Gender differences in clinical characteristics of patients with non-cystic fibrosis bronchiectasis in different age groups in northern China.

INTRODUCTION: Patient gender has clinical and prognostic implications in non-cystic fibrosis bronchiectasis, yet the potential effect of gender on clinical characteristics of patients with non-cystic fibrosis bronchiectasis is still unclear. OBJECTIVES: This study aimed to investigate the gender differences in clinical characteristics of patients with bronchiectasis in different age groups in northern China. METHODS: A total of 777 patients diagnosed with bronchiectasis were retrospectively included in Beijing Chaoyang Hospital and divided into two groups by gender: the male group and the female group. Each group was then subdivided into two according to their age (≤65 and >65 years). Gender differences in clinical characteristics were compared in all patients with bronchiectasis in the two age groups, respectively. RESULTS: A total of 777 bronchiectasis patients were included. Of these patients, the prevalence of female non-smokers was substantially higher than that of male non-smokers (94.0% vs. 36.8%). There were gender differences in etiology of bronchiectasis, with more post-measles and connective tissue disease in females (p = 0.006 and 0.002 separately) and more chronic obstructive pulmonary disease (COPD) in males (p < 0.001). The male group had a significantly higher C-reactive protein (CRP) on admission (p = 0.03). Female patients showed a higher forced expiratory volume in 1 s as percentage of predicted volume (FEV1%pred) and forced vital capacity rate of 1 s (FEV1/FVC) (p < 0.001), lower partial pressure of carbon dioxide (PaCO2 ) (p = 0.04) and hospital costs (p = 0.02) than males, and a higher prevalence of infection with Pseudomonas aeruginosa in >65-year-old group (p = 0.019). CONCLUSIONS: There were many differences between male and female patients in smoking status, etiology, lung function, blood gas analysis, and hospital costs in all patients or different age groups.

Recruitment and phenotypic characteristics of interleukin 9-producing CD4+ T cells in malignant pleural effusion.

BACKGROUND: Our previous data have demonstrated that the number of IL-9-producing CD4(+) T cells (Th9 cells) in malignant pleural effusion (MPE) was significantly increased when compared with that in blood. The aim of the present study was to investigate the mechanism by which Th9 cells were recruited into MPE and the phenotypic characteristics of pleural Th9 cells. METHODS: The expression patterns of chemokine receptors (CCRs) on Th9 cells and the chemoattractant activity of chemokine CCL20 for Th9 cells in vitro were observed. The phenotypic features of Th9 cells in MPE were determined by flow cytometry. RESULTS: We found that Th9 cells in both MPE and blood expressed a high level of CCR6 on their surface. An in vitro migration assay confirmed that both MPE and supernatants of cultured pleural mesothelial cells could induce the migration of Th9 cells, and anti-CCL20 mAb significantly inhibited the ability of MPE or supernatants to stimulate Th9 cell chemotaxis. We also noted that pleural Th9 cells expressed high levels of CD45RO and very low levels of CD45RA and CD62L, displaying the phenotype of effector memory cells. CONCLUSIONS: Our data revealed that recruitment of Th9 cells into MPE could be induced by pleural CCL20 and that the majority of Th9 cells in MPE displayed the phenotype of effector memory cells.

[Hemodynamic effects of synchronous and asynchronous independent lung ventilation with different levels of positive end-expiratory pressure and tidal volumes on unilateral lung injury in dogs].

OBJECTIVE: To investigate the effects of asynchronous independent lung ventilation and synchronous independent lung ventilation with different levels of positive end-expiratory pressure (PEEP) and tidal volumes on hemodynamics and gas exchange in dogs with a hydrochloric acid induced acute lung injury. METHODS: Twelve dogs with hydrochloric acid induced acute lung injury (left lung) were ventilated with volume controlled ventilation (VCV). The animals were randomly divided by random digit table into 2 groups. The first group (group NS, n = 6) received asynchronous independent lung ventilation with the left lung PEEP 10 cm H2O (1 cm H2O = 0.098 kPa), VT 3.5 ml/kg and the right lung PEEP 0 cm H2O, VT 5 ml/kg. The second group (group S, n = 6) received synchronous independent lung ventilation with the parameters as same as group NS. HR, mABP, mPAP, PAWP, CO and blood gas levels were measured during ventilation with different levels of PEEP (15, 20, 25 cm H2O) and VT (5, 7.5, 10 ml/kg) for 30 min. RESULTS: (1) After 30 min ventilation, no significant differences for hemodynamics and gas exchange were found between group NS and group S when Left lung PEEP was 15 or 20 cm H2O and VT was 5 or 7.5 ml/kg. (2) After 30 min ventilation, HR, mABP, CO, PaO2/FiO2, SvO2 in group NS [(98 ± 8) beats/min, (84 ± 6) mm Hg (1 mm Hg = 0.133 kPa), (1.10 ± 0.13) L/min, (199 ± 14) mm Hg and (55 ± 6)%, respectively] were significantly lower than those in group S [(124 ± 9) beats/min, (103 ± 7) mm Hg, (1.52 ± 0.28) L/min, (221 ± 15) mm Hg and (62 ± 4)%, respectively] when PEEP was 25 cm H2O (all P < 0.01). (3) After 30 min ventilation, HR, mABP, CO, PaO2/FiO2, SvO2 in group NS [(92 ± 6) beats/min, (83 ± 9) mm Hg, (1.23 ± 0.08) L/min, (196 ± 8) mm Hg and (57 ± 2)%, respectively] were significantly lower than those in group S [(122 ± 10) beats/min, (104 ± 4) mm Hg, (1.56 ± 0.12) L/min, (216 ± 14) mm Hg and (63 ± 4)%, respectively] when VT was 10 ml/kg (all P < 0.01). CONCLUSIONS: In this animal model, the hemodynamics kept stable when the difference between the left lung PEEP and the right lung PEEP was less than 20 cm H2O. Synchronous independent lung ventilation caused less hemodynamic compromise when higher PEEP (> 25 cm H2O) was used because of the marked asymmetry in the mechanics of the 2 lungs.

[Effects of lateral position and independent lung ventilation on unilateral acute lung injury in dogs].

OBJECTIVE: To investigate the effects of conventional ventilation, lateral position, asynchronous independent lung ventilation and synchronous independent lung ventilation on gas exchange, lung mechanics, hemodynamics, pulmonary perfusion and inflammatory mediators in dogs with a hydrochloric acid induced unilateral acute lung injury (ALI). METHODS: Twenty-eight dogs with hydrochloric acid induced unilateral ALI (the left lung) were ventilated with volume controlled ventilation. The animals were divided into four groups. The first group (group A, n = 7) received conventional ventilation in a supine position. The second group (group B, n = 7) received conventional ventilation in the healthy lung dependent position with the parameters as same as group A. The third group (group C, n = 7) received asynchronous independent lung ventilation. The fourth group (group D, n = 7) received synchronous independent lung ventilation with the parameters as same as group C. All the animals were observed for 4 h under the above described ventilation. Oxygenation, lung mechanics, hemodynamics and lung injury score were measured during the ventilation. The right and left pulmonary arterial blood flows were measured after 4 h ventilation. RESULTS: (1) After 30 min ventilation, PaO2/FiO2 in group A [(180 +/- 25) mm Hg, 1 mm Hg = 0.133 kPa] was significantly lower than those in group B, group C and group D [(277 +/- 23), (296 +/- 31), (299 +/- 22) mm Hg respectively, all P < 0.01]. PaO2/FiO2 in group C [(348 +/- 34) mm Hg] and group D [(343 +/- 29) mm Hg] was significantly increased when compared with that of group B [(314 +/- 33) mm Hg] after 60 min ventilation (P < 0.05), but there was no significant difference between group C and group D. (2) After 120 min ventilation, C(st) in group B [(23 +/- 4) ml/cm H2O] significantly increased when compared with that of group A [(19 +/- 2) ml/cm H2O, P < 0.05]. After 60 min ventilation, C(st)-L in group C and group D increased significantly as compared to the beginning of the ventilation. (3) The left lung pulmonary arterial flow in group B, group C and group D [(31.3 +/- 4.6)%, (27.5 +/- 1.3)% and (27.3 +/- 2.8)%, respectively] significantly decreased when compared with that of group A (38.3 +/- 2.2)% after 4 h ventilation (P < 0.05 and P < 0.01). CONCLUSIONS: Both lateral position and independent lung ventilation can improve gas exchange, while independent lung ventilation is better than lateral position ventilation. The improvement of oxygenation may be related to the effect on the distribution of pulmonary arterial flow.