Immunoglobulin G4-related disease: case report and literature review.

Immunoglobulin (Ig) G4-related disease (IgG4-RD) is a rare and chronic progressive clinical entity, characterized by elevated serum IgG4 along with tissue infiltration by IgG4 + plasma cells. It is an immune-mediated fibro-inflammatory condition that can affect virtually any organ and tissue. IgG4-related lung disease (IgG4-RLD) occupies 14% of all IgG4-RD, with nonspecific symptoms and various abnormal radiographic patterns. Published data on IgG4-related hypertrophic pachymeningitis (IgG4-RHP), an increasingly recognized central nervous system manifestation of IgG4-RD, is also limited. Both lung and cranial dura involvement have not yet been reported until now. We further entail a review of the literature on the clinicopathologic features and differential diagnosis of this uncommon disease. We herein report an interesting case of a 70-year-old male patient admitted due to headache and fever. A magnetic resonance imaging (MRI) of the brain revealed extensive dural thickening with marked enhancement. Chest computed tomography (CT) scan showed nodular or mass-like consolidation and focal interstitial change. Thoracoscopic lung biopsy and lumbar puncture were conducted. After careful histopathological observation and consideration of alternative differential diagnoses, he was diagnosed with IgG4-related disease with lung and cranial dural involvement based upon significant elevation of serum and cerebrospinal fluid (CSF) IgG4 concentration. The patient was started on oral prednisolone 60 mg/day (1.0 mg/kg/day) for 14 days, and a tapering dose of 5 mg every 2 weeks followed by maintenance therapy at low dose for 3 months. His clinical manifestations, and serologic and imaging findings improved with steroid treatment. Currently, the patient remains well without disease progression. IgG4-RD should be considered as a differential when diagnosing other similar multisystemic lesions. Clinical examination, careful histological observation, and immunostaining for appropriate markers are essential in establishing the diagnosis. Clinicians should become familiar with this alternative differential diagnosis.

Malignant glomus tumor of the lung with multiorgan metastases: case report and literature review.

Glomus tumor is an exceedingly rare neoplasm that is derived from cells of the neuromyoarterial glomus or glomus body. It rarely occurs in the visceral organs where glomus body may be sparse or even absent, such as the stomach, intestines, mediastinum, and respiratory tract. It is unusual for a glomus tumor to demonstrate atypical or malignant histopathological characteristics. It is also rare for such a tumor to express clinically aggressive behavior. However, when metastasis does occur, this disease is often fatal. We herein report an interesting case of a middle-age woman admitted due to progressive cough and hemoptysis. A polypoid mass was found to occlude the left lingular lobar bronchus. Final histopathologic examination showed the presence of malignant glomus tumor, confirmed by immunoreactivity for smooth muscle actin and vimentin. Two months later, the patient developed abdominal distension and gastrointestinal bleeding. Further evaluation lead to the discovery of widespread metastatic disease to the gastrointestinal tract, spleen, and the left adrenal gland. We further entail a review of the literature on the clinicopathologic features and diagnosis of this uncommon tumor.

[Efficacy and Safety of Tiotropium Bromide in the Treatment of Chronic Obstructive Pulmonary Disease--a Multi-center Randomized Clinical Trial].

OBJECTIVE: To investigate the efficacy and safety of domestic tiotropium inhalation capsule in patients with chronic obstructive pulmonary disease (COPD) with multi-center randomized clinical trial. METHODS: Patients with stable slight to moderate COPD were randomized into trial group (n=109) with tiotropium 18 pg Qd or control group (n =111) with ipratropium 40 µg Qid for a treatment of four weeks. The spirometry and scoring questionaire were recorded at different visits during the treatment. Rescue medication consumption and adverse events were recorded. Results Forced expiratory volume in 1 s (FEV1) of both groups increased obviously 30 min and 3 h after first dosing. After four weeks treatments, FEV, and forced vital capacity (FVC) in both groups were improved obviously, and the improvement in tiotropium group was significantly higher than that ipratropium group. COPD symptom scores were significantly reduced in both groups, and the improvement in tiotropium group was significantly better than that in ipratropium group. There was no significant difference in rescue medication consumption between the two groups. The ratios of adverse events were 22. 02% and 15. 32% in tiotropium and ipratropium group, respectively (P=0. 23). CONCLUSION: Domestic tiotropium inhalation capsule is efficient and safe in the treatment of COPD.

Attitudes toward the American nutrition guidelines for the critically ill patients of Chinese intensive care physicians.

Nutrition therapy is essential for the management of critically ill patients. Some guidelines have been published to standardize and optimize the nutrition therapy. However, there are still many controversies in nutrition practice and there is a gap between guidelines and clinical nutrition therapy for patients in intensive care units (ICUs). This study aimed to assess attitudes and beliefs toward nutrition therapy of Chinese intensive care physicians by using the American guidelines as a surrogate. A questionnaire was sent to 45 adult ICUs in China, in which surveyed physicians were asked to rate their attitudes toward the American guidelines. A total of 162 physicians from 45 ICUs returned the questionnaires. Physicians were categorized into groups according to their professional seniority, hospital levels and whether they were members of Chinese Society for Parenteral and Enteral Nutrition (CSPEN). Overall, 94% of the respondents thought that nutrition therapy for critically ill patients was very important, and 80% mentioned that they used the American guidelines. There was diversity of opinion on the recommendations pertaining to nutrition assessment, supplemental parenteral nutrition and cutoff values for gastric residual volume, negative or neutral attitudes about these recommendations were 43%, 59% and 41%, respectively. Members of CSPEN were more likely to select a greater strength of recommendation than non-members. In conclusion, the overall attitudes of Chinese intensive care physicians toward the American guidelines were positive. Nevertheless, given the great guideline-practice gap, nutrition-focused education is warranted for many intensive care physicians in China.

Thrombolysis during extended cardiopulmonary resuscitation for autoimmune-related pulmonary embolism.

BACKGROUND: Massive pulmonary embolism (MPE) and acute myocardial infarction are the two most common causes of cardiac arrest (CA). At present, lethal hemorrhage makes thrombolytic therapy underused during cardiopulmonary resuscitation, despite the potential benefits for these underlying conditions. Hypercoagulability of the blood in autoimmune disorders (such as autoimmune hemolytic anemia) carries a risk of MPE. It is critical to find out the etiology of CA for timely thrombolytic intervention. METHODS: A 23-year-old woman with a 10-year medical history of autoimmune hemolytic anemia suffered from CA in our emergency intensive care unit. ECG and echocardiogram indicated the possibility of MPE, so fibrinolytic therapy (alteplase) was successful during prolonged resuscitation. RESULTS: Neurological recovery of the patient was generally good, and no fatal bleeding developed. MPE was documented by CT pulmonary angiography. CONCLUSIONS: A medical history of autoimmune disease poses a risk of PE, and the causes of CA (such as this) should be investigated etiologically. A therapy with alteplase may be used early during cardiopulmonary resuscitation once there is presumptive evidence of PE. Clinical trials are needed in this setting to study patients with hypercoagulable states.

[Roles of long noncoding RNA in lung cancer].

Long noncoding RNAs are a group of noncoding RNAs with a length more than 200 nucleotides. Recent studies have revealed that long noncoding RNAs play an important role in the development and progression of cancer. Lung cancer is the leading cause of cancer-related death all over the world. In this article, we review the roles of long noncoding RNAs in lung cancer to provide new insights into the diagnosis and treatment of the disease.

Nkx2-1: a novel tumor biomarker of lung cancer.

Nkx2-1 (Nkx homeobox-1 gene), also known as TTF-1 (thyroid transcription factor-1), is a tissue-specific transcription factor of the thyroid, lung, and ventral forebrain. While it has been shown to play a critical role in lung development and lung cancer differentiation and morphogenesis, molecular mechanisms mediating Nkx2-1 cell- and tissue-specific expression in normal and cancerous lungs have yet to be fully elucidated. The recent identification of prognostic biomarkers in lung cancer, particularly in lung adenocarcinoma (ADC), and the different reactivity of patients to chemotherapeutic drugs have opened new avenues for evaluating patient survival and the development of novel effective therapeutic strategies. The function of Nkx2-1 as a proto-oncogene was recently characterized and the gene is implicated as a contributory factor in lung cancer development. In this review, we summarize the role of this transcription factor in the development, diagnosis, and prognosis of lung cancer in the hope of providing insights into the utility of Nkx2-1 as a novel biomarker of lung cancer.

[Diagnosis value of serum NKX2-1 for primary lung cancer].

OBJECTIVE: To evaluate serum Nkx2-1 (NKX homeobox-1) levels in diagnosis of primary lung cancer. METHODS: The serum NKX2-1 and CEA (carcinoma embryonic antigen) levels were measured in 61 patients with primary lung cancer admitted from May 2009 to December 2010 and 49 healthy individuals served as controls. The receiver operating characteristic curve (ROC) of NKX2-1 in diagnosis for primary lung cancer was analyzed. The value of serum NKX2-1 in diagnosing primary lung cancer was compared with that of CEA by X(2) test and Kappa test. RESULTS: The serum Nkx2-1 levels in lung cancer were significantly higher than those in controls [(1.4206 ±0.1257)ng/ml compared with (0.7646 ±0.0734)ng/ml,P<0.01]. ROC analysis showed the area under the curve of serum NKX2-1 was 0.859. The Kappa value of NKX2-1 was higher than that of CEA (0.586 compared with 0.396,P<0.05). Combination of serum NKX2-1 with CEA improved the Kappa value to 0.704, and also had high sensitivity (83.6%) and specificity (87.0%) for diagnosis of primary lung cancer. CONCLUSION: Serum NKX2-1 protein can be used as a marker for diagnosis of lung cancer, the combination of NKX2-1 with CEA may further improve the diagnostic value.

Urticaria as the initial presentation of early stage bronchioloalveolar carcinoma: a case report.

Bronchioloalveolar carcinoma is a subtype of the lung adenocarcinoma. Early stage bronchioloalveolar carcinoma is usually asymptomatic, especially in the peripheral lung. Rarely, urticaria has been described occurring with lung cancer, usually small-cell lung cancer, but no case has been reported of the bronchioloalveolar carcinoma yet. We report here a unique and initial urticaria on a patient, lasting for 6 months, who finally was diagnosed as early stage bronchioloalveolar carcinoma (T1aN0M0). After treatment of surgery, the symptom of urticaria disappeared and did not recur. Therefore, we consider that utricaria is a possibly clinical manifestation in early stage bronchioloalveolar carcinoma.

A case study of imported pulmonary coccidioidomycosis.

Coccidioidomycosis is an endemic disease of the Western hemisphere. The cases in non-endemic areas are mostly imported. Determining a history of exposure is critical for performing the diagnosis of coccidioidomycosis, especially for cases occurring in a non-endemic area. In this study, a 71-year-old Chinese male presented to our hospital with chronic cough and malaise, and was found to have a mass in the middle lobe of right lung. He had been visiting Arizona, USA for four months before admission. Pulmonary coccidioidomycosis was confirmed by the results of histopathological examination after lobectomy. Typical microscopic features of Coccidioides are definitely diagnostic, but need be differentiated from other budding yeast infection or carcinoma histopathologically.

[Report of a case of bronchioloalveolar carcinoma with natural growth for 10 years and review of the literature].

OBJECTIVE: To better understand the clinical and imaging characteristics of bronchioloalveolar carcinoma (BAC). METHODS: A case diagnosed with BAC with a natural history for 10 years was reported and the related literature was reviewed. We searched literatures in PubMed with "bronchioloalveolar carcinoma", "ground glass opacity", "high resolution computed tomography" as the search term, in WANFANG MED ONLINE with "bronchioloalveolar carcinoma", "ground glass opacity" as the search term by June 2010. RESULTS: The clinical and imaging characteristics of BAC were variable. A case of BAC in a 76 year old asymptomatic man was reported. He presented with a small 'flake like' density shadow in the left upper lobe which gradually increased in density over a 10 year follow-up. Subsequent upper lobectomy and mediastinal node dissection confirmed BAC. We received 35 literatures reported 664 cases of ground-glass performance BAC, including reviews of 4, retrospective analysis of 24, reported case of 7 in PubMed. We received a retrospective analysis reported 24 cases in WANFANG MED ONLINE. CONCLUSIONS: Patients presenting with ground glass opacities on chest CT with no specific clinical manifestations should alert the clinicians to the possibility of BAC. Regular follow-up with CT scans is needed and surgical resection should be considered if BAC is suspected.

Diagnostic value of transthoracic Doppler echocardiography in pulmonary hypertension: a meta-analysis.

BACKGROUND: A commonly used noninvasive method, transthoracic Doppler echocardiography (TDE) has been widely recommended for the diagnosis of pulmonary hypertension (PH). We aimed to review comprehensively the evidence for the use of TDE to diagnose PH. METHODS: After a systematic review of English-language studies, we used random-effects models to pool sensitivity, specificity, and other measures of accuracy of TDE for the diagnosis of PH. Summary receiver operating characteristic (SROC) curves were used to summarize overall test performance. RESULTS: Six studies met our inclusion criteria. The summary estimates for TDE in the diagnosis of PH in the included studies were as follows: sensitivity, 0.82 (95% confidence interval (CI), 0.76-0.88); specificity, 0.68 (95% CI, 0.64-0.72); positive likelihood ratio (PLR), 2.88 (95% CI, 1.77-4.70); negative likelihood ratio (NLR), 0.31 (95% CI, 0.18-0.53); and diagnostic odds ratio (DOR), 11.36 (95% CI, 4.62-27.94). CONCLUSIONS: Current evidence suggests that TDE is a test with acceptable mixed sensitivity, but in isolation, it has insufficient specificity for detecting PH. It may be useful as a first-line surveillance modality in patients in whom PH is suspected. The value of the combination of TDE with other noninvasive methods for PH detection warrants further investigation.

[Determination of volatile organic compounds in lung cancer cell lines and lung cancer tissue].

OBJECTIVE: To identify the volatile organic compounds (VOCs) in lung cancer tissue and lung cancer cell lines. METHODS: The lung cancer tissue samples from 18 patients were cultured and 4 lung cell lines (A549, NCI-H446, SK-MES-1, BEAS-2B) were also included in the study. Air samples in the headspace of culture flasks were analyzed for VOCs with solid-phase micro-extraction and gas chromatography-mass spectroscopy technique (SPME-GC/MS). RESULT: Two kinds of VOCs 2-pentadecanone and nonadecane were detected in lung cancer cell lines A549, NCI-H446 and SK-MES-1. The concentration of 2-pentadecanone were (1.382 + or -0.171) X 10(-5)mg/L, (1.681 + or - 0.190) X 10(-4)mg/L and (2.835 + or - 0.401) X 10(-6)mg/L, respectively; the concentrations of nonadecane were (8.382 + or - 0.606 ) X 10(-6)mg/L, (1.845 + or - 0.130) X 10(-5)mg/L and (6.220 + or - 0.362) X 10(-6)mg/L), respectively. The eicosane was detected in A549 and NCI-H446 with the concentration of (8.313 + or - 1.130) X 10(-6)mg/L and (1.020 + or - 0.141) X 10(-5)mg/L), respectively. All the 3 VOCs were not detected in cell line BEAS-2B. The concentrations of 12 VOCs including decane, 2- pentadecanone, nonadecane and eicosane were high in 18 lung cancer tissue samples; the concentrations of 2-pentadecanone were 5.421 X 10(-6)mg/L-3.621 X 10(-5)mg/L,those of nonadecane were 5.805 X 10(-6)mg/L-1.830 X 10(-5)mg/L, those of eicosane were 2.730 X 10(-6)mg/L-2.343 X 10(-5)mg/L. There were no differences of VOCs levels among patients with different cancer differentiation (P>0.05). The concentration of eicosane in the non-squamous carcinoma was higher than that in squamous carcinoma, the same results were confirmed in the lung cancer cell lines. CONCLUSION: This study has identified VOCs produced by lung cancer tissue, which may support to use breath test as a complementary noninvasive diagnostic method for lung cancer.

[Measurement of exhaled volatile organic compounds in lung cancer patients].

OBJECTIVE: to study the characteristics of volatile organic compounds (VOCs) in exhaled breath of lung cancer patients, and therefore to explore its use in the diagnosis of the disease. METHODS: from February 2007 to September 2009, 55 patients with lung cancer, 21 patients with benign lung diseases and 30 healthy controls were enrolled in our study. The VOCs in exhaled breath were detected by the SPME (solid phase microextraction)-GC (gas chromatography) system. RESULTS: heptanal was detected in 45 patients of the lung cancer group, 1 of the benign lung disease group, and 1 of the healthy control group. The positive rate was higher in the lung cancer group as compared to the benign lung disease group and the healthy group combined (P < 0.05). The detection of heptanal was not related to age, smoking, histological type and staging (P > 0.05). CONCLUSION: heptanal maybe a useful marker in VOCs from patients with lung cancer.

[Tracheal lobular capillary hemangioma: two case report and review of the literature].

OBJECTIVE: to highlight the clinical manifestation, histologic characteristics, diagnostic and therapeutic method of tracheal lobular capillary hemangioma (LCH). METHODS: the clinical, auxiliary examinational and pathological data of two patients with tracheal LCH were presented, and relevant literatures were reviewed. RESULTS: LCH is a polypoid form of capillary hemangioma which usually occurs on skin or muscosal surface of oral and nasal, rarely be seen in trachea. The most common presenting symptom of tracheal LCH is recurrent haemoptysis, CT scan can help to make diagnosis. Transbronchoscopic interventional therapy is the most effective treatment for tracheal LCH. Histologic examination can help to make the extreme diagnosis. CONCLUSIONS: tracheal LCH is a scarce benign lesion of tracheal. There isn't any typical clinical manifestation and auxiliary examination. Histologic examination can make a definite diagnosis, and bronchoscopes plays the most effective part in diagnosis and therapy.

Clinical evaluation of oral levofloxacin 500 mg once-daily dosage for treatment of lower respiratory tract infections and urinary tract infections: a prospective multicenter study in China.

Levofloxacin (LVFX), a fluoroquinolone agent, has a broad spectrum that covers Gram-positive and -negative bacteria and atypical pathogens. It demonstrates good clinical efficacy in the treatment of various infections, including lower respiratory tract infections (LRTIs) and urinary tract infections (UTIs). To evaluate the efficacy and safety of oral LVFX 500 mg once daily, a large open-label clinical trial was conducted in 1266 patients (899 with LRTIs and 367 with UTIs) at 32 centers in China. In the per-protocol population, the clinical efficacy rate (cure or improvement) at 7 to 14 days after the end of treatment was 96.4% (666/691) for LRTIs and 95.7% (267/279) for UTIs. In 53 patients diagnosed with atypical pneumonia the treatment was effective. The bacteriological efficacy rate was 96.6% (256/265) for LRTIs and 93.3% (126/135) for UTIs. The eradication rate of the causative pathogens was 100% (33/33) for Haemophilus influenzae and 96.0% (24/25) for Streptococcus pneumoniae in LRTIs, and 94.1% (80/85) for Escherichia coli in UTIs. The overall efficacy rates were 89.3% (617/691) for LRTIs and 87.8% (245/279) for UTIs. The incidence of drug-related adverse events (ADRs) was 17.3% (215/1245), and the incidence of drug-related laboratory abnormalities was 15.7% (191/1213). Common ADRs were dizziness, nausea, and insomnia. Common laboratory abnormalities included "WBC decreased", "alanine aminotransferase (ALT) increased", "aspartate aminotransferase (AST) increased", and "lactate dehydrogenase (LDH) increased". All of these events were mentioned in the package inserts of fluoroquinolones including LVFX, and most events were mild and transient. Thirty-four patients (2.7%) were withdrawn from the study because of the ADRs. No new ADRs were found. This study concluded that the dosage regimen of LVFX 500 mg once daily was effective and tolerable for the treatment of LRTIs and UTIs.

[Perioperative intervention to prevent lower extremity deep venous thrombosis after gynecologic surgery].

OBJECTIVE: To investigate the preventative effect of perioperative intervention to lower extremity deep venous thrombosis (DVT) after gynecologic surgery. METHODS: The 1062 patients,who received gynecologic surgery during 2007 June to 2008 June, were divided into intervention and nonintervention groups randomizely. According to the risk factors of DVT, the patients in intervention group were divided into 4 subgroups: low, mid, high and extremely high risk. Each group had its own preventive measures. If patients had spontaneous pain, tenderness and swelling, positivity of Neuhof or Homan syndrome, and extension of one low extremity superficial vein, the low extremity color Doppler ultrasound would be carried out immediately. The ultrasound would also be routinely carried out in the high and extremely high risk groups in intervention group after 2 and 7 days after surgery. A prospective study was carried out investigating incidence of DVT and coagulation function perioperation. The vein blood samples were taken at in a week before surgery and 48 hours post-operation. RESULTS: The incidence of DVT of intervention group was 1.10% (6/546), and in nonintervention group, the incidence was 3.29% (17/516). There was significant difference between two groups (P < 0.05). The incidence of DVT in extremely high risk subgroup was 21.05% (4/19), which was significantly higher than that of low(0), mid(0)and high risk groups [2.13% (2/94), P < 0.05]. D-dimer, antithrombin-III (AT-III) post-operation were all higher than that pre-operation in the two groups, but there was no significant difference (P > 0.05). The indexes of coagulation system,such as blood platelet count, prothrombin time (PT), active partial thromboplastin time (APTT), fibrinogen (Fbg), thrombin time (TT), tissue-plasminogen activator (t-PA), plasminogen activator inhibitor (PAI), were not significantly changed perioperation (P > 0.05 in all pre-or post-operation indexes). CONCLUSIONS: Perioperative intervention measurement according to different risk of DVT could cut down the incidence of DVT. DVT preventive intervention is suggested to high and extremely high risk people.

[The impact of right ventricular dysfunction on the clinical outcome of normotensive patients with pulmonary embolism].

OBJECTIVE: To investigate the prevalence and clinical outcome of right ventricular (RV) dysfunction among normotensive PE patients. METHODS: Inclusion criteria included: (1) Confirmed PE at Sir Run Run Shaw Hospital from January 2001 to December 2004. (2) Normotensive. (3) Echocardiography done before therapy. RV dysfunction was assessed with echocardiography in the presence of one or more of the following criteria: RV dilatation, pulmonary hypertension as evidenced by pulmonary artery systolic pressure>30 mm Hg, pulmonary artery mean pressure>20 mm Hg and tricuspid regurgitant velocity>2.8 m/s. The clinical outcome of these two groups normotensive PE patients with and without RV dysfunction was analyzed. RESULTS: 57 cases of normotensive PE were included in this study. 27 of the 57 patients were judged to have RV dysfunction. There was no difference in age, gender, prevalence of deep venous thrombosis (DVT), cancer or other risk factors in these two groups. In the group with RV dysfunction, 5 patients (19%) died as a result of PE. In comparison, in the group without RV dysfunction, only one patient died related to bladder cancer with multiple brain metastasis, so none of the patients of this group died directly related to PE. After therapy, 22 patients of this group became better and RV function also improved in short-term. CONCLUSIONS: The mortality related to PE in normotensive patients with RV dysfunction is significantly higher than those without. In patients with PE, echocardiography is quite useful because it can often help to detect RV dysfunction which is a significantly high risk of death. After therapy, RV function of normotensive patients with PE will improve in short-term. Echocardiography is an important means of evaluating of therapeutic outcome in pulmonary embolism.