%))patients received invasive procedures. Broad-spectrum antibiotics were used in 136 (87.1%) patients. There were differences in age, hospitalization days, smoking history, history of COPD, mechanical ventilation, and operation between the 2 hospitals(P<0.05). CONCLUSION: Most of the MRSA strains at Ruijin Hospital and Tongren Hospital between January 2013 and June 2014 were multi-drug resistant, and the susceptibility spectrum of different genotypes was different.

Influence of interleukin-17 gene polymorphisms on the development of pulmonary tuberculosis.

We conducted a case-control study in a Chinese population to examine the correlations between interleukin (IL)-17 gene polymorphisms and tuberculosis (TB) development. The study population included 336 TB subjects and 351 control subjects who were enrolled between June 2012 and June 2014. Genotyping analyses of IL-17A rs2275913 and rs3748067 and IL-17F rs763780 were analyzed using polymerase chain reaction-restriction fragment length of polymorphism. The genotype distributions of IL-17 rs2275913 were found to be in Hardy-Weinberg equilibrium in the controls, while the IL-17 rs3748067 and rs763780 were not. Based on unconditional logistic regression, individuals carrying the AA genotype and GA + AA genotype of rs2275913 were more likely to have a significantly increased risk of TB compared to subjects with the GG genotype. The ORs (95%CI) for the AA genotype and GA + AA genotype were 2.20 (1.35-3.60) and 1.52 (1.11-2.09), respectively. The CC genotype and TC + CC genotype of rs763780 were associated with increased risk of TB when compared with the TT genotype. The ORs (95%CI) for the CC genotype and TC + CC genotype were 1.99 (1.05-3.87) and 1.58 (1.07-2.33), respectively. In conclusion, rs763780 may play a critical role in the etiology of TB.

Obvious emphysema on computed tomography during an acute exacerbation of chronic obstructive pulmonary disease predicts a poor prognosis.

BACKGROUND: Emphysematous change on computed tomography (CT) during the stable phase of chronic obstructive pulmonary disease (COPD) is reported to correlate with COPD prognosis. Acute exacerbation of COPD (AECOPD) is associated with a high risk of mortality and a poor prognosis. AIMS: This study aims to study the relationship between prognosis and emphysematous changes on CT during an AECOPD. METHODS: Histories were recorded, and CT acquired for 106 patients who visited the emergency department for an AECOPD. Emphysematous change was quantified by measuring the percentage of low-attenuation areas (LAA%) in the entire lung on CT images with a threshold of -950 Hounsfield units. Other factors that could influence AECOPD prognosis were also recorded on admission and analysed. At follow ups conducted in 1 year, patient survival, the modified Medical Research Council (mMRC) Dyspnoea Scale, and performance status (PS) were evaluated, and a COPD Assessment Test (CAT) was completed. RESULTS: The 1-year follow up was completed by 103 of 106 patients. The median LAA% was significantly higher in non-survivors (11%, n = 16) than in survivors (5.69%, n = 87) (P = 0.006) at the 1-year follow up. LAA% was significantly correlated with mMRC grade (r = 0.285, P = 0.008), PS (r = 0.397, P < 0.001) and CAT score (r = 0.27, P = 0.017) at the 3-month follow up, and with mMRC grade (r = 0.405, P < 0.001) and PS (r = 0.377, P < 0.001) at the 1-year follow up. LAA% > 7.5% was a significant predictor of 1-year mortality, higher mMRC and PS at the 3-month and 1-year follow ups, after adjustment for other prognostic predictors. CONCLUSION: Obvious emphysematous changes on CT (LAA% > 7.5%) during an AECOPD predicts a poor prognosis independent of other known indicators.

Meta-analysis demonstrates lack of association between the ACE gene I/D polymorphism and obstructive sleep apnea-hypopnea syndrome occurrence and severity.

Published data on a possible association between the angiotensin-converting enzyme (ACE) gene I/D polymorphism and obstructive sleep apnea-hypopnea syndrome (OSAHS) occurrence and its severity risk are inconclusive. We performed a meta-analysis of case-control studies published in English or Chinese. Thirteen studies, totaling 1361 cases and 1373 controls, were investigated for association of the ACE I/D polymorphism with OSAHS. We also made a study of ACE I/D with OSAHS severity risk, including 879 mild/moderate OSAHS patients and 357 severe OSAHS patients. A random-effects model was used, irrespective of between-study heterogeneity. Study quality was assessed in duplicate. Overall, the ACE I/D polymorphism was not significantly associated with an increase in OSAHS risk [odds ratio (OR) = 1.21; 95% confidence interval (95%CI) = 0.88-1.65; P = 0.24]. In subgroup analysis by ethnicity, comparison of alleles I with D demonstrated a 58% (nonsignificantly) increased risk for OSAHS in Chinese (OR = 1.58; 95%CI = 0.92-2.70; P = 0.09). We also found that there was no significant association between ACE I/D and OSAHS severity risk. No publication biases were observed. This meta-analysis suggests that there is no significantly increased risk for OSAHS occurrence or severity associated with the ACE I/D polymorphism.

4-1BB ligand-mediated imbalance of helper 17 T cells and regulatory T cells in patients with allergic asthma.

OBJECTIVES: To investigate the presence of 4-1BB ligand (4-1BBL) in the peripheral blood of patients with allergic asthma and evaluate its role in controlling the balance between helper 17 T (T(h)17) and regulatory T (T(reg)) cells. METHODS: Soluble 4-1BBL (s4-1BBL) was quantified by enzyme-linked immunosorbent assay in plasma from patients with asthma (n = 45) and from healthy control subjects (n = 35). The proportion of monocytes positive for membrane-bound 4-1BBL (m4-1BBL) was determined by flow cytometry. Peripheral blood mononuclear cells from patients with asthma were incubated with anti-4-1BB monoclonal antibody in vitro. Concentrations of interleukin (IL)-17 and transforming growth factor (TGF)-ß(1) in the culture supernatant were analysed. RESULTS: Plasma s4-1BBL concentrations and the proportion of m4-1BBL-positive monocytes were significantly lower in patients with asthma than in control subjects. The culture supernatant concentration of TGF-ß(1) was increased and that of IL-17 was decreased by incubation with anti-4-1BB monoclonal antibody. CONCLUSIONS: Both soluble and membrane-bound 4-1BBL were reduced in patients with allergic asthma compared with control subjects. 4-1BBL/4-1BB signalling may play an important role in allergic asthma by regulating the T(h)17/T(reg) balance.