Successful treatment of diffuse panbronchiolitis in a child from Western China: A case report.

The present report describes a case of diffuse panbronchiolitis (DPB) in a child from Western China and the favorable outcome associated with early diagnosis. DPB is an uncommon presentation in pediatric patients. A 13-year-old Chinese boy was admitted to the respiratory outpatient department due to recurrent cough and progressive exertional dyspnea that had persisted for 1 year. An initial diagnosis of bronchial asthma was made, and the patient was prescribed inhaled fluticasone combined with salmeterol (50/250 µg, twice daily), and montelukast (4 mg daily). However, 2 months later no clinical improvement was observed. The disease was re-diagnosed as DPB following the identification of features such as centrilobular small nodular opacities, a 'tree-in-bud appearance' and thickening of the bronchial walls meeting the diagnostic criteria for DPB. Complete resolution of the disease and sustained alleviation of the patient's respiratory symptoms were achieved following the early institution of erythromycin therapy, and the exacerbation of chronic bronchitis was reduced. In conclusion, it is essential to consider that successful treatment for DPB lies in early diagnosis and early treatment. DPB may be treated well by use of erythromycin.

Serum Amyloid-Beta Levels are Increased in Patients with Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is associated with cognitive decline, but the molecular link between COPD and dementia or Alzheimer's disease (AD) remains unclear. This study was aimed to investigate whether serum Aß levels are correlated with COPD. 77 cognitively normal COPD patients and 45 age- and gender-matched normal controls were admitted to the study. Serum Aß40 and Aß42 levels were measured using ELISA kits. Serum C-reactive protein (CRP), interleukin 6 (IL-6), and procalcitonin (PCT) measurements were done using standard laboratory methods. Pulmonary function tests were performed to assess the pulmonary function and determine the degree of lung damage. Significantly increased levels of serum Aß40, Aß42, and total Aß levels were found in patients with COPD in comparison with normal controls. In COPD patients, serum Aß levels were higher in subjects with serum CRP, IL-6, and PCT upper the limit of normal. Moreover, serum Aß levels were dramatically higher in COPD patients with worse pulmonary function. Our study suggests that cognitively normal COPD patients may undergo AD-related pathological changes, and COPD might facilitate AD-type pathogenesis.

Intrapleural instillation of autologous blood for persistent air leak in spontaneous pneumothorax in patients with advanced chronic obstructive pulmonary disease.

BACKGROUND: We evaluated the safety and efficacy of increasing doses of autologous blood patch pleurodesis in treating persistent air leaks in patients with advanced chronic obstructive pulmonary disease (COPD). METHODS: Forty-four patients with COPD and spontaneous pneumothorax (SP) on the 7th day after intercostal tube drainage were randomly assigned to 4 groups, with 11 patients in each group. Groups A, B, and C were given increasing doses of autologous blood--ie, 0.5 mL/kg, 1 mL/kg, 2 mL/kg, respectively--whereas group D was given 1 mL/kg normal saline only. The procedure was repeated if the air leak persisted on postoperative days 9 and 11. Patients in group D crossed over and received autologous blood as in group B if the air leak was still present on the 13th postoperative day. RESULTS: No patient died in the study. The air leak was sealed by the 13th postoperative day only in patients with air leaks smaller than size 3. Air leaks were classified as 0 to 3 [12], ie, size 0=no air leak; size 1=air leak on vigorous coughing only; size 2=small continuous air leak on gentle respiration; and size 3=large continuous air leak on gentle respiration. The success rates by the 13th postoperative day in groups A, B, C, and D were 27%, 82%, 82%, and 9%, respectively. The success rate (82%) was significantly higher in groups B and C than in group A (p=0.003) and D (p>0.01). CONCLUSIONS: Using autologous blood to treat secondary spontaneous pneumothorax (SSP) in patients with advanced COPD is easy, safe, and effective. The dose of blood required for autologous blood patch pleurodesis should be dependent on the body weight, and 1 mL/kg blood may be efficient.

Hypersensitivity pneumonitis due to residential mosquito-coil smoke exposure.

We reported a previously healthy 25-year-old female patient who developed hypersensitivity pneumonitis following repeated exposures to the smoke of mosquito coils. The patient presented with vague symptoms of cough and fever for 3 days. Diagnostic criteria proposed for clinical use in this case included history, exposure to a recognized antigen, physical examination, consistent radiographic images, bronchoalveolar lavage and lung biopsy. Much symptomatic relief and better radiographic response were noted after short-term use of oral corticosteroid and removal of the offending antigen.

[Analysis on vaccine-derived poliovirus found from acute flaccid paralysis cases and effectiveness for emergency response in Binzhou in 2007].

OBJECTIVE: To analyze VDPV found from acute flaccid paralysis cases and effectiveness for emergency response in Binzhou, Shandong in 2007. METHODS: Outbreak investigation, rapid evaluation for oral poliomyelitis attenuate live vaccine (OPV) coverage rate, active searched for acute flaccid paralysis (AFP)cases, supervision for VDPV case, virology and serology surveillance, mopping-up of OPV were used for this emergency response to prevent the possible VDPV spread. RESULTS: The case was reported from the AFP surveillance system. The poliovirus type I was isolated from stool specimen, which was identified as VDPV by gene sequencing. This AFP case was diagnosed as Guillain-barre syndrome (GBS) with 11 doses of OPV and normal self-immunity function test. The investigation results showed that the OPV coverage rates and the neutralization antibody to poliovirus type 1-3 were at high level among the local children, no similar VDPV was isolated from stools of healthy children around the case. The quality of AFP surveillance system was good, and had not found additional similar case in Bizhou city. Additional VDPV was not found in continuous stool specimen from this case. The case was diagnosed as VDPV infected vector but not VDPV case by the national and provincial expert group. CONCLUSION: This VDPV was found in the area with high coverage rate OPV, There was no evidence for the VDPV circulation. The emergency response for the VDPV was rapid and effective. The VDPV surveillance and research related should be strengthened.

[Effect of measles control at different stages in Binzhou Municipal].

OBJECTIVE: To evaluate the effect of measles control at different stages in Binzhou of Shandong. METHODS: The data of measles incidence, measles vaccine (MV) coverage, the population immune levels of measles IgG antibody from 1956 to 2008, and the cost-benefit of measles control were analyzed. RESULTS: The measles incidences were declined continually with implementing the strategies of measles control. Measles vaccine coverages have been keeping at the level of 87.12%-93.45% and the population immune levels of measles IgG antibody have been remaining at high level after implemention EPI. According to the progress of MV immunization strategy, the process of measles control could be divided into stage A (1956-1966, no specific immunization conducted), stage B (1967-1978, MV began to popularized), stage C (1979-1997, the EPI was implemented) and stage D (1998-2008, accelerated measles control and elimination). To compared between stage B and stage A, stage C and stage B, stage D and stage C, the average annual cases were decreased 9989, 18 500, and 378 respectirely, and the average annual dead cases were reduced 267, 49 and 50 respectively. The cost-benefit ratio was 1:22.97 for total 41 years on the process of the measles control and elimination from 1967 to 2008. CONCLUSION: The effect was obtained on the process of measles control in Binzhou city. More efforts should be made to reach the target of measles elimination.

3-amino-7-phthalazinylbenzoisoxazoles as a novel class of potent, selective, and orally available inhibitors of p38alpha mitogen-activated protein kinase.

The p38 mitogen-activated protein kinase (MAPK) is a central signaling molecule in many proinflammatory pathways, regulating the cellular response to a multitude of external stimuli including heat, ultraviolet radiation, osmotic shock, and a variety of cytokines especially interleukin-1beta and tumor necrosis factor alpha. Thus, inhibitors of this enzyme are postulated to have significant therapeutic potential for the treatment of rheumatoid arthritis, inflammatory bowel disease, osteoporosis, and many other diseases where aberrant cytokine signaling is the driver of disease. Herein, we describe a novel class of 3-amino-7-phthalazinylbenzoisoxazole-based inhibitors. With relatively low molecular weight, these compounds are highly potent in enzyme and cell-based assays, with minimal protein shift in 50% human whole blood. Compound 3c was efficacious (ED 50 = 0.05 mg/kg) in the rat collagen induced arthritis (CIA) model.

Discovery of highly selective and potent p38 inhibitors based on a phthalazine scaffold.

Investigations into the structure-activity relationships (SAR) of a series of phthalazine-based inhibitors of p38 are described. These efforts originated from quinazoline 1 and through rational design led to the development of a series of orally bioavailable, potent, and selective inhibitors. Kinase selectivity was achieved by exploiting a collection of interactions with p38alpha including close contact to Ala157, occupation of the hydrophobic gatekeeper pocket, and a residue flip with Gly110. Substitutions on the phthalazine influenced the pharmacokinetic properties, of which compound 16 displayed the most desirable profile. Oral dosing (0.03 mg/kg) of 16 in rats 1 h prior to LPS challenge gave a >50% decrease in TNFalpha production.

Palladium-catalyzed one-pot synthesis of 2-alkyl-2-arylcyanoacetates.

A one-pot procedure for the synthesis of 2-alkyl-2-arylcyanoacetates based on a Pd(OAc)2/DPPF (DPPF = 1,1'-diphenylphosphino ferreocene)-catalyzed enolate arylation followed by in situ alkylation has been developed. This procedure tolerates a diverse range of aryl and heteroaryl bromides, and provides a rapid entry to a variety of 2-alkyl-2-arylcyanoacetates in good to excellent yield.

[The changes of apoptosis and proliferation of pulmonary tissue in chronic obstructive pulmonary disease rats].

OBJECTIVE: To observe the changes of apoptosis and proliferation of pulmonary tissue cells in rats with chronic obstructive pulmonary disease (COPD). METHODS: The rat model of COPD was established by exposure to cigarette smoking. Thirty-three Wistar rats were randomly divided into a normal control (NC) group, a smoking inhalation for 1 month (COPD-1) group and a smoking inhalation for 2 month (COPD-2) group. Pathologic changes of lung tissues and inflammatory cell differentials were studied. Immunohistochemistry and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) methods were carried out to examine the percentage of positive cells and distribution of apoptotic cells and proliferating cells in the lung tissue. RESULTS: Significant increases in total leukocyte numbers and neutrophils in the bronchoalveolar lavage were found in the COPD groups as compared to NC group. Two months after smoking exposure, enlargement of airspaces distal to the terminal bronchiole, destruction of alveolar walls, and loss of the alveolar unit were observed. The percentage of apoptotic cells of airway epithelium, alveolar wall cell and vascular smooth muscle cells were (36.2 +/- 8.5)%, (32.7 +/- 6.4)%, (16.1 +/- 7.2)% in COPD-1 group; (39.5 +/- 9.3)%, (37.3 +/- 7.6)%, (21.4 +/- 6.5)% in COPD-2 group; the difference being significant (all P < 0.01), as compared with NC group [(5.8 +/- 1.7)%, (6.1 +/- 2.3)%, (4.9 +/- 1.4)%]. The percentage of proliferative cells of airway epithelium, alveolar wall cell and vascular smooth muscle cells were (33.4 +/- 6.3)%, (30.1 +/- 4.6)%, (28.4 +/- 6.3)% in COPD-1 group; (35.5 +/- 9.8)%, (33.2 +/- 7.7)%, (34.5 +/- 6.7)% in COPD-2 group; the difference being significant (all P < 0.01), as compared with NC group [(7.4 +/- 2.3)%, (5.2 +/- 2.1)%, (4.4 +/- 1.8)%]. The numbers of apoptotic and proliferating cells were significantly higher in the COPD-2 group than those in the COPD-1 group (all P < 0.01). The ratio of proliferative index (PI)/apoptotic index (AI) of the pulmonary tissue cells were also different. The ratio of PI/AI of airway epithelium in COPD-1 and COPD-2 group [(0.82 +/- 0.13)%, (0.78 +/- 0.24)%] was much lower than NC group [(1.12 +/- 0.23)%, P < 0.05]; The ratio of PI/AI in small pulmonary vessels in the COPD groups [(1.55 +/- 0.25)%, (1.47 +/- 0.28)%] was significantly higher than NC group [(0.92 +/- 0.05)%, P < 0.05]. CONCLUSION: The changes of apoptosis and proliferation of pulmonary tissue in COPD rats might contribute to the pathogenesis of COPD.