Atorvastatin in pulmonary arterial hypertension (APATH) study.

Statins have been shown to both prevent and attenuate pulmonary hypertension in animal models. This study investigates the potential therapeutic benefits of atorvastatin as an affordable treatment for pulmonary hypertension patients. 220 patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) were randomised, double-blind, to receive atrovastatin 10 mg daily or matching placebo in addition to supportive care. At 6 months, 6-min walk distance decreased by 16.6 m in the atorvastatin group and 14.1 m in the placebo group. The mean placebo-corrected treatment effect was -2.5 m (95% CI: -38-33; p=0.96), based on intention to treat. A small nonsignificant increase in pulmonary vascular resistance and fall in cardiac output was seen in both treatment groups. There was no significant difference in the proportion of patients who improved, remained stable or showed a deterioration in World Health Organization functional class between atorvastatin and placebo treatments. Nine patients died in the atorvastatin group and 11 in the placebo group. Serum cholesterol levels fell significantly on atorvastatin treatment. Discontinuation rates were 23.2% and 26.9% on atorvastatin and placebo, respectively. Atorvastatin 10 mg daily has no beneficial effect on the natural history of PAH or CTEPH over 6 months.

[Relationship between serum uric acid levels and patient conditions and prognosis in idiopathic pulmonary arterial hypertension].

OBJECTIVE: To explore the relationship between serum uric acid levels and patient conditions and prognosis in idiopathic pulmonary arterial hypertension (IPAH). METHODS: A total of 76 IPAH patients confirmed by right heart catheterization were enrolled consecutively and followed up until the endpoint of all-cause death. Their baseline data were recorded and analyzed by Spearman's rank test and independent t-test. And the follow-up outcomes were analyzed with Kaplan-Meier plots. RESULTS: There were 27 males and 49 females with a mean age of 29.7 ± 9.7 years. They were classified into World Health Organization functional class (WHO-FC)II (n = 28), class III (n = 45) and class IV (n = 3). Their baseline mean pulmonary artery pressure was (65 ± 16) mm Hg, pulmonary vascular resistance (1677 ± 669) dyn×s(-1)×cm(-5), pulmonary capillary wedge pressure (9.6 ± 5.0) mm Hg, mean right atrial pressure (9.8 ± 6.1) mm Hg, cardiac index (2.07 ± 0.57) L ×min(-1)× m(-2) and serum uric acid (391 ± 103) µmol/L. The correlation analysis indicated that the serum level of uric acid correlated positively with right ventricular diameter (r = 0.28, P = 0.018) and negatively with CI (r = -0.34, P = 0.003). Independent t-test results indicated that the patients with a higher level of uric acid were apt to have a worse WHO-FC, and the higher level uric acid group (serum uric acid > 416.5 µmol/L) had a relative higher level of WHO-FC, NT-proBNP and endothelin-1. A lower level of CI denoted more severe conditions and prognosis. Survival analysis indicated that the serum level of uric acid could strongly predict survival in IPAH patients with over time and those with a high level of uric acid had a worse prognosis. CONCLUSION: The serum level of uric acid correlates significantly with patient conditions and prognosis in IPAH. And a higher serum level of uric acid predicts worse conditions and prognosis.

[Multicenter study of disease attributes in adult patients with pulmonary hypertension].

OBJECTIVE: To understand the demographic, hemodynamic and clinical features of adult patients with pulmonary hypertension (PH) in China. METHODS: Between May 2007 and October 2010, a total of 551 adult PH patients were recruited from 31 clinical centers all over China. All fulfilled the traditional hemodynamic criteria diagnosed through right heart catheterization (RHC). The relevant data of demographic, clinical and hemodynamic features of all patients, analyzed the similarities and differences of demographic characteristics between different subtypes. They were divided into 2 groups: WHO functional class I/II and III/IV. And their hemodynamic and clinical features were compared. RESULTS: There were 165 males and 386 females with a mean age of (35 ± 12) years. The mean body mass index (BMI) was (21 ± 4) kg/m(2). There were pulmonary arterial hypertension (PAH, n = 487) and chronic thromboembolic pulmonary hypertension (CTEPH, n = 64). Fatigue (421, 76.4%) and dyspnea (398, 72.2%) were the most common symptoms; Physical examination revealed such a common sign as an accentuated pulmonic second sound (P(2)) in 510 patients (92.6%). Over half (325, 59.0%) of them were of WHO functional class II and 213 (38.6%) patients functional class III. The 6-minute walking distance (6MWD) and Borg dyspnea score were (352 ± 91) m and 3.0 (2.0 - 4.0) respectively. ECG of 497 (90.2%) patients showed right ventricular hypertrophy. Mean right atrial pressure was (9 ± 6) mm Hg (1 mm Hg = 0.133 kPa), pulmonary arterial pressure (67 ± 20) mm Hg, cardiac index (2.7 ± 1.2) Lmin(-1)m(-2) and pulmonary vascular resistance (1496 ± 783) dyn.sec.cm(-5). CONCLUSIONS: Young females with a low BMI are predominantly affected by PH. Severe functional and hemodynamic compromises often appear on presentation. And hemodynamic impairment is correlated with 6MWD and WHO functional class.

[Clinical analysis of 150 patients with idiopathic pulmonary arterial hypertension].

OBJECTIVE: To explore the demographic characteristics and clinical features of patients with idiopathic pulmonary arterial hypertension (IPAH) in China. METHODS: Between March 2007 and September 2010, IPAH diagnosis was confirmed by right heart catheterization in 150 adult patients from 31 clinical centers in China. Clinical and hemodynamic data were analyzed and patients were divided into WHO functional class I/II and WHO functional class III/IV group. RESULTS: The mean age of 150 patients were 36 ± 13 years with female patient/male patient ratio of 2:1, and mean BMI was (21.3 ± 3.5) kg/m(2). Fatigue (n = 123, 82.0%) and dyspnea (n = 112, 74.7%) are the most common symptoms. Accentuated pulmonic second sound (P(2)) was detected in 92.0% (n = 138) of patients during physical examination, which was also the most common sign. About 49.0% (n = 73) patients were WHO functional class I/II patients and 46.0% (n = 68) patients were WHO functional class III/IV patients. Six minutes walking distance (6MWD) and Borg dyspnea score was (337 ± 101) m and 2.0 (2.0, 4.0), respectively. Right ventricular hypertrophy was suggested by ECG in 93.1% (n = 140) patients. Right atrial pressure was (10 ± 6) mm Hg, mean pulmonary artery pressure was (61 ± 16) mm Hg, cardiac index was (2.3 ± 0.8) L×min(-1)×m(-2) and pulmonary vascular resistance (1484 ± 699) dyn×s(-1)×cm(-5) in this cohort. 6 MWD (305 m ± 89 m vs. 377 m ± 88 m) was significantly shorter while Borg dyspnea score [3.0 (3.0, 5.0) vs. 2.0 (2.0, 3.0)] was significantly higher in WHO functional class III/IV patients than in WHO functional class I/II patients. Similarly hemodynamic parameters were also worse in WHO functional class III/IV patients than in WHO functional class I/II patients (all P < 0.05). CONCLUSION: Idiopathic pulmonary arterial hypertension patients in this cohort affect mostly young adults, dominated by female gender and lower body mass index. Fatigue and dyspnea are the most common symptoms and accentuated pulmonic second sound (P(2)) is the most common sign. IPAH patients are often displaying severe functional and hemodynamic disturbance at first visit to hospitals. Dyspnea and hemodynamic impairment are related to 6MWD and WHO functional class.

[Preliminary study on the efficacy and safety of oral sildenafil in pulmonary arterial hypertension in China].

OBJECTIVE: Sildenafil has been shown to be effective in pulmonary arterial hypertension (PAH). However, the impact of sildenafil on PAH has been under-investigated in China. The aim of the present study was to evaluate the efficacy and safety of oral sildenafil in PAH patients in China. METHODS: In this prospective, open-label and multi-center study, 90 patients were recruited from 14 centers to receive oral sildenafil (75 mg/d) for 12 weeks. They underwent a six-minute walk test (SMWT) and cardiac catheterization at the beginning and the end of 12 weeks. The primary endpoint was the changes in exercise capacity as assessed by SMWT. And the secondary endpoints included assessment of functional class, evaluation of cardiopulmonary hemodynamics and clinical deterioration (defined as death, transplantation and re-hospitalization for PAH). Drug safety and tolerability were also examined. RESULTS: There were 19 males and 71 females with an average age of 32.5 ± 12.1 years old (range: 18 - 61). Their etiologies were idiopathic (n = 15), related with congenital heart disease (n = 60), or related with connective tissue disease (n = 9) and chronic thromboembolic pulmonary hypertension (n = 6). Oral sildenafil significantly increased the SMWT distances [(342 ± 93) m vs. (403 ± 88) m, P < 0.001]. There was also remarkable improvement in Borg dyspnea score (2.9 ± 2.6 vs. 2.4 ± 2.0, P = 0.005). Furthermore, significant improvements in World Healthy Organization (WHO) functional class and cardiopulmonary hemodynamics were also found (mean pulmonary artery pressure, P < 0.001; cardiac index, P < 0.001; pulmonary vascular resistance, P < 0.001). Side effects were mild and consistent with other reports. CONCLUSION: This study confirms and extends previous studies. Oral sildenafil is both safe and effective for the treatment of adult PAH patients in China.

[Sildenafil therapy for pulmonary hypertension: a prospective study].

OBJECTIVE: To explore the safety and efficacy of oral sildenafil therapy for pulmonary arterial hypertension (PAH), and to provide evidence for sildenafil treatment for Chinese patients with PAH. METHODS: In this 12-week, prospective, open-label, uncontrolled study, 56 patients with PAH were given oral sildenafil (25 mg, tid). The primary end point was change from baseline to 12 weeks in exercise capacity assessed by 6 min walk (6MW) test. Secondary end points included changes in WHO class and cardiopulmonary hemodynamics. Clinical worsening was defined as death, transplantation, hospitalization for PAH, or initiation of additional therapies for PAH, such as intravenous epoprostenol or oral bosentan. RESULTS: After 12 weeks, the compliance was good in 56 patients. Significant improvement was seen in NYHA heart function class and WHO class as compared to baseline (P < 0.01): from class IV to class III in 2, from class III to class II in 8 and to class I in 2 cases, and from class II to class I in 5 cases. No NYHA heart function class and WHO PAH function class deterioration were observed. Oral sildenafil increased 6MW distance, from (352 ± 80) m to (396 ± 78) m, with a change of (44 ± 70) m (P < 0.01). Significant improvement was seen in hemodynamics (mean pulmonary artery pressure, P < 0.01; cardiac index, P < 0.01; pulmonary vascular resistance, P < 0.01) at week 12 as compared with baseline. Mean right atrial pressure decreased (3 ± 11) mm Hg (1 mm Hg = 0.133 kPa), mean pulmonary arterial pressure decreased (6 ± 14) mm Hg, cardiac output increased (1.1 ± 2.0) L/min, cardiac index increased (0.7 ± 1.1) L×min(-1)×m(-2), and total pulmonary resistance decreased (490 ± 831) Dys×s×cm(-5). Side effects were mild and consistent with those reported with sildenafil treatment. No statistically significant clinical worsening was observed with sildenafil therapy for PAH patients. CONCLUSIONS: Sildenafil improves exercise capacity, WHO functional class, and hemodynamics in patients with pulmonary arterial hypertension.

Registry and survival study in chinese patients with idiopathic and familial pulmonary arterial hypertension.

BACKGROUND: To evaluate the clinical features and survival data of patients with idiopathic pulmonary arterial hypertension (PAH) and familial PAH in Chinese patients. METHODS: Seventy-two patients with idiopathic PAH and familial PAH were enrolled in the study from 1999 to 2004 and were classified into two groups according to World Health Organization (WHO) functional class (I/II and III/IV). Clinical and hemodynamic data were recorded. RESULTS: The mean age of the 72 patients was 35.9 years with female patient/male patient ratio of 2.4:1. A significant difference was identified in the clinical presentation between two WHO functional class groups at baseline. Echocardiography showed a mean pulmonary systolic pressure of 98 mm Hg. Left ventricular end-diastolic diameter was significantly smaller in the group of patients in WHO functional class III/IV than in those in class I/II group. After follow-up for a mean (+/- SD) duration of 40.1 +/- 20.0 months, the survival rates at 1, 2, 3, and 5 years were 68.0%, 56.9%, 38.9%, and 20.8%, respectively. A significant difference was identified in survival rate between the class I/II and class III/IV groups (p = 0.02 [log rank test]). CONCLUSIONS: The baseline characteristics and survival rates of our cohort study are close to those of the National Institutes of Health Registry in the 1980s, and the 1-year survival rate is obviously lower for patients in this registry than for those in the French registry between 2002 to 2003. Lack of effective treatment was the main cause of poor survival in this study. Our results support the need of an appropriate treatment strategy for this devastating disease in China.

[The efficacy and safety of long term home noninvasive positive pressure ventilation in patients with stable severe chronic obstructive pulmonary disease].

OBJECTIVE: To evaluate the long term efficacy and safety of long term home noninvasive positive pressure ventilation (HNPPV) in stable hypercapnic patients with chronic obstructive pulmonary disease (COPD). METHODS: Forty patients with stable severe COPD [arterial PaCO2>or=55 mm Hg (1 mm Hg=0.133 kPa)] after hospital discharge were divided into 2 groups: the HNPPV group (n=20) with conventional therapy and HNPPV, and the control group (n=20) with conventional therapy only. Parameters before and after 2 year follow-up observation were compared, which included dyspnea grade, scale for accessory muscle use, scoring for emotional disorders, lung function test, arterial blood gases, 6-min walking distance (6MWD), mean pulmonary arterial pressure (mPAP) by electrocardiography, mortality and hospitalization rates. RESULTS: The age, gender, height, weight, dyspnea grade, scale for accessory muscle use, anxiety scores, depression scores, 6MWD, mPAP, arterial PaCO2 and PaO2, FVC, FEV1, and hospitalization rates of the 2 groups on admission were similar (t values were 1.08, 1.15, 1.20, 1.09, 0.86, 0.54, 0.00, 0.00, 0.43, 0.96, 0.76, 0.38, 0.26, 0.24 and 0.87 respectively, all P>0.05). The mortality was reduced slightly by HNPPV but with no statistically significant difference (3/20 and 8/20, respectively, chi2=3.27, P>0.05). After 2 years, the difference of the dyspnea grade, scale for accessory muscle use, anxiety scores, depression scores, arterial PaCO2 and PaO2, 6MWD, mean pulmonary artery pressure, and hospitalization rates in the HNPPV group [2.4+/-0.5, 2.6+/-0.6, 6.9+/-2.1, 6.1+/-1.6, (49.5+/-2.2) mm Hg, (60.8+/-4.7) mm Hg, (213+/-45) m, (30.3+/-2.2) mm Hg, (1.4+/-0.4) times/year] was statistically significant compared to the control group [3.9+/-0.3, 4.8+/-0.4, 11.2+/-2.6, 11.6+/-2.1, (61.5+/-2.3) mm Hg, (52.8+/-2.4) mm Hg, (127+/-23) m, (36.4+/-2.3) mm Hg, (3.9+/-0.3) times/year] (t values were 9.53, 10.83, 4.92, 7.83, 14.07, 5.41, 6.07, 4.81 and 10.22 respectively, all P<0.01). CONCLUSION: Long-term use of home noninvasive positive ventilation in patients with stable severe COPD is effective and safe.

[Analysis on inpatient pulmonary hypertension surveillance in Fuwai Cardiovascular Hospital from 1996 to 2005].

OBJECTIVE: To investigate the inpatient pulmonary hypertension (PH) surveillance in a single center of cardiovascular hospital during last ten years. METHODS: In this retrospective analysis, data from patients with discharge diagnosis as PH from Jan. 1996 to Dec. 2005 were collected. RESULTS: A total of 7085 out of 106 640 patients (6.63%) were documented as PH during the survey period and 3.77% PH was idiopathic, 65.93% PH originated from congenital heart diseases, 22.61% from left heart diseases, 5.66% from thrombotic diseases, 0.89% from respiratory diseases, 0.61% from connective tissue diseases, 0.51% from pulmonary vasculitis and 0.03% from portal hypertensive diseases. Both total inpatient number and patients with PH increased year by year during the last 10 years in our hospital. The number of in-hospital patients with PH was significantly higher in 2004 - 2005 than that in 1996 - 2003 (P < 0.0001) and more PH was originated from cardiomyopathy and valvular heart diseases. Idiopathic pulmonary hypertension also tended to increase and PH due to congenital heart diseases was significantly reduced during 2004 - 2005. CONCLUSION: The data from a single center of cardiovascular hospital shows a tendency for increased in-hospital prevalence of pulmonary hypertension during the last ten years.

Changes of the proportion and mortality of pulmonary thromboembolism in hospitalized patients from 1974 to 2005.

BACKGROUND: Pulmonary thromboembolism (PTE) has become a common disease that severely endangers people's health. This study analysed the changes in proportion and mortality of PTE in hospitalized patients to provide data for prevention and management of the disease. METHODS: The data of 763 hospitalized patients with PTE from 1974 to 2005 in Fuwai Hospital were analysed. RESULTS: During the 1970s, 0.27% of patients in a cardiovascular hospital had PTE (< 5 cases per year); while so far this century the proportion is 0.94% (48 to 113 per year). The mortality of hospitalized PTE patients fell from 20.00% in the 1970s to 4.10% this century. Prior to 1990, the mortality of hospitalized PTE patients was 12.50%, and in the years after 1990 only 3.40%. The difference was statistically significant (P < 0.005). People with this disease were mostly between the ages of 30 and 69 years. Men were most susceptible between the ages of 30 and 69 years, while women between the ages of 40 and 69 years. Men contracted PTE 10 years earlier than women. The mortality of male PTE patients was 4.70%, not significantly different from female patients, 5.06% (0.50 < P < 0.75). There were not any significant differences between the mortality of patients in the different age groups overall (< or = 39, 40 - 49, 50 - 59, and > or = 60 years, P > 0.1). More people contracted the disease in winter than in other seasons (P < 0.05). There was no obvious difference between the mortality in different seasons overall (0.75 < P < 0.90). CONCLUSION: PTE is an increasingly significant disease and deserves adequate attention.

[Relationship between myocyte proliferation and cardiac function in adult rats with heart failure].

OBJECTIVE: To confirm whether there is myocytes proliferation in the adult rat with heart failure or not, and to investigate the relationship between myocyte proliferation and heart function. METHODS: Descending anterior branch of left coronary artery was ligated in 20 adult male SD rats so as to establish an heart failure models. Eight rats were used as controls. Hemodynamic parameters, blood pressure (BP), left ventricle end systolic pressure (LVESP), left ventricle end diastolic pressure (LVEDP), +LVdp/dt(max), and -LVdp/dt(max), were measured 30 days after the coronary occlusion. Based on the results of heart function examination, the heart infarct rats were divided into 2 subgroups: cardiac functional compensation subgroup (8 rats), and cardiac functional decompensation subgroup (6 rats). Then the rats were killed and their hearts were taken out and stained with propidium iodide (PI) and antibody to alpha-sarcomeric actin. Immunohistochemistry was used to detect the proliferation cell nuclear antigen (PCNA). Confocal microscopy was used to observe the mitotic image. Light microscopy was used to observe the PCNA positive rate in the myocardium. RESULTS: (1) Mitotic images of myocytes could be identified by confocal microscopy in the left ventricle of all rats. (2) PCNA expression was detected in the nuclei of both infarct and normal hearts. The PCNA positive rate of the cardiac functional compensation subgroup was 7.2% +/- 1.4%, significantly higher than that of the control group (2.2% +/- 0.8%, P = 0.648). However, the PCNA positive rate of the cardiac functional decompensation subgroup was 3.0% +/- 1.3%, not significantly different from that of the control group (P = 0.648). (3) The correlation coefficient between PCNA-positivity of cardiomyocytes and +LVdp/dt(max) in the infarct rats were 0.80 (P < 0.01) and the correlation coefficient between PCNA-positivity of cardiomyocytes and -LVdp/dt(max) was -0.76 (P = 0.01). CONCLUSION: (1) There is myocyte proliferation in the adult rat heart. (2) Myocyte proliferation is positively correlated with heart systolic function, and negatively correlated with heart diastolic function in chronic heart failure.

[Long-term follow-up study of moderate chronic obstructive pulmonary disease in elderly patients].

OBJECTIVE: To investigate the prognosis of moderate chronic obstructive pulmonary disease (COPD) in the elderly patients, and to evaluate the factors for long term survival. METHODS: From May 1993, a prospective cohort study was carried out, in which 191 elderly patients with moderate COPD were recruited in Shougang communities, Shijingshan District, Beijing. The general health state, arterial blood gas, pulmonary function test, electrocardiograph, chest X-ray and 6-minute-walk test (6MWT) were recorded. The patients were followed for 12 years. Univariate analysis of survival rate was performed by Kaplan-Meier method. The significance test was done by Log-rank method, and the baseline factors were analyzed using the COX regression model multiplicity. RESULTS: During the 12 years of follow-up, 10 patients were lost because of migration. Twenty-six patients died of non-COPD diseases, while 52 died of COPD. The survival rate was 81.7% (156/191) in 5 years, and 56.9% (103/181) in 12 years. The result with COX multiplicity showed that the important factors for prognosis of the patients were body mass index [BMI, relative risk (RR) = 0.916, 95% confidence intervals (95% CI) = 0.841 - 0.996], forced expired volume in one second (FEV(1), RR = 0.999, 95% CI = 0.998 - 1.000), arterial partial pressure of oxygen (PaO(2), RR = 0.929, 95% CI = 0.892 - 0.967), 6MWT (RR = 0.997, 95% CI = 0.995 - 1.000) and P pulmonale of ECG (RR = 4.081, 95% CI = 1.567 - 10.624). CONCLUSION: The important factors for prognosis of moderate COPD in elderly patients included BMI, FEV(1), PaO(2), 6MWT and P pulmonale in ECG.

[Clinical analysis of 8 cases of paradoxical embolism].

OBJECTIVE: To describe the clinical features of paradoxical embolism and therefore to improve its diagnosis. METHODS: Case analysis and literature review. RESULTS: Eight cases of pulmonary embolism complicated with paradoxical embolism were diagnosed, of whom there were six men and two women (mean age, 47.6 years). Patent foramen ovale with right to left shunt was identified in only 3 cases. Cerebral embolism occurred in three patients, kidney artery embolism in 2 patients, left atrial thrombus in 1 patient, lower limb artery and aortic embolism in 1 patients respectively. The diagnosis of paradoxical embolism can only be confirmed when a venous thrombus was detected lodged at arterial-venous communication; otherwise, paradoxical embolism was considered a clinical diagnosis. Of the 8 cases, 7 were clinically diagnosed, while 1 was confirmed. CONCLUSIONS: Paradoxical embolism is not uncommon. The diagnosis should be considered when venous thromboembolism is complicated with systematic embolism or unknown cause of systematic embolism.

[Vicissitudes of proportion and mortality of patients with pulmonary thromboembolism].

OBJECTIVE: To investigate the vicissitudes of the proportion and the mortality of patients with pulmonary thromboembolism (PTE). METHODS: To analyze respectively the data of 442 patients with PTE admitted to the Fuwai Hospital during the period 1974-2002 were analyzed retrospectively. RESULTS: The numbers of PTE in-patients every year during the 1970s and 48-79 cases in the early 2000s. The hospitalization constituent ratio of PTE was 0.1152% in 1970s and was 0.5866% in early 2000s. The age of onset ranged from 30 to 60. The tide age was from 30 to 60 in the male patients and from 40 to 60 in the female patients. The in-hospital mortality of PTE patients was descending from 20.0% in 1970s to 5.8% in early 2000s. The in-hospital mortality was 12.5% before 1990 and was 4.5% after 1990 (P = 0. 005). The in-hospital mortality rates of the male and female patients were 4.6% and 8.6% respectively (P = 0.09). The in-hospital mortality rates of the patients younger than 70 and elder than 70 were 5.5% and 19.0% respectively (P < 0.05). CONCLUSION: PTE The mortality of PTE, which attacks males more frequently than females, and the proportions of the number of PTE in-patients to the number of the whole in-patients increased and the in-hospital mortality increased during the past 3 decades.

[Effects of comprehensive interventions in community on smoking, chronic bronchitis, and asthma in rural areas of Beijing].

OBJECTIVE: To study the effects of comprehensive interventions in community on smoking, chronic bronchitis, and asthma in rural areas of Beijing. METHODS: Twenty-three villages in rural areas of Beijing were randomly divided into interventional (13 villages) and control villages (10 villages) in 1992. Comprehensive interventions including education of former-smokers and improvement of living environment were carried out in the interventional villages, and none was done in the control villages. In April 2000, surveys on smoking, chronic bronchitis, and asthma were carried out among 34,436 participants aged 15 or more in the interventional and control villages. During the same period, knowledge on prevention from chronic obstructive pulmonary diseases (COPD), living environments, and smoking were assessed among 1658 high-risk individuals of COPD at baseline and following-up period. RESULTS: The scores of knowledge and improvement on living environments in the interventional villages were significantly higher than those in control villages (P < 0.001). The decrease rate of smoking and current smoking rate in the interventional villages were significantly higher than in the control villages (0.4% vs -0.8%, P < 0.001; 2.4% vs 1.3%, P < 0.001) in men, while not different in women (P > 0.05). Among never smokers at baseline, the accumulated incidence of smoking among people aged 15 to 24 from 1993 to 2000 was significantly lower in the interventional villages than in the control villages in men (18.9% vs 23.7%, P = 0.005) and in women (0% vs 0.7%, P = 0.005). Daily cigarettes smoked by smokers in the interventional villages were less than in control villages in both men (14.8 +/- 7.0 vs 17.2 +/- 8.2 cigs daily, P < 0.001) and women (12.8 +/- 6.9 vs 13.4 +/- 7.2 cigs daily, P = 0.088). The increase of prevalence of chronic bronchitis in the interventional villages was less than in the control villages (men: 0.9% vs 1.3%, P = 0.012; women: 0.1% vs 0.3%, P = 0.003). After the age factor is adjusted, odds ratio (OR) for accumulated incidence of chronic bronchitis from 1993 to 2000 in the interventional villages were 0.80 (95%CI: 0.60-1.07) for men, 0.76 (95%CI: 0.45-1.28) in women. The OR for asthma was not significant in both men and women. CONCLUSIONS: Comprehensive interventions in community may improve knowledge of COPD prevention and living environments, decrease the smoking rate, cigarettes smoked per day, and incidence of chronic bronchitis, but have no significant effects on asthma.

[The clinical application of electron beam tomography in the diagnosis of pulmonary thromboembolism].

OBJECTIVE: To evaluate the clinical significance of electron beam computerized tomography (EBCT) in the diagnosis and differential diagnosis of pulmonary thromboembolism (PTE). METHODS: EBCT was performed before March 2004 in 114 consecutive patients with clinically suspected pulmonary vascular diseases, including 76 patients with PTE, 29 with pulmonary arteritis, 5 with primary pulmonary arterial tumor, and 4 with pulmonary arterial invasion by lung or mediastinal carcinoma. EBCT was performed using Imatron C-150 scanner with enhanced continuum volume scan (CVS). The slice thickness was 3 mm with scanning time of 0.1 s. The total amount of contrast media (Omnipaque-300) used was 50-100 ml, with flow rates of 3.0-4.0 ml/s and a delay time of 14-25 s. RESULTS: Deep venous thrombosis (DVT) was confirmed in 58 (76.3%) of the 76 patients with PTE (52 men and 24 women), 8 (10.6%) of them without apparent causes. Of the 2 356 pulmonary arterial branches observed in the 76 cases, 1,668 branches (70.8%) showed signs of PTE, with 545 branches (32.7%) of the central pulmonary arteries and 1 123 branches (67.3%) of the peripheral pulmonary arteries. Central type filling defect, such as the "railway sign" or the "drifting sign", was specific for acute thrombosis. Thrombus calcification was a specific sign of chronic PTE. Indirect signs of PTE included mosaic signs, enlargement of the right ventricle and atrium, pulmonary artery enlargement, pulmonary infarction, pericardial and/or pleural effusion, pulmonary atelectasis and pulmonary consolidation. Pulmonary arteritis (including pulmonary arterial involvement in Takayasu arteritis) was diagnosed by EBCT in 27 (93.1%) of the 29 patients, in which the diagnosis was confirmed by pulmonary angiography in 16, and clinically in 13 Patients. Of the 5 patients with primary pulmonary arterial tumor confirmed by pathology, 1 was misdiagnosed by EBCT. Of the 4 patients with pulmonary arterial involvement by lung or mediastinal carcinoma, 3 were confirmed by surgery and 1 by pulmonary angiography. CONCLUSIONS: DVT and PTE are different manifestations of one disease. The diagnostic strategy aims to detect thrombosis in the pulmonary arteries and in the deep veins of the lower limbs at the same time. EBCT is an effective and non-invasive examination in the diagnosis and differential diagnosis of PTE. By EBCT, acute and chronic thrombi can be initially differentiated, and changes in lung parenchyma, mediastinum, and the pulmonary and systemic arterial walls can be observed, and therefore more valuable radiological information can be collected for clinical decision-making.

[Preliminary reports of noninvasive accurate method to measure pulmonary vascular capacity in normal volunteers].

OBJECTIVE: Because the traditional loop of breathing control and regulation effect on blood circulation, there was rare study of pulmonary vein capacity. We need a noninvasive and accurate pulmonary vascular capacity measurement and analysis method. METHODS: Twelve normal volunteers were performed a total lung CT scan, image data analysis processing by computer software, the whole lungs from the apex to the base of lung with 40-50 layers by hand-cut, the connection between adjacent layers automatically by a computer simulation, the full pulmonary vascular (≥ 0.6 mm) were treated by high-accuracy three-dimensional imaging technology after removing the interference, and then calculate the whole lung and pulmonary vascular. RESULTS: The whole lung of the 12 normal volunteers from the apex to the base of lung CT scan image layers was 530 ± 98 (range, 431-841). The total capacity of lung and pulmonary vascular blood was 3705 ± 857 (range, 2398-5383) ml, and the total volume of the pulmonary vascular blood was 125 ± 32 (range, 94-201) ml. The pulmonary vein vascular blood volume was 63 ± 16 (range, 47-100) ml. CONCLUSION: The method of measuring the three-dimensional imaging of pulmonary vascular capacity by analyzing lung CT scan data is available and accurate.

[The correlation of the stroke volume with pulmonary venous volume and left atrial volume].

OBJECTIVE: The same person's pulmonary venous blood volume, left atrial volume and stroke volume were measured by lung CT scans and cardiac CT angiography (CTA). Then their relationships were analyzed in order to investigate the mechanism of breathing control. METHODS: As we described before, full pulmonary vascular (-0.6mm) volume was accurately calculated by three-dimensional imaging technology from lung CT scan; left atrial volume and stroke volume of left ventricle were calculated from the CTA data. Then the relationships among them were analyzed for estimation of the lung-artery time. RESULTS: The total volume of lung and pulmonary vascular blood was 3486 ± 783 (2156-4418) ml, and the pulmonary vascular blood volume was 141 ± 20 (105-163) ml. The estimated pulmonary venous volume was 71 ± 10 (52-81) ml. Left atrial volume at the end diastolic was 97 ± 39 (53-165) ml, Stroke volume of left ventricle was 86 ± 16 (60-106) ml. Pulmonary venous volume and the left atrial volume were double of stroke volume(1.7-2.4). CONCLUSION: The estimated lung-artery time was three heart beat.