Association between KLKB1 Polymorphisms and Pulmonary Thromboembolism.

OBJECTIVE: To investigate the potential correlation between the single nucleotide polymorphisms (SNPs) in the KLKB1 region and pulmonary thromboembolism(PTE) in a Chinese Han population. METHODS: In this case-control study, 95 patients with confirmed PTE were enrolled as the PTE group and 90 healthy subjects as the control group. The genotypes, alleles, and haplotypes of the SNPs were analyzed with PLINK 1.07 and Haploview 4.2 software using chi-square test and Logistic regression analysis. SNPs were further analyzed under three genetic models (additive, dominant, and recessive). RESULTS: The distribution of rs3733402 in KLKB1 gene showed significant difference between PTE group and control group (P=0.041). The distributions of GTG haplotypes consisted of rs2292423, rs4253325,and rs3733402 in KLKB1 gene were also significantly different between PTE group and control group(P=0.040). CONCLUSION: The rs3733402 locus variation in KLKB1 gene is associated with PTE in Chinese Han people.

[Clinical analysis of 15 cases of saddle pulmonary embolism].

OBJECTIVE: To improve recognition of saddle pulmonary embolism (SPE). METHODS: A retrospectively review was performed for patients diagnosed with SPE determined by CTPA from Jan 2004 to Jan 2012. RESULTS: Fifteen SPE patients(4.44%) were found in 338 documented PE patients confirmed by CTPA. There were 7 males and 8 females, with an average age of (57 ± 13) years. The bifurcation of the main pulmonary artery was completely blocked in one case, while partial obstruction was found in the others. Hemodynamic stability was observed in 11 cases, shock in 1 case, and hypotension in 3 cases. Thromboembolectomy was performed in 1 case accompanied by patent foramen ovale straddling thrombus, and thrombolytic therapy was administered in 5 cases while anticoagulant therapy alone in 9 cases. All the cases survived. Minor bleeding was observed in 2 patients and no major bleeding occurred. CONCLUSION: The prevalence of SPE in this series was similar to that reported in the literature. But the incidence might be underestimated. Mortality rate was low. No more aggressive therapeutic interventions (thrombolytics or catheter thrombectomy) were needed in those patients with hemodynamic stability and without patent foramen ovale straddling thrombus.

[Pulmonary mucormycosis: report of 5 cases and review of 46 cases reported in China].

OBJECTIVE: To describe the clinical manifestations and diagnosis of pulmonary mucormycosis. METHODS: We presented 5 proven diagnosed cases of pulmonary mucormycosis in our hospital and reviewed all proven cases of pulmonary mucormycosis previously reported in mainland China. Publications in the form of case reports and articles between January 1982 and December 2011 were searched from Wan Fang Data and China Hospital Knowledge Database. RESULTS: Of the 5 patients in our hospital, the main symptoms included cough, fever, and hemoptysis. Two cases were diagnosed by transbronchial lung biopsy (TBLB), 1 by surgery, 1 by CT-guided percutaneous lung biopsy, and 1 by blood culture. Three patients were cured by antifungal chemotherapy alone, 1 was cured by surgery, and 1 died. Forty-six proven diagnosed cases of pulmonary mucormycosis were retrieved from Wan Fang Data and China Hospital Knowledge Database using key word (pulmonary mucormycosis). Of the 51 patients in total, there were 31 males and 20 females, with a mean age of (47 ± 13)years. The most common risk factors for pulmonary mucormycosis were poorly controlled diabetes mellitus (18 cases), administration of immunosuppressants (7 cases), malignancy (5 cases) and kidney diseases (5 cases). Chest CT showed nodules (27 cases), infiltrates (21 cases), and cavities (18 cases). White blood cell count and neutrophil percentage were elevated in 26 patients. Eighteen cases were diagnosed by histological study of transbronchial biopsy or TBLB specimen. The diagnosis was proven with surgical specimen in 15 patients, CT-guided percutaneous lung biopsy specimen in 7 patients, autopsy in 4 patients, skin biopsy in 1 patient, and renal biopsy in one patient. Three cases were diagnosed by pleural effusion cultures and 2 were diagnosed by blood cultures. Administration of low-dose liposomal amphotericin B (AMB) alone or combined with posaconazole in 12 patients were effective and safe. Fourteen patients who had received surgical resection were cured. CONCLUSIONS: There were no specific clinical features of pulmonary mucormycosis. Transbronchial biopsy and CT-guided percutaneous lung biopsy are useful diagnostic tools for pulmonary mucormycosis. Surgical resection and administration of low-dose liposomal AMB alone or combined with posaconazole were all effective and safe.

[Clinicopathological diagnosis of hypersensitivity pneumonitis].

OBJECTIVE: To enhance the understandings of clinical, radiological and pathological features of hypersensitivity pneumonitis (HP). METHODS: Six HP cases with pathological data, clinical and radiological data were retrospectively analyzed during the period from February 2009 to September 2011 at Beijing Hospital of Ministry of Health. There were 2 males and 4 females with a mean age of 51.5 years (range: 38-61). Clinically, the patients presented with chronic cough, shortness of breath and dyspnea (n = 2). The disease course was 1-8 months. Five cases had fed pigeons and other contact histories. Specimens obtained by transbronchial lung biopsy (n = 3) and open lung biopsy (n = 3) were paraffin embedded and stained by hematoxylin and eosin, special stains and immunohistochemistry. RESULTS: Four cases had subacute HP and 2 cases chronic HP. Three cases of subacute HP underwent transbronchial lung biopsy. One case of subacute HP and 2 cases of chronic HP were diagnosed by open lung biopsy. High-resolution computed tomography of lungs showed diffuse ground glass and patch shadow along the bronchial and centrilobular distributions. There was a predominance of upper half zone. Typical visible mosaic syndrome was present. There was poorly formed granuloma without cheesy necrosis. With an insidious medical history and complicated radiological features, chronic HP cases were characterized by pulmonary interstitial fibrosis. There were usual interstitial pneumonitis (UIP)-like fibrosis and fibrosis with an airway-centered distribution type. The lesions were distributed around bronchioles. Continuous bridge fibrosis might be present. There were bronchiolar metaplasia of peribronchiolar alveoli, poorly formed granuloma and multinucleated giant cells in interstitium. Schaumann body was identified in 1 case. CONCLUSIONS: Because of its diverse clinical, radiological and pathological features, HP may be easily confused with other interstitial lung diseases. Aggregate analyses yield a definite diagnosis.

[Endobronchial lipoma: report of 2 cases and review of the Chinese literature].

OBJECTIVE: To describe the epidemiology of endobronchial lipoma and to propose appropriate diagnostic and therapeutic policies for this tumor. METHODS: Two cases of endobronchial lipoma were presented and 38 cases reported in literatures published in mainland China were reviewed. RESULTS: Thirty-one male and 9 female patients were included, with a mean age of (53 ± 11) years. The overwhelming majority of the tumors (n = 37) were found in the trachea, left or right main bronchi and lobular bronchi. The main symptoms included cough, dyspnea, fever and hemoptysis. Chest CT showed fat or soft tissue density endobronchial masses in 75% (21/28) cases. Eight patients (22.2%) were diagnosed by histological study of the transbronchial biopsy specimen. Thirty-two patients underwent surgical resection. Bronchoscopic resection was carried out in 7 cases. CONCLUSION: CT and bronchoscope are highly useful diagnostic tools for endobronchial lipoma. Bronchoscopic resection should be considered as the first choice of treatment for endobronchial lipoma.

[The effect of montelukast, a leukotriene antagonist, on improvement of exercise-induced bronchoconstriction].

OBJECTIVE: To study the efficacy of montelukast, a cysteinyl leukotriene receptor antagonist, in the treatment and prevention of exercise-induced bronchoconstriction (EIB) in mild asthmatic patients and patients with exercise-induced asthma (EIA). METHODS: Thirty mild asthmatic patients with positive standardized exercise challenge test were enrolled. The subjects received montelukast 10 mg once daily in the evening. Standard exercise challenge was performed before, three days and twenty-eight days after the administration of the drug. The end points included: (1) Area under the percent fall in forced expiratory volume in one second (FEV1) versus time curve (AUC0 to approximately 60 min); (2) Time of recovery to within 5% of the pre-exercise baseline FEV1 value; and (3) Maximal percent fall in FEV1 from pre-exercise baseline. RESULTS: Montelukast caused significant reduction in AUC0 to approximately 60 min, which was (39 +/- 21)%.min before treatment as compared to (13 +/- 14)%.min and (12 +/- 14)%.min three days and twenty-eight days respectively after the treatment with montelukast. Time of recovery to within 5% of the pre-exercise baseline FEV1 value were (51 +/- 36) min, (26 +/- 28) min and (25 +/- 33) min respectively. The mean maximal percentage decrease in FEV1 after exercise was 44.4% before treatment, 26.8% and 18.2% following montelukast. FEV1 and peak expiratory flow rate (PEFR) were maintained to nearly normal during all the study. Inhale corticosteroid did not prevent EIB/EIA. CONCLUSION: Montelukast attenuates and protects against EIB/EIA.

[The role of matrix metalloproteinases-9 and tissue inhibitor of metalloproteinaes-1 in chronic obstructive pulmonary disease].

OBJECTIVE: To evaluate the role of matrix metalloproteinases-9 (MMP-9) and tissue inhibitor of metalloproteinases-1 (TIMP-1) in the pathogenesis of chronic obstructive pulmonary disease (COPD). METHODS: Five milliliters of peripheral venous blood were extracted form 36 patients with COPD, subdivided into stable group (CS group, n = 12), exacerbation group (CE group, n = 12), and exacerbation group with glucocorticosteroids treatment (CE + G group, n = 12), and 12 normal controls. The peripheral blood mononuclear cells (PBMCs) were isolated and the mRNA expressions of MMP-9 and TIMP-1 therein in each group were measured by RT-PCR quantitative analysis. The MMP-2 and MMP-9 levels in the plasma were studied by gelatin zymography. The relationship between MMP and pulmonary function was evaluated. RESULTS: (1) The MMP-9 mRNA expression and MMP-9: TIMP-1 ratios in the samples obtained from patients with COPD were higher in comparison with those from the control group (all P < 0.05). (2) The MMP-9 levels in plasma were higher in the COPD groups than in the control group (P < 0.05). (3) In the COPD groups, the MMP-9 mRNA expression, MMP-9: TIMP-1 ratio, and MMP-9 level in plasma were negatively correlated with FEV(1.0)% of prediction (r = -0.789, P < 0.05; r = -0.53, P < 0.05; and r = -0.652, P < 0.05), and positively correlated with RV/TLC% (r = 0.375, P < 0.05; r = 0.44, P < 0.05; and r = 0.529, P < 0.05). CONCLUSION: MMP-9 and the imbalanced ratio of MMP-9: TIMP-1 may not only play a role in the pathogenesis of COPD, but also relate to FEV(1.0)% of prediction and RV/TLC%.

[Long-term evaluation of laser in situ keratomileusis for extremely high myopia].

OBJECTIVE: To evaluate the long-term efficacy and safety of laser in situ keratomileusis (LASIK) for extremely high myopia (with a preoperative refraction more than -10.00 diopters). METHODS: 173 eyes of 99 patients with a mean spherical equivalent (SE) of (-13.70 +/- 3.60) D (range -10.00 approximately 23.50 D), including 41 eyes with more than -15.00 D, were treated with LASIK and followed up for more than 18 months. The examinations included slitlamp microscopy, fundus examination, Orbscan II corneal topography system, tonometry, pachymetry, cycloplegic and subjective refraction. RESULTS: At 18 months postoperatively, the uncorrected visual acuity (UCVA) was 0.5 or better in 148 eyes (85.6%), and the best spectacle-corrected visual acuity (BSCVA) remained the same or increased in 147 eyes (84.4%). No eye lost more than two lines of BSCVA. 109 eyes (63.0%) were within +/- 1.00 D of emmetropia. The percentage was 73.5% and 29.3% in eyes with a preoperative SE of less than -14.75 D and more than -15.00 D, respectively. Postoperatively, the posterior corneal surface bulge was detected in all eyes. The mean elevation of the posterior corneal surface against the best-fit sphere was (0.029 +/- 0.010) mm preoperatively, (0.069 +/- 0.031) mm at 3 months, (0.065 +/- 0.025) mm at 18 months. At final follow-up, corneal flap folds were found in 2 eyes, and 6 patients (10 eyes) complained of glare or decreased scotopic vision. CONCLUSION: LASIK appeared to be an effective and safe treatment for correction of extremely high myopia. Meanwhile the candidates should be carefully screened.

[Dynamic contrast-enhanced CT patterns and pathologies of noncalcified pulmonary tuberculomas].

OBJECTIVE: To analyze characteristic CT enhancement patterns of noncalcified pulmonary tuberculomas and their pathological basis. METHOD: Fifty-six patients with noncalcified pulmonary tuberculomas underwent surgical resection of the tuberculomas. Enhanced CT images of these tuberculomas were reviewed and analyzed in relation to the histological findings. RESULTS: Of the 56 patients, 45 showed no enhancement in the tuberculomas, which were histologically characterized by central caseous necrosis and a poorly vascularized peripheral fibrotic zone. Eleven patients showed ring-like or eggshell enhancement, and the central low density region was histologically confirmed to be caused by caseous or liquefied necrosis, while the ring enhancement resulted pathologically from moderately or well vascularized peripheral fibrotic or granulomatous tissues. CONCLUSIONS: Pulmonary tuberculomas consists mainly of caseous necrotic tissues characterized by no enhancement and ring or eggshell enhancement on dynamic contrast-enhanced CT.

[Three-dimensional reconstruction and image fusion between liver focal lesions and dynamic contrast-enhanced magnetic resonance angiography].

BACKGROUND & OBJECTIVES: Identifying the correlation of focal lesions to the liver vessel system is a key factor in selecting treatment patterns for focal hepatic diseases. This study was to evaluate the feasibility of 3-dimensional reconstruction and the fusion image between the 3-dimensional dynamic contrast-enhanced magnetic resonance angiography (3D DCE MRA) and the focal hepatic lesions, and further, explore the clinical application of this method. METHODS: 3D DCE-MRA and conventional magnetic resonance imaging (MRI) were performed. The angiography and focal hepatic lesions were reconstructed with maximum intensity projection (MIP) and surface shaded display (SSD), and then fused together. Of the 25 cases with evaluable images, 2 were hemangioma, 3 were focal nodular hyperplasia, 1 was hepatocellular adenoma, 2 were macroregenerative nodule, 2 were hepatobiliary cystadenocarcinoma, and 17 were hepatocellular carcinoma; 21 were confirmed by operation resection, and 4 received digital subtraction angiography (DSA). RESULTS: The anatomic relationship between the lesions and the vessels were well shown. Of the 27 cases, 5 showed normal vessel branching, 6 showed feeding arteries from the hepatic artery, 11 showed compressed and shifted trunks of the vessels, 6 showed tumor invaded vessels, and 11 showed the tumor embolism in the portal vein or the inferior vena cave; 9 also showed MRI signs of portal hypertension. MIP was prior to SSD in demonstrating small branches of the hepatic vessels. CONCLUSION: The 3-dimensional reconstruction and fusion images between 3D DCE-MRA and the focal hepatic lesions by using MIP and SSD can easily display the anatomic relationship between the focal hepatic lesions and the hepatic vessels, and thus can help the surgeons to localize lesions, minimize operating time and decide the extent of surgical resection.