[The clinical value of autofluorescence bronchoscopy for the diagnosis of lung cancer].

OBJECTIVES: To evaluate the benefit of using autofluorescence bronchoscopy (AFB) for the detection and localization of early invasive lung cancer. METHODS: AFB and white light bronchoscopy (WLB) were performed on 198 cases of suspected lung cancer, and the relative sensitivity of WLB plus AFB compared with WLB alone. RESULTS: Included 198 biopsy specimens, and 160 were classified as positive by pathology, including 156 invasive cancer and 4 severe dysplasia. The relative sensitivity to detect intraepithelial neoplasia of WLB + FLB versus WLB was 97.5% and 80.0% respectively, significantly (P < 0.05). CONCLUSION: AFB was more sensitive than WLB in detecting preneoplastic bronchial changes and early lung cancer in high-risk subjects.

[The clinical features of invasive pulmonary aspergillosis in 53 chronic obstructive pulmonary disease patients].

OBJECTIVE: To study the clinical features of invasive pulmonary aspergillosis (IPA) with chronic obstructive pulmonary diseases (COPD), so as to provide evidence for early diagnosis and treatment. METHODS: A retrospective analysis was made upon clinical data, diagnosis, treatment and prognosis of 53 patients with IPA and COPD admitted between January 2005 and February 2011 collected in a respiratory unit of the Second Xiangya Hospital Affiliated Central South University. RESULTS: There were 53 cases of diagnosed as IPA with COPD, with history of using broad-spectrum antibiotics. And there were 43 cases using steroids more than 2 weeks, 51 with obvious breathlessness, and 20 with fever. Early stage didn't present characteristical changes on CT scan. However, after disease progression, 32 cases had maculas shadows and nonspecific consolidations in bilateral lung, 14 with solitary or multiple nodules, 4 with solitary or multiple air crescent sign, and 2 with halo sign. Four patients of COPD with IPA underwent bronchoscopy examination. In fungi pathogeny, sputum positive rate and galactomannan positive rate were 56.6% and 52.8%, respectively. A total of 53 cases received antifungal treatment. Among 37 cases which underwent mechanical ventilation, 24 received noninvasive ventilation and 13 received invasive ventilation. There were 33 cases which were improved and cured, and 20 cases which had no relief after half-a-month treatment or withdrew treatment. Among them, 13 cases died because of multiple-organ failure (5/15) or acute renal failure (8/15). CONCLUSIONS: Early suspected diagnosis, timely examination in allusion to IPA, actively searching for etiological and imaging evidences, early established diagnosis and antifungal treatment would improve prognosis of patients with COPD combined IPA who have history of high doses of corticosteroids, obvious breathlessness and non-response to antibiotics.

[The effects of Tumstatin185-191 on lung adenocarcinoma cell lines and the association with protein kinase B and extracellular regulated protein kinase activation].

OBJECTIVE: to investigate the antitumor effects of tumstatin185-191 as a single agent or combination with cisplatin (DDP) on non-small lung cancer (NSCLC) cell lines A549. In addition, the changes of the protein kinase B(Akt) and extracellular regulated protein kinase (ERK) in cultured NSCLC cells treated by tumstatin185-191 and cisplatin were evaluated. METHODS: A549 cells were treated with tumstatin185-191 and cisplatin. Cell viability was assessed using the modified 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Cell apoptosis was measured by flow cytometry. The activation of Akt and Erk were evaluated by Western blotting. RESULTS: Tumstatin185-191 inhibited the proliferation of A549 and the IC(50) values of tumstatin 185-191 was 73.7 micromol/L. After cotreatment with 20 micromol/L tumstatin185-191, IC(50) values of cisplatin in A549 cells reduced from 5.2 micromol/L to 3.5 micromol/L, while 40 micromol/L tumstatin185-191 reduced from 5.2 micromol/L to 1.4 micromol/L. The early apoptosis rate was (19.34 +/- 0.97)% in the cotreatment group, (12.5 +/- 2.1)% in cisplatin group and (9.6 +/- 1.6)% in tumstatin185-191 group (F = 5.74, P < 0.01). The levels of phospho-Akt (p-Akt) and phospho-ERK (p-ERK) in the A549 cells were remarkably lower after being treated with tumstatin 185-191, while tumstatin 185-191 treatment whether alone, or in combination with cisplatin, had the similar effects on the protein levels of p-Akt and p-ERK in A549 cells. CONCLUSION: our data suggest that tumstatin185-191 might enhance the sensitivity of A549 cells to cisplatin. The effects of promoting apoptosis and downregulation of proliferation induced by tumstatin185-191 may be mediated through inactivation of the Akt and ERK pathways.

[Tumstatin185-191 increases the sensitivity to cisplatin in a cisplatin-resistant human lung adenocarcinoma cell line].

OBJECTIVE: To investigate the effects and related mechanisms of Tumstatin 185-191 as a single agent or in combination with cisplatin on proliferation and apoptosis in a cisplatin-resistant human lung adenocarcinoma cell line A549-DDP cells. METHODS: A549-DDP cells were treated with Tumstatin185-191 and cisplatin at varying concentrations. Cell viability was assessed by a modified 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. 50% inhibiting concentration (IC(50)) values of the chemotherapeutic drugs were analyzed by MTT assay. Cell apoptosis was measured by flow cytometry. The activation of Akt and ERK was evaluated by Western blotting. RESULTS: Tumstatin185-191 inhibited the proliferation of A549-DDP cells and its IC(50) value was 80.25 micromol/L. After cotreatment with 20 micromol/L Tum185-191, the IC(50) value of cisplatin in A549-DDP cells reduced from 77.16 micromol/L to 57.97 micromol/L, the reverse index was 1.33, while with 40 micromol/L Tumstatin185-191 the IC(50) was reduced from 77.16 to 26.40 micromol/L and the reverse index was 2.92. The early apoptosis rate was 19.5% +/- 1.1% in the cotreatment group, while 13.3% +/- 1.5% in cisplatin group and 10.2% +/- 2.0% in Tum185-191 group (F = 4.09, P < 0.05). The levels of phospho-Akt (p-Akt) and phospho-ERK (p-ERK) in the A549-DDP cells were remarkably lower after treatment with Tumstatin 185-191. The Tumstatin 185-191 treatment alone or in combination with cisplatin had a similar effect on the protein levels of p-Akt and p-ERK in A549-DDP cells. CONCLUSION: Our data suggest that Tumstatin185-191 may promote apoptosis, downregulate proliferation and partly reverse the drug resistance of A549-DDP cells to cisplatin. The effects induced by Tum185-191 may be mediated through inactivation of the Akt and ERK pathways.

[Application of sequential noninvasive following invasive mechanical ventilation in COPD patients with severe respiratory failure by investigating the appearance of pulmonary-infection-control-window].

OBJECTIVE: To evaluate the application of sequential noninvasive following invasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) patients with severe respiratory failure by investigating the appearance of pulmonary-infection-control-window. METHODS: From November 2001 to October 2004, 76 case of COPD patients with severe respiratory failure due to pulmonary infection were intubated and recruited in the study. When the pulmonary infection was significantly controlled (the time of pulmonary infection control was called PIC window) by the antibiotic and comprehensive therapy, all cases were randomized into noninvasive veatiation group (NIV) and control group. The early extubation was conducted and followed by noninvasive mechanical ventilation via facial mask with bilevel positive airway pressure mode immediately in the NIV group. Conventional invasive synchronized intermittent mandatory ventilation (SIMV) plus pressure support ventilation (PSV) was used as the weaning technique in the control group. RESULTS: Thirty eight cases among 76 patients were in the NIV group, and the rest in the control group. The NIV group and the control group had similar age, sex, APACHE scores, RR, HR, MAP, PaO2 and PaCO2 at the time of commencement and PIC window (P > 0.05). The time of PIC window was (7.5 +/- 1.9) d in the NIV group, and (8.0 +/- 2.5) d in the control group (P > 0.05). In the NIV group, the durations of invasive mechanical ventilation (MV) and total MV were (7.5 +/- 1.9) d and (12.5 +/- 4.0) d respectively, while the durations were (23.5 +/- 9.5) d in the control group (P < 0.05). The durations of RICU stay and hospital stay were shorter than that in the control group. The incidence of ventilation associated pneumonia (VAP) was 18.4% (7/38) in the NIV group, 39.5% (15/38) in the control group respectively (P < 0.05). The incidence of reintubation was 13.2% (5/38) in the NIV group, 34.2% (13/38) in the control group respectively (P < 0.05). Hospital mortality was 7.9% (3/38) in the NIV group, and 28.9% (11/38) in the control group (P < 0.05). CONCLUSION: In those COPD patients requiring intubation and mechanical ventilantion who have severe respiratory failure due to pulmonary infection, sequential noninvasive following invasive mechanical ventilation at the appearance of PIC window can significantly reduce the MV duration, the length of RICU stay and hospital stay, and decrease the occurrence of VAP, reintubation and hospital mortality as well. So it is an efficient strategy to be generalized.