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Objective To evaluate the clinical characteristics and prognostic predictors of patients with diffuse alveolar hemorrhage (DAH) and/or interstitial lung disease (ILD) secondary to microscopic polyangiitis (MPA) in a Chinese general hospital. Methods We retrospectively reviewed the medical records of MPA patients admitted to internal medicine departments between the year 2002 and 2012. The patients were divided into the ILD, DAH, DAH combined with ILD (DAHILD), and no pulmonary involvement (NPI) groups according to pulmonary involvement patterns. The clinical characteristics at diagnosis were analyzed. The risk factors associated with short-term death and long-term death were identified with

sObjectiveInpatients with high risk of venous thromboembolism (VTE) usually face serious threats to their health and economic conditions. Many studies using machine learning (ML) models to predict VTE risk neglected an important statistical phenomenon, ‘fuzzy feature’, and achieved inferior results. Considering the effect of ‘fuzzy feature’, our study aims to develop a VTE risk assessment model suitable for Chinese medical inpatients.Materials and MethodsInpatients in the medical department of Peking Union Medical College Hospital (PUMCH) from January 2014 to June 2016 were collected. A new ML VTE risk assessment model was built through population splitting. First patients were classified into different groups based on values of VTE risk factors, then trustless groups were filtered out, and finally ML models were built on training data in unit of groups. Predictive performances of our method, five traditional ML models, and the Padua model were compared.ResultsThe ‘fuzzy feature’ was verified on the whole dataset. Compared with the Padua model, the proposed model showed higher sensitivities and specificities on training data, and higher specificities and similar sensitivities on test data. Standard deviations of predictive validity of five ML models were larger than the proposed model.DiscussionThe proposed model was the only one which showed advantages on both sensitivity and specificity over Padua model. Its robustness was better than traditional ML models.ConclusionThis study built a population-split-based ML model of VTE for Chinese medical inpatients and it may help clinicians stratify VTE risk and guide prevention more efficiently.

Background Pulmonary embolism (PE) is a life-threatening condition. Few studies have evaluated the relationship between air pollution and PE, and these results have been inconsistent. Therefore, our study aimed to investigate the association between air pollutant exposure and the risk of hospitalization due to PE. Materials and methods Daily PE admissions, meteorological data, and ambient pollution data from January 1, 2015, to December 31, 2018, were collected in Beijing. A quasi-Poisson regression model combined with time-stratified case-crossover design and a distributed lag nonlinear model was used to determine the effect of air pollutant exposure on PE admission. To examine the stability of air pollutants' effects, multi-pollutant analyses were performed. Stratified analyses by age and sex were further conducted. Results There were 5060 PE admissions during the study period, with an estimated incidence of 6.5 per 100,000. PM2.5, PM10, SO2, O3 and CO exposures were significantly associated with elevated risk of PE hospitalization. The highest cumulative risks were observed at a lag of 0–28 days for PM2.5 (relative risk [RR] = 1.056, 95% confidence intervals [CI]: 1.015–1.098), PM10 (RR = 1.042, 95%CI: 1.010–1.075), and CO (RR = 1.466, 95%CI: 1.127–1.906), at a lag of 0–27 days for SO2 (RR = 1.674, 95%CI: 1.200–2.335), and at a lag of 0–4 days for O3 (RR = 1.019, 95%CI: 1.001–1.038). All associations mentioned above except O3 remained significant in multi-pollutant models. Stratified analyses showed that women and those aged ≥65 years people were more sensitive to PM10 and CO exposure than men and those aged Conclusions Exposure to PM2.5, PM10, SO2, and CO showed a positive association with PE hospitalization. High-risk PE groups should take special precautions on days with poor air quality.

Objective To summarize the characteristics of Chinese coccidioidomycosis cases, improve the diagnosis and treatment of this disease and prevent misdiagnosis as well as therapeutic error.Methods Search in databases including Medline,Wanfang,and CNKI using "Coccidioidomycosis" and "China" as index words yielded 23 articles that reported a total of 32 Chinese coccidioidomycosis cases.In addition,one patient with disseminated coccidioidomycos was treated in our center in April 2016.The demographic data,site of infection,clinical manifestations,past medical history,exposure history,imaging and laboratory findings,and pathological features of these 33 patients were analyzed.Results Among these 33 patients,7(21.2%)had visited an epidemic area and 6(18.2%)were immunocompromised.The disease involved the respiratory system,skin,bone,central nervous system,cornea,and stomach in 24,6,3,2,1,and 1 patients,respectively.Eight patients (24.2%) had multiple system involvement,and three of them died.The imaging findings included pulmonary nodules(

The aim of this study was to investigate the effect of natural herb material Galla Chinensis extraction (GCE) on the wear resistance of dentine in vitro. Forty sound bovine dentine blocks were prepared and randomly divided into two groups. The samples were first treated with 4000 ppm aqueous solution of Galla chinensis and distilled deionized water (DDW) was used as a control. Then the samples were subjected to 5,000 cycles of attrition bathed under artificial saliva with 150 N loads. Wear measurement, scanning electron microscopy (SEM) examination and energy-dispersive X-ray spectrometry (EDX) analysis were utilized to evaluate the effects of GCE on the wear resistance. The depth of the wear scar of DDW-treated surface (mean = 32.5 μm, SD = 11.8 μm) was significantly greater than that of GCE-treated surface (mean = 26.4 μm, SD = 13.9 μm) (p < 0.05). Furthermore, the SEM images showed severe wear on the DDW specimens and less wear on the GCE-treated samples. Finally, from EDX data, GEC group had higher percentage of Ca and P than the control. In conclusion, our study suggested that Galla chinensis could enhance wear resistance of dentine.

To evaluate the effect of grape seed extract (GSE) on remineralization of artificial dentin caries.Sixty human dentine fragments were stored in a demineralization solution for 24 h at 37 degrees centigrade to induce artificial dentin caries lesions. The fragments were then randomly divided into 4 groups: 10% GSE, 1 mg/L NaF, 10% GSE+1 mg/L NaF and distilled water (DDW, as control). The demineralized samples were pH-cycled for 8 days and surface dentine microhardness was assessed before and after pH-cycling regimen. The percentage surface microhardness recovery (SMHR) was calculated. The samples were subsequently analyzed with scanning electron microscopy (SEM) and energy-dispersive X-ray spectrometry (EDXS). The date was analyzed using ANOVA and Fisher's tests by SPSS17.0 software package.The percentage surface microhardness recovery (SMHR) was obtained for GSE, NaF, GSE+NaF and DDW group(40.87 ± 9.92,44.60 ± 12.48, 48.54 ± 9.27 and 15.98 ± 8.33, respectively). The treatment groups significantly increased the microhardness of the lesions (P0.05) compared to DDW group, with no statistically significant difference among the treatment groups(P0.05). Scanning electron microscopy of the treatment groups revealed greater mineral deposition on dentinal tubules, and DDW group formed honeycomb structure. Furthermore, from EDXS data, the treatment groups had higher percentage of Ca and P than the control.GSE positively affects the remineralization processes of artificial dentinal caries lesions, which may be a promising natural agent for remineralization therapy instead of fluoride.

To improve understanding of the clinical characteristics and diagnosis of hypersensitivity pneumonitis (HP).We retrospectively analyzed the clinical data, including clinical symptoms, laboratory tests, exposure, pulmonary function tests, chest CT imaging and cytological classification of bronchoalveolar lavage (BAL) of 96 patients with HP from Jan 2001 to Jun 2011 in Peking Union Medical College Hospital. We divided the patients into 2 groups: a pathologically-confirmed group and a clinically-suspected group.There were 58 females and 41 males. The median age at the diagnosis was 53 years. The most common exposures were low-molecular-weight chemicals (42.7%) and animal proteins (37.5%). Common clinical symptoms included dyspnea on exertion (90.6%) and cough (76.0%). Pulmonary function test showed diffusion abnormality (73.5%) and restrictive ventilatory impairment (59.7%). Chest CT scan revealed patchy or diffuse bilateral ground-glass opacities (64.6%), centrilobular nodules (21.9%), and air trapping (15.6%). Reticulation (45.8%), traction bronchiectasis (21.9%) and honeycombing(9.4%) were present in chronic HP. BAL lymphocyte counts0.2 and CD4/CD80.9 were more commonly seen in patients with a disease course of less than 1 year. The pathologically-confirmed group and the clinically-suspected group shared many similar characteristics including age at diagnosis, gender, clinical manifestation, pulmonary function impairments and imaging findings, but significant differences existed in certain parameters. In the pathologically- confirmed group, the duration of disease was longer (24 months vs 6 months, Z = -2.492, P = 0.013) and clubbed fingers were more common (23.4% vs 8.2%, χ(2) = 4.227, P = 0.040). Diffusion abnormality was present in more patients of this group (90.7% vs 44.0%, χ(2) = 35.219, P0.01). By CT scan, reticulation, traction bronchiectasis and honeycombing (57.5% vs 26.5%, χ(2) = 9.434, P0.01) were more evident as compared to the clinically-suspected group. The value of transbronchial lung biopsy for diagnosing HP was limited, with a positive result of only 8.2%. Surgical lung biopsy was needed in uncertain cases.The diagnosis of HP was difficult. In some cases a clinical diagnosis can be made by combination of history of exposure, CT manifestations and cell classification of BAL. For atypical cases a multi-disciplinary approach including pathologists, radiologists and pulmonologists is needed.

To observe the immunohistochemical staining of IgG4 in nonspecific interstitial pneumonia (NSIP) and to study the clinicopathological features of IgG4-related NSIP.Retrospective analysis was carried out for 32 patients with NSIP who had been admitted into Peking Union Medical College Hospital from November 2002 to October 2010. The diagnosis of NSIP was established by surgical lung biopsy and all specimens were fixed in neutral formalin and embedded in paraffin. Sections were cut for HE and immunohistochemical stain. According to the diagnostic criteria for IgG4-related disease, 4 cases were confirmed to be IgG4-related NSIP. The clinicopathological features including clinical history, laboratory examination, and pathologic evaluation were studied.The 4 patients with IgG4-related NSIP included 1 man and 3 women, with a median age of 48 years (range, 44 - 56 years). The presenting symptoms were dry cough or shortness of breath. One patient (1/4, 25.0%) was found to have a positive autoantibody but no cases showed positive RF in serum. The histological finding of the 4 cases was characterized by inflammatory cell infiltration in interstitium with fibrosis, and 1 case showed obliterative arteritis. The numbers of IgG4-positive plasma cells in the 4 cases were 42/hpf, 22/hpf, 11/hpf, and 33/hpf respectively, while the percentages of IgG4-positive to IgG-positive plasma cells were 70%, 71%, 57%, 43% respectively.IgG4-related interstitial pulmonary disease can be characterized as the NSIP pattern. The pathological features of IgG4-related NSIP include infiltration of lympho-plasmacytes and eosinophils in interstitium with fibrosis, and lymphoid follicles are frequently identified in the area of lymphocyte aggregation, but obliterative arteritis is infrequently identified in the lesion. Immunohistochemical staining of IgG and IgG4 is very helpful for a definite diagnosis of IgG4-related disease.

This study was to evaluate the efficacy and limitation of CT-guided percutaneous cutting needle lung biopsy in the diagnosis of diffuse parenchymal lung diseases (DPLD).A total of 481 patients admitted in Peking Union Medical College Hospital from January 2000 to December 2008 underwent CT-guided percutaneous cutting needle lung biopsy. The patients were evaluated by clinical history, physical examination and lung HRCT. Those with localized opacity or lesions in a single lung in the CT scan were excluded. Finally, 248 patients with DPLD in HRCT were enrolled for this study.The study patients included 114 males and 134 females, and the mean (± SD) age at diagnosis was 50 ± 16 (range from 13 - 78) years. Confirmed diagnosis by percutaneous needle lung biopsy was obtained in 130 patients (52.4%), including pulmonary infection (35.4%, 46/130), pulmonary malignant diseases (25.4%, 33/130), bronchiolitis obliterans organizing pneumonia/organizing pneumonia (22.3%, 29/130), pulmonary vasculitis (6.2%, 8/130), granulomatous lesions (4.6%, 6/130), pulmonary sarcoidosis (2.3%, 3/130), acute interstitial pneumonia (1.5%, 2/130), pulmonary amyloidosis (1.5%, 2/130), and pulmonary alveolar proteinosis (0.8%, 1/130). Open lung biopsy/video-assisted thoracoscopic surgery was performed in 37 out of 118 cases for which the diagnosis was undetermined by percutaneous lung biopsy. Confirmed diagnosis was obtained in 36 patients, including non-specific interstitial pneumonia (NSIP, 33.3%, 12/36), usual interstitial pneumonia (UIP, 8.3%, 3/36), pulmonary infection (16.7%, 6/36), neoplasm (8.3%, 3/36), lymphoid interstitial pneumonia, pulmonary vasculitis (5.6% 2/36), hypersensitivity pneumonitis (5.6%, 2/36), and pulmonary sarcoidosis, allergic bronchopulmonary aspergillosis, pulmonary hyalinizing granuloma, pneumoconiosis, Castleman's disease, and lymphoproliferative disorder (1 case respectively).CT-guided percutaneous cutting needle lung biopsy can provide confirmed diagnosis in half of patients with DPLD, and has a high diagnostic yield in patients with infectious or neoplastic diseases, but it is not a good method for diagnosis of interstitial lung diseases such as NSIP and UIP.

To explore the clinical features of pulmonary involvement in patients with microscopic polyangiitis (MPA).We retrospectively investigated the clinical data of 50 patients hospitalized with MPA in Peking Union Medical College Hospital from January 2008 to December 2009, the data included clinical manifestation, laboratory parameters, echocardiography, pulmonary function test, chest computed tomography, and histopathology of kidney.Pulmonary involvements were observed in 46 patients, common symptoms include cough (34/46), expectoration (30/46), dyspnea (19/46) and hemoptysis (16/46). Pulmonary involvement was the initial manifestation in 14 patients, five cases had radiographic evidences of usual interstitial pneumonia before MPA was diagnosed. The prevalence of positive MPO-ANCA antibodies in MPA patients was 96%. The prevalence of positive PR3-ANCA antibodies was 6%. Radiographic manifestations included ground glass attenuation (16/37), interstitial changes (16/37), infiltrates (12/37) and pleural effusion (7/37). The most frequent abnormality in pulmonary function test was reduced carbon monoxide diffusing capacity (12/15) and restrictive ventilation dysfunction (4/15). The incidences of pulmonary hypertension was 33% (13/39), the average pulmonary artery systolic pressure was (48 ± 8) mm Hg (1 mm Hg = 0.133 kPa).The prevalence of pulmonary involvement in patients with MPA was high, pulmonary involvement was the initial manifestation in 28% patients. The clinical manifestations were nonspecific, radiographic manifestations included ground glass attenuation, interstitial changes, infiltrates and pleural effusion. The short term prognosis was well in patients with pulmonary involvement treated with systemic corticosteroids and cyclophosphamide, infection was a leading cause of death in patients with pulmonary involvement.

To investigate the clinical, pathological and imaging characteristics, misdiagnosis and treatment of pulmonary non-Hodgkin's lymphoma with diffuse ground-glass opacities (GGO).Six cases of pulmonary non-Hodgkin's lymphoma with diffuse GGO on chest CT diagnosed from January 2008 to March 2010 were retrospectively analyzed.There were 5 males and 1 female with average age of 52 years old (range: 30-59). The course had a range of 2-36 months. Most patients presented with dyspnea (n=5) and loss of weight (n=5). Enlargement of superficial lymph nodes (n=2) and hepatosplenomegaly (n=2) were also found. Laboratory tests showed that average hemoglobin decreased to 25 g/L and average serum LDH was 755 U/L. Chest CT showed diffuse GGO (n=2), diffuse GGO with consolidations (n=3), with wide lung septum (n=3), with multiple nodules (n=2), with enlargement of mediastinal lymph nodes (n=2). Diagnosis of the 6 cases were made by lung biopsy. Histological findings including intravascular lymphoma (n=2), diffuse large B cell lymphoma (n=2) and T cell lymphoma (n=2). The average follow-up period was 4 months (range: 2-6). Chemotherapy was administered in 4 patients with B cell lymphoma and all of them improved or remained stable. One patient with T cells lymphoma was lost to follow-up and another patient with T cell lymphoma died due to lung infection.Non-Hodgkin's lymphoma with diffuse GGO on chest CT scan is rare. And its misdiagnosis is common due to a lack of specific clinical manifestations. And lung biopsy is necessary for an early diagnosis.

To explore the clinical characteristics of acute pulmonary thromboembolism (PTE) in elderly patients, in order to improve the diagnosis and treatment of the disease.The clinical data were reviewed for patients aged over 60 years old hospitalized with acute PTE in Peking Union Medical College Hospital from January 2006 to January 2009.The average age of the 68 patients was (72 +/- 6) years old. Deep vein thromboembolism was found in 33 cases. Hypertension (55.9%), cancer (32.4%), surgery (29.4%), immobility (29.4%), diabetes (23.5%) and obesity (20.6%) were the most common risk factors, with 70.6% (48/68) of these patients having more than 2 risk factors. The common symptoms were dyspnea (77.9%), cough (26.5%), chest pain (13.2%), palpitation (13.2%), faint (13.2%) and asymmetric edema of the lower extremities (30.9%). All of the arterial blood gas in 61 cases showed hypoxemia. The positive rate of blood D-dimer elevation was 84% (47/56). The main signs in chest X-ray were infiltrates (37.5%) and pleural effusions (18.8%). Non-specific ST-T changes (59.3%) and sinus tachycardia (23.7%) were the most common abnormalities in electrocardiogram. Forty seven cases (69.1%) were diagnosed through CT pulmonary angiography (CTPA), and 20 cases (29.4%) were through ventilation-perfusion lung scintigraphy. Sixty one cases received anticoagulant therapy and 5 received thrombolytic therapy. Vena cava filters were implanted in 5 patients. Fifty six cases improved after treatment, and the case fatality ratio was 18% (12/68).The most common risk factors for PTE in elderly patients were chronic diseases, cancer, surgery and immobility. The symptoms and auxiliary examination of these patients were not specific, and CTPA was the most useful diagnosing tool. Anticoagulation was the basic treatment for PTE in elderly patients and it was safe and effective, while the overuse of thrombolytic therapy and vena cava filter should be avoided.

The purpose of this paper was to investigate the clinical and radiological features of pulmonary tuberculosis presenting as interstitial lung diseases (ILD).We analyzed the data of cases suspected of diffuse parenchyma lung diseases at this hospital between October 2003 and October 2007. The diagnosis of active pulmonary tuberculosis was based on epithelioid granuloma or positive acid-fast bacilli in lung biopsy and changes on serial radiographs obtained during treatment.The data of a series of 230 consecutive patients with suspected ILD were retrospectively analyzed. The diagnosis was confirmed by lung biopsy. Twelve patients were confirmed to have pulmonary tuberculosis. There were 5 males and 7 females with a mean age of 38 +/- 11 years (range, 17 - 68). The median course of disease in these patients was 3 months (range, 0.5 - 18 months). Patients with pulmonary tuberculosis presented with fever (11/12), cough (9/12), weight loss (7/12), dyspnea (7/12), lymphadenopathy (4/12), and splenohepatomegaly (2/12). On chest CT scan, ground-glass attenuation was identified in 4, bilateral patchy infiltration in 5, tree-in-bud appearance 1, and centrilobular lesions in 2 of the 12 patients. During the follow-up period (median, 9 month, range from 3 to 12 month), 11 patients improved, but 1 died of diabetic ketoacidosis.The diagnosis of pulmonary tuberculosis should be considered in suspected ILD patients presenting with fever, splenohepatomegaly and lymphadenopathy.

To investigate the clinical and radiological features of hepatopulmonary syndrome (HPS).Twenty two cases diagnosed as HPS in Peking Union Medical College Hospital from Nov, 1996 to Nov, 2008 were reviewed. Their clinical features and radiological findings were analyzed.The study included 12 males and 10 females with a mean age of (44 +/- 17) years and mean course of (54 +/- 52) months. Abnormalities on chest CT scans were found in 12 cases, which included intrapulmonary artery dilatation in 10 cases, with subpleural small nodular, reticular and patchy opacities; bilateral lower basal segmental artery dilatation in 3 cases; main pulmonary artery dilation in 1 case; right ventricular enlargement in 1 case and bilateral pleural effusion in 1 case. The chest CT was normal in 6 cases. CTPA and pulmonary artery angiogram were performed in 15 cases and artery dilatation was found in 4. Diffuse liver diseases were found in 12 cases by CT scans, 10 of them presented as typical hepatic cirrhosis and 2 cases as liver hepatomegaly, while esophagus varix and(or) fundus gastricus varix were found in 12 cases and splenomegaly in 6 cases, hydroperitonia in 3 cases.Clinical manifestations combined with CT features were helpful for the diagnosis of HPS.

To study the pathologic characteristics of chronic hypersensitivity pneumonitis, especially the pattern of pulmonary interstitial fibrosis; and to compare the histologic features with those of idiopathic interstitial pneumonitis.The HE-stained paraffin sections of 10 cases of chronic hypersensitivity pneumonitis encountered during the period from 2000 to 2008 were retrospectively analyzed.There were altogether 6 males and 4 females, with age of patients ranging from 23 to 59 years (mean=47.2 years). Clinically, the patients presented with chronic cough and shortness of breath for 4 months to 6 years. Histologically, 7 cases showed usual interstitial pneumonitis (UIP)-like fibrosis. Patchy fibrosis was observed under the pleura, adjacent to interlobular septa and around bronchioles. In all of the 7 cases, foci of fibroblastic proliferation, as well as bronchiolar metaplasia of peribronchiolar alveoli and mild bronchiolitis, were noted. Three cases presented with mild honeycomb changes of lung and 3 cases showed non-specific interstitial pneumonitis (NSIP)-like fibrosis, in which the alveolar septa were expanded by fibrous tissue and collagen, with relative preservation of alveolar architecture. Bronchiolitis and lymphocytic infiltrates in alveolar septa were seen. Schaumann bodies were identified in 1 case. In general, patients with chronic hypersensitivity pneumonitis were younger than patients with idiopathic UIP. Computed tomography often showed upper and middle lobar involvement and mosaic attenuation. Compared with idiopathic UIP, the UIP-like fibrosis of chronic hypersensitivity pneumonitis often occurred not only under the pleura and adjacent to interlobular septa, but also around bronchioles and was accompanied by bronchiolar metaplasia.Chronic hypersensitivity pneumonitis can mimic other types of lung conditions with interstitial fibrosis, especially UIP and NSIP. As a result, some cases of chronic hypersensitivity pneumonitis may be misdiagnosed as such.

To explore the feasibility of the therapeutic strategy to use T-bet gene modified dendritic cells (DCs) to reverse the course of asthma.(1) Mature DCs were derived from mononuclear cells obtained from femur of BALB/c mouse and divided into 3 groups, T-bet group transfected with recombinant adenovirus Ad-T-bet containing T-bet gene, LacZ group transfected with recombinant adenovirus Ad-LacZ containing LacZ gene, and control group. Seven days later ELISA was used to detect the interferon (IFN)-gamma level in the culture fluid. (2) Airway inflammation abrogating trial. Twenty-four BALB/c mice were sensitized with intraperitoneal injection of ovalbumin (OVA) (on day 1 and 15) to establish asthma models, and then randomly divided into 3 equal groups: T-bet group injected intravenously with T-bet-modified DCs on day 27, LacZ group injected with LacZ-modified DCs, and model control group without intravenous injection. Two days later the model mice began to undergo challenge by inhalation of OVA twice (on day 29 - 31). Eight mice were used as control group treated with PBS. On day 37 all mice were killed, ELISA was used to detect the blood interleukin (IL)-4 and IFN-gamma levels, and microscopy was conducted to observe the airway inflammation. (3) Airway inflammation reversing trial. Another 24 model mice were divided into 3 equal groups as well: re-challenged T-bet group injected intravenously with T-bet-modified DCs on day 27 and 42, re-challenged LacZ group injected intravenously with LacZ-modified DCs on day 27 and 42, and model control group. Since the day 45 OVA inhalation was given once a day for successive 3 days. On day 49 these mice were all killed to undergo the tests as mentioned above.The IFN-gamma level in the culture fluid of the T-bet gene modified DCs was (15.24 +/- 4.75) ng/ml, significantly higher than that of the LacZ gene modified DCs and control DCs [(3.08 +/- 0.61) and (2.35 +/- 0.41) ng/ml respectively, both P0.01]. The IFN-gamma in mice blood plasma of T-bet groups in abrogating and reversing trial were (130.2 +/- 10.5) and (145.7 +/- 16.7) pg/ml respectively, both significantly higher than those of the abrogating and reversing trial normal control groups [(25.0 +/- 6.5) and (24.6 +/- 5.9) pg/ml respectively], asthmatic model control groups [(20.7 +/- 4.5) and (16.5 +/- 7.0) pg/ml respectively] and LacZ groups [(17.6 +/- 7.0) and (24.2 +/- 9.0) pg/ml respectively] (all P0.01). However, the IL-4 levels in mice blood plasma of T-bet groups were both significantly lower than those of asthmatic model control groups and LacZ groups (all P0.01). The airway inflammation of T-bet groups were remarkable milder than those of the model control groups and LacZ groups.The asthma management strategy based on T-bet gene modified DCs is feasible with the plausible mechanism that the T-bet gene modified DCs regulate the T cells differentiation and polarization on the antigen presenting level.

To evaluate the role of transbronchial needle aspiration (TBNA) in the diagnosis of patients with enlarged mediastinal and/or hilar lymph node.Patients with mediastinal and/or hilar lymphoadenopathy proven by CT scan were eligible for TBNA as reported. All specimens were directly and instantly smeared for pathological examination.From June 1 2004 to December 31 2007, 164 patients were examined: including 80 lung cancers, 69 lung benign diseases, 2 other malignancy tumor, and 13 without definite diagnosis. Total 260 lymph nodes were punctured. TBNA procedures were successfully carried out in 445/463 (96.1%). Sensitivity of TBNA was 82.5% (66/80) in patients who had been proven to suffer from bronchogenic carcinoma. There were 25 patients that diagnosis of lung cancer was pathologically determined by TBNA only. A total of 122 lymph nodes in the 80 lung cancer patients were aspirated by TBNA with a positive rate of 65.6% (80/122). Severe complications were rare except small amount of bleeding at the TBNA site (100/164, 61.0%). From June 1 2006 to December 31 2007, lymph node tissues able to make histology diagnosis were yield in 73.5% (64/87) patients. Through histology pathology, the sensitivities of TBNA were 53.3% (8/15) for sarcoidosis and 78.6% (33/42) for lung cancer.TBNA is quite safe and helpful in diagnosis and staging of bronchogenic carcinoma, and in diagnosis of benign lung diseases.

To investigate the clinical, radiographic and pathological characteristics of intravascular lymphomatosis primarily manifested in the lung, without skin and central nervous system involvements.A case of T cell intravascular lymphomatosis presenting with fever and multiple pulmonary shadows on chest radiograph was described and 14 similar cases reported in the English literature were reviewed.We described a case of T cell intravascular lymphomatosis, who was a 36 year old man, complained of fever and multiple pulmonary shadows on chest radiograph and admitted to Peking Union Medical College Hospital in march, 2008. Open lung biopsy showed features characteristic of intravascular lymphomatosis. He received CHOP chemotherapy, but died 20 days after diagnosis. Most cases of intravascular lymphomatosis primarily manifested in the lung occurred in older patients, ranging from 36 to 79 years of age (mean 59 years), with a male predominance (M : F = 11 : 4). The chief complaints were dyspnoea (10/15), cough (9/15), fever (5/15) and weight loss (5/15). Pulmonary function tests usually revealed some degree of decreased diffusing capacity. Eight cases had high serum lactate dehydrogenase levels. Chest CT scan showed multiple reticular or/and nodular density. Immunophenotypically, 10 cases were B cell lineage, 3 cases were T cell lineage. Six cases of B cell intravascular lymphomatosis were followed, of whom 4 and were alive, and 2 died of respiratory failure. Three cases of T cell intravascular lymphomatosis showed poor prognosis, both of whom died of respiratory failure.Intravascular lymphomatosis primarily manifested in the lung is a rare malignant disease. Its pulmonary symptoms were nonspecific, and pulmonary function tests and chest CT scan manifested as those of interstitial pneumonia or pulmonary infection. It can be pathologically diagnosed through transbronchial lung biopsy or surgical lung biopsy.

To study the clinical characteristics, pathology, diagnosis and treatment of primary pulmonary lymphoma.Eighteen cases of primary pulmonary lymphoma diagnosed from Jan 1989 to Feb 2007 were retrospectively analyzed.There were 6 males and 12 females, with a median age of 47.5 years (17-71 years). Fifteen cases were diagnosed by surgical lung biopsy; 1 by percutaneous needle lung biopsy (1/6), 1 by percutaneous needle lung biopsy and bronchoscopic examination at the same time, the other 1 by bronchoscopic examination (1/10). Histological diagnosis showed that 2 cases were Hodgkin lymphoma, 9 mucosa-associated lymphoid tissue lymphoma, 1 follicular lymphoma, 2 diffuse large B cell lymphoma 2 anaplastic large cell lymphoma, 2 non-Hodgkin lymphoma whichcould not be classified because the slides were from other hospitals. The most common symptoms were cough (9/18) and fever (6/18). ESR elevation was common (10/12). CT features included solitary or multiple nodules (14/18), patchy opacities (11/18), consolidations (5/18), pleural effusions (5/18), atelectasis (5/18), and cavities (1/18). Misdiagnosis was found in 11 patients. Treatment modalities included surgical resection, radiotherapy and chemotherapy. Median follow-up time was 11 months (10 d to 205 mon). Thirteen patients were still alive, 4 patients were lost, and 1 patient died. The prognosis was associated with the level of [25.1 x 10(9)/L(18.1 - 39. -1) x 10(9)/L in poor prognosis group, 6.7 x 10(9)/L (5.48 - 8.41) x 10(9)/L in good prognosis group, u = 0.000, P0.05] leukocytosis (3/3 vs 1/10, P0.05).The clinical manifestations of primary pulmonary lymphoma are nonspecific. Misdiagnosis is common. Surgical lung biopsy is necessary for early diagnosis.

Acute exacerbation of diffuse parenchymal lung disease (DPLD) is a condition in which patients with usual interstitial pneumonia (UIP), and other forms of interstitial lung disease, develops rapid respiratory failure, accompanied by extensive radiological infiltrates, and had no evidence of infection. The pathologic features of this condition are usually diffuse alveolar damage (DAD) and the outcome is poor. Our study was to define the clinicopathologic features and outcome of acute exacerbation in 3 patients with UIP and 3 with nonspecific interstitial pneumonia (NSIP).The clinical data of the 6 patients from April 1999 to Jun 2007 were analyzed retrospectively.In the 6 patients, 2 were males. The median age was 51 yrs (29 -57 yrs). Three case had UIP [1 UIP/idiopathic pulmonary fibrosis (IPF), 1 UIP/dermatomyositis (DM), 1 UIP/UCTD], 2 had NSIP (1 idiopathic NSIP, 1 NSIP/DM), and 1 was diagnosed as DAD (the basic pathology was NSIP/DM) by autopsy. Four of the patients underwent video-assisted thoracoscopic surgery (VATS) for diagnosis, and 1 underwent CT-guided transthoracic needle biopsy. Two of them underwent surgical lung biopsy 1 week before acute exacerbation. Five cases had fever. Computed tomography data were available in all cases and showed the presence of extensive bilateral ground-glass opacities (5/6), sometimes accompanied by focal consolidation (2/6), superimposed on underlying fibrosis. The median oxygenation index was 200 (quartile range: 158-237) mm Hg (1 mm Hg = 0.133 kPa). Five patients were treated with corticosteroids, and in some combined with cyclophosphamide or intravenous immunoglobulin. Two patients survived the acute episode and were discharged from hospital. All 3 patients using mechanical ventilation died.Both UIP and NSIP can develop acute exacerbations. The trigger of acute exacerbation was unclear, but in some cases it maybe related to VATS. The clinical features include rapid respiratory failure, accompanied by extensive radiological infiltrates. The fatality is high. Corticosteroids or intravenous immunoglobulin may be helpful in the treatment of the condition.

Polymyositis-dermatomyositis has been associated with various histological patterns of interstitial lung disease (ILD). This study was to investigate the clinico-pathologic features of interstitial lung diseases associated with polymyositis-dermatomyositis.We retrospectively identified 26 patients with polymyositis-dermatomyositis associated ILD who underwent lung biopsies (6 autopsies, 5 surgical lung biopsies and 15 percutaneous lung biopsies) at our hospital during a 27-year period from January 1980 through October 2007. Histopathologic findings were analyzed and correlated with radiological features and outcome.Median age was 48 years (range, 19 to 65 years), and 16 patients were women. Chest X-ray imaging revealed bilateral infiltrates including ground-glass attenuation, patchy infiltration, and reticular opacities. The major histopathologic patterns included diffuse alveolar damage (DAD) (n = 5), lymphocytic interstitial pneumonia (n = 2), nonspecific interstitial pneumonia (NSIP) (cellular pattern, n = 6; mixed pattern, n = 8), organizing pneumonia (n = 4), usual interstitial pneumonia (UIP) (n = 1). Treatment commonly included prednisone with immunosuppressive agent. During the follow-up period (median, 15 month,range from 6 to 108 month), 18 patients improved or remained stable. Eight patients died, including 5 deaths from DAD, 2 from NSIP mixed pattern, 1 from UIP.A variety of histological patterns can be seen in patients with polymyositis-dermatomyositis-associated ILD. Those with DAD tended to have poor prognosis.

This study was designed to investigate the clinical characteristics of systemic vasculitis with cardiac involvement.Clinical information of 10 patients with systemic vasculitis complicated by myocardial vasculitis, selected from 181 small vessel vasculitis patients and 114 systemic vasculitis patients were analyzed.The clinical manifestations were varied significantly dependent on the etiology of small vessel vasculitis. It is usually difficult to make the diagnosis because of the insidious onset, varied etiology and the undifferentiated manifestations of heart involvement. Echocardiography is commonly used in detecting and monitoring cardiac involvement. Glucocorticoid therapy can improve left ventricular systolic function dramatically when used properly.The cardiac involvement of systemic vasculitis is quite rare. Dyspnea of various degrees and left ventricular systolic dysfunction are the most common clinical findings. The earlier the establishment of diagnosis and institution of appropriate treatment, the better the prognosis.

To study the clinical and pathologic features of Churg-Strauss syndrome (CCS).Three cases of Churg-Strauss syndrome, including 1 autopsy case and 2 cases with open thoracoscopic lung biopsy, were retrospectively reviewed. All the tissue samples were formalin-fixed, paraffin-embedded and stained with hematoxylin and eosin.The first patient was a 68-year-old man who had history of asthma for 4 years, with recent exacerbation and chest pain for 2 weeks. Patient died 1 day after admission due to myocarditis and myocardial infarction. He did not have peripheral eosinophilia, skin or paranasal sinus pathology. CSS represented an incidental autopsy finding and he had never been treated with corticosteroid before. The other 2 patients were a 58-year-old male and a 12-year-old female, respectively. Both had history of asthma, peripheral eosinophilia and lung consolidations on computed tomographic examination. Pathologically, all cases showed vasculitis, perivascular allergic-type granulomas, eosinophilic pneumonia and asthmatic bronchitis.Thorough understanding of the clinical and pathologic criteria is essential for arriving at a correct diagnosis of CSS. Although some patients may present with atypical symptoms, lung biopsies often reveal the classic histologic findings which include vasculitis and perivascular allergic granuloma formation.

This study was to evaluate the efficacy and limitations of transbronchial lung biopsy (TBLB) in the diagnosis of diffuse parenchymal lung diseases (DPLD).TBLB was performed in 416 patients with diffuse lung diseases from January 2001 to October 2006 in Peking Union Medical College Hospital. The results of clinical data and pathologic diagnosis were retrospectively analyzed.Confirmed diagnosis by TBLB was obtained in 124 patients, the total positive diagnostic rate was 29.8%. The diseases included pulmonary sarcoidosis (52/124, 41.9%), bronchiolitis obliterans organizing pneumonia/organizing pneumonia (BOOP/OP) (28/124, 22.6%), pulmonary alveolar proteinosis (19/124, 15.3%), lung cancer (12/124, 9.7%), pulmonary vasculitis (5/124, 4.0%), pulmonary tuberculosis (3/124, 2.4%), and pneumocystis carinii pneumonia, lung fungal infection, lymphangiomyomatosis, and pulmonary amyloidosis (each 1/124, 0.8%). Open lung or thoracoscopic biopsy was performed in 104 cases in whom the diagnosis was undetermined by TBLB. Confirmed diagnosis was obtained in 109 patients, including nonspecific interstitial pneumonia (37/104, 37.7%), usual interstitial pneumonia (18/104, 18.4%), pulmonary sarcoidosis (11/104, 11.2%), BOOP/OP (6/104, 6.1%), and lung cancer (5/104, 5.1%).Pathologic diagnosis can be obtained by TBLB in about 30% of the cases with DPLD, and therefore it should be considered to be a routine diagnostic procedure before open lung or thoracoscopic biopsy.

To investigate the radio-pathological features of pulmonary sarcoidosis.Forty six consecutive patients from January 2000 to August 2005 in Peking Union Medical College Hospital with pathologic features of epithelioid cell granuloma were enrolled in the study.All the cases were confirmed by pathological findings consistent with sarciodosis. Bronchoalveolar lavage (BAL) fluid analysis showed that, the differential count of lymphocytes was 0.47 +/- 0.18, and the CD(4)/CD(8) ratio was 6.63 +/- 4.51. Serum angiotensin converting enzyme level was (47 +/- 16) U/L. Chest computed tomography scan showed bilateral hilar adenopathy (33%, 12/46), well circumscribed pulmonary nodules (35%, 16/46) distributed randomly or along the bronchovascular bundle, patchy areas of alveolar consolidation (28%, 13/46), and bilateral ground glass infiltrations (11%, 5/46). Open lung biopsy, video-assistant thoracoscopic biopsy or mediastinoscopic biopsy were performed in 13 patients, and percutaneous lung biopsy or transbronchial lung biopsy in 33 patients. The characteristic pathologic finding was noncaseating epithelioid cell granulomas, which were embedded in the substance of hyalinization. The granulomas were distributed around blood vessels, lymphatics, or in the bronchial submucosa. Granulomatous vasculitis was noted in some cases.The diagnosis of sarcoidosis can be proposed by clinico-radiologic and BAL fluid findings. However, histologic evidence of noncaseating epithelioid cell granulomas and the therapeutic efficacy of glucocorticoids are essential to the final diagnosis.

To investigate the clinicopathological features of drug-induced lung injury.The clinical, radiological and pathological presentations of drug-induced lung injury diagnosed from January 2003 to October 2005 in Peking Union Medical College Hospital were reviewed.There were 7 cases of drug-induced lung injury, 3 caused by amiodarone, and the other 4 caused by interferon-alpha, atorvastatin, carbamazepine, and propylthiouracil respectively. The clinical manifestations included cough, fever, worsening dyspnea and inspiratory crackles. Patchy infiltration, ground-glass attenuation with thickening of bronchovascular markings were the main findings in computed tomography. The most common pathological manifestation was cellular interstitial pneumonia associated with intra-alveolar macrophages with fine vacuolation in the cytoplasm, and type II pneumocyte hyperplasia. The organizing pneumonia pattern was observed in 2 patients. Diffuse alveolar hemorrhage was present in 2 cases.Drug-induced pulmonary toxicity can be difficult to diagnose. The diagnosis of pulmonary drug toxicity should be considered in patients with a history of drug therapy and new onset or progressive respiratory complaints.

To investigate the mechanism of immunotolerance caused by allergen immunotherapy in allergen-induced asthmatic airway inflammation.Sixty ovalbumin (OVA)-sensitized BALB/c mice were randomly divided into two groups, 50 in the experimental group and 10 in the control group. The mice in the experimental group were treated with 3 injections of ovalbumin intraperitoneally (1 mg for each separated for two weeks) and challenged by ovalbumin inhalation 1 h/day for 10 successive days. Then the mice were divided further into group A, group B, group C, group D and E with 10 mice in each group. The mice in group A were sacrificed after 10 day challenge. The mice in group B and D were continuously exposed to inhaled OVA for 4 and 8 weeks (1 h/day, 5 days a week), respectively, then to inhaled OVA 1 h/day for 10 successive days. The inhalation was interrupted for 4 weeks in group C after initial challenge and restarted for another 10 days (1 h/day) afterwards. The mice in group E were exposed continuously to inhaled OVA for 4 weeks (1 h/day, 5 days a week) after initial challenge, which was interrupted for 4 weeks, and restarted for 10 days (1 h/day). Bronchoalveolar lavage (BAL) was performed, and total cells, eosinophils, lymphocytes were assessed; CD4+, CD8+, CD4+ IL-10+ cells were determined using flow cytometry, and IL-4, IFN-gamma and IL-10 in the BAL fluid were measured by ELISA. Serum ovalbumin-specific IgE, IL-4, IFN-gamma and IL-10 were also determined. Pathologic manifestation of the lung was analyzed.The percentage of EOS, B lymphocytes, CD4+ IL-10+ cells in BAL were 0.010 +/- 0.000, 2.1 +/- 1.9 and 4.9 +/- 1.5, respectively in the control group; 0.480 +/- 0.110, 5.1 +/- 2.6 and 5.1 +/- 2.3, respectively, in group A; 0.120 +/- 0.020, 8.9 +/- 3.6, and 10.4 +/- 3.6, respective, in group B; 0.560 +/- 0.050, 4.7 +/- 1.7 and 6.3 +/- 3.1, respectively, in group C; 0.070 +/- 0.030, 10.1 +/- 2.9 and 12.7 +/- 4.5, respectively, in group D; 0.680 +/- 0.030, 5.6 +/- 3.2 and 6.1 +/- 3.4, respectively, in group E. The difference was significant among different groups (F = 36.46, 31.89, 167.89 respectively; all P0.01). The percentage of CD4+ IL-10+ cells in BAL was increased in group B and group D, which were significantly higher than those in group A (q = 5.8, 6.4, P0.05). The levels of IL-4 and IL-10 in BAL fluid were (21 +/- 3) pg/ml and (44 +/- 12) pg/ml, respectively, in the control group; (128 +/- 23) pg/ml and (68 +/- 18) pg/ml, respectively, in group A; (54 +/- 12) pg/ml and (127 +/- 27) pg/ml, respectively, in group B; (133 +/- 21) pg/ml and (78 +/- 17) pg/ml, respectively, in group C; (8 +/- 18) pg/ml and (135 +/- 34) pg/ml, respectively, in group D; (143 +/- 26) pg/ml and (76 +/- 15) pg/ml, respectively, in group E. The difference was statistically significant among different groups (F = 37.20, 143.78 respectively; all P0.01). The levels of IL-10 in BAL fluid were increased in group B and group D, which were significantly higher than that in group A (q = 7.8, 9.6, all P0.05).The results show that continuous allergen inhalation suppresses allergen-induced airway inflammation and produces immunotolerance, in which IL-10 may play an important role.

To evaluate the role of transbronchial needle aspiraion (TBNA) in the diagnosis of bronchogenic carcinoma with enlarged mediastinal and/or hilar lymph node.Patients with mediastinal and/or hilar lymphoadenopathy proven by CT scan were eligible for TBNA as reported by WANG. All specimen was directly and instantly smeared for cytological examination.From June 2004 to May 2006, 77 such patients were examined: including 38 lung cancers, 35 lung benign diseases and 4 without definite diagnosis. All TBNA procedures were successfully carried out in 222/225 ( 98.7%). Positive TBNA rate was 81.6% (31/38) in patients who had been proven to suffer from bronchogenic carcinoma. The diagnosis of lung cancer was confirmed via TBNA only in 9 patients. A total of 63 lymph nodes in the 38 lung cancer patients were aspirated by TBNA with a positive rate of 65.1% (41/63). The sensitivity of TBNA was significantly correlated with pathology type, lymph node size and experience of the cytologist. Severe complications were rare except small amount of bleeding at the TBNA site (52/77, 67.5%).TBNA is quite safe and helpful in diagnosis and staging of bronchogenic carcinoma, yet it is not helpful in diagnosis of benign lung diseases.

To study the clinical, pathologic and radiologic features of amiodarone-induced lung injury.The clinical, pathologic and radiologic features, including treatment and follow-up information of three cases diagnosed as amiodarone-induced lung injury from October 2004 to October 2005 in the Peking Union Medical College Hospital were reviewed.All the patients were males, with age ranging from 35 to 64 years. The duration of symptoms varied from 20 days to 3 years. All presented with cough. Worsening dyspnea and inspiratory crackles were noted in two patients. Computerized tomography showed bilateral patchy infiltration, ground-glass appearance and accentuation of bronchovascular markings. The most common pathologic manifestations included cellular interstitial pneumonia associated with intra-alveolar collections of macrophages and type II pneumocyte hyperplasia. Some of the macrophages contained finely vacuolated cytoplasm. An organizing pneumonia pattern was seen in one patient.Amiodarone-induced lung injury has characteristic pathologic features which may provide clues to diagnosis. Correlation with clinical and radiologic findings is also important.

To analyze the characteristics of pathologically proved cases of cryptogenic organizing pneumonia (COP) including manifestation of CT scan, bronchoalveolar lavage (BAL) fluid cytology, pulmonary histopathological appearance.Twenty-three consecutive patients from April 1994 to October 2005 in Peking Union Medical College Hospital with pathologic features of organizing pneumonia were enrolled in the study.Eighteen patients were diagnosed as COP. Percutaneous lung biopsy/transbronchial lung biopsy was performed in 10 patients, while open lung biopsy/video-assistant thorascopic biopsy was performed in 8 patients. There were 8 males and 10 females, aged (53.5 +/- 11.0) yr. Dyspnea, cough, inspiratory crackles were the most common symptoms and signs. Lung function tests showed a restrictive ventilatory defect (11/18), and impairment of carbon monoxide transfer factor (T(LCO), 18/18). Chest computed tomography scan in 18 cases mainly showed ground glass opacities (4/18), patchy areas of alveolar consolidation (13/18) with air bronchograms (3/18), and pleural effusion (4/18). BAL fluid cytological analysis showed the percentage of lymphocyte was 0.40 +/- 0.16, neutrophil 0.15 +/- 0.08, eosinophil 0.05 +/- 0.03; the CD(4)/CD(8) ratio was 0.43 +/- 0.21. All patients were treated with corticosteroids. Sixteen were alive and clinically improved or stabilized at the last follow up (8.7 +/- 6.2 months after diagnosis). Two patients died, one of respiratory failure, and another of pulmonary infection.The diagnosis of COP is usually suggested by clinical-radiological findings, but needs to be confirmed histopathologically. The combination of BAL fluid cytological findings and lung histological appearance obtained during a bronchoscopic procedure appears to be an effective method for diagnosing this disease.

To investigate the roles of dendritic cells (DCs) in the pathogenesis of asthma.(1) DCs were derived from peripheral blood monocytes of asthmatics with acute exacerbation (group A, n = 20), patients at remission (group B, n = 15) and healthy volunteers (group C, n = 10), and cultured using media supplemented with granulocyte-macrophage colony stimulation factors (GM-CSF), interleukin-4 (IL-4) and tumor necrosis factor-alpha (TNF-alpha). The antigen-uptaking function of the monocyte-derived DCs was evaluated by phagocytosis of fluorescence labeled ovalbumin (OVA), and their antigen-presenting function was determined by expression of membrane markers (MHC-II) and co-stimulatory molecules (CD(80) and CD(86)). The proliferation of T lymphocytes induced by DCs was assessed using autologous mixed T lymphocyte reaction. (2) The expression of MHC-II and CD(80) and CD(86) of DCs were determined from the bronchoalveolar lavage (BAL) of asthmatic rats. The effects of dexamethasone on the expression of these markers and molecules were studied. Twenty-four rats were divided into the experimental group (group D) and the control group (group E). In group D, rats were subdivided into two groups with 8 rats in each. One group (group D(2)) received pre-treatment with dexamethasone (10 mg/kg), and another group (group D(1)) did not received dexamethasone pre-treatment, while group E was matched with the experimental group with regard to both age and weight. The rats were sensitized and challenged with OVA, and BAL was obtained. (3) All the membrane markers and co-stimulatory molecules on the surface of DCs were determined using flow cytometric method.(1) The phagocytosis of fluorescence labeled OVA in group A was increased [(41 +/- 12)%] compared with those in group B [(29 +/- 10)%, P0.01] and group C [(29 +/- 10)%, P0.01]. The expression of MHC-II, CD(1alpha) and CD(80) on the surface of DCs was the highest in group A [(44 +/- 15)%, (32 +/- 11)% and (32 +/- 13)%, respectively] compared with those in group B [(22 +/- 10)%, (19 +/- 9)% and (19 +/- 10)%, all P0.01, respectively], as well as with those in group C [(18 +/- 12)%, (13 +/- 7)% and (14 +/- 7)%, all P0.01, respectively]. There was no statistical difference in the expression of CD(86) on the cell membrane in group A, group B and group C. In autologous mixed T lymphocyte reaction study, when DC/T ratio was 1/5, DCs had the highest ability in stimulating the proliferation of T lymphocytes in group A (stimulating index = 2.32 +/- 0.44) compared with those in group B (1.01 +/- 0.11, P0.01), and those in group C (1.62 +/- 0.27, P0.01). (2) The expression of MHC-II in BAL cells of asthmatic rats reached peak value at 6 h after challenge, (15.2 +/- 5.0)% in group D(1), and (2.0 +/- 1.0)% in group E, P0.01. The expression of CD(80) and CD(86) increased rapidly 2 h after challenge in group D(1) [(10.6 +/- 3.9)% and (7.5 +/- 3.8)%, respectively] compared with those in group E [(2.1 +/- 0.7)%, P0.01 and (1.7 +/- 0.7)%, P0.05, respectively]. The maximal inhibition effect of dexamethasone on the expression of MHC-II was at 10 h, (7.8 +/- 2.4)% in group D(1), and (2.8 +/- 1.5)% in group D(2), P0.01. The inhibition effect of dexamethasone on the expression of CD(80) and CD(86) was maximal at 24 h, (5.8 +/- 2.7)% and (5.5 +/- 1.5)% respectively in group D(1), and (2.8 +/- 1.1)% and (2.9 +/- 1.6)% respectively in group D(2), P0.05.The antigen up-taking and presenting function of DCs were significantly enhanced in asthmatics at exacerbation and in a rat asthmatic model. Pretreatment with dexamethasone inhibited the function of DCs significantly in the animal model. The results suggest that DCs play important roles in antigen presentation in the pathogenesis of asthma, and the inhibition of glucocorticiod on DCs might be a critical mechanism in treatment of bronchial asthma.

To observe the production of IFN-gamma and IL-4 released in peripheral T lymphocytes in asthmatic patients and rat models and to clarify the dynamic changes of proliferation and differentiation of T lymphocytes during the progress of airway inflammation.Twenty patients with moderate to severe acute exacerbation and 15 patients with remission of asthma were included in this study. Ten normal volunteers were also enrolled as control group. T lymphocytes were obtained from their peripheral blood and the percentage of IFN-gamma(+)CD4(++), IFN-gamma + CD8(++) and IL-4(+)CD4(++) cells were determined by flow cytometric method. Asthmatic rat models were established by sensitizing and challenging by ovalbumin (OVA), and the blood samples were taken and the percentage of IFN-gamma(+)CD4(+), IFN-gamma + CD8(+) and IL-4 + CD4(+) cells were assessed 2, 4, 6, 8, 10, 12, 24, 48, and 72 h after OVA challenge.(1) The percentages of IFN-gamma(+)CD4(+), IFN-gamma(+)CD8(+) and IL-4(+)CD4(+) cells in the peripheral blood were significantly higher in the patients with acute exacerbation [(30% +/- 10%), (42% +/- 15%), and (4.2% +/- 1.6%) respectively] than those in the patients with remission asthma [(20% +/- 8%), (30% +/- 10%), and (2.0% +/- 0.8%) respectively, and P0.001;] and those in the normal subjects [(18% +/- 8%), and (24% +/- 9%), P0.01, and (1.9% +/- 0.9%), P0.001; respectively]. But all the parameters were not different significantly between the patients with remission asthma and the normal subjects. (2) In the asthmatic rat models, the IFN-gamma(+)CD4(+) cells in peripheral blood increased 2 h after OVA challenge (5.7% +/- 1.6%), and peaked 10 h after (9.9% +/- 4.4%), and decreased afterwards. The IFN-gamma(+)CD8(+) cells in peripheral blood increased 2 h after (11.5% +/- 5.1%) OVA challenge, and peaked 10 h after (38.7% +/- 6.3%), and then decreased afterwards. The IL-4(+)CD4(+) cells increased 2 h (1.7% +/- 1.0%) after OVA challenge, and peaked 36 h after (4.0% +/- 1.6%), and then decreased.Both Th1 (IFN-gamma) and Th2 (IL-4) cytokines generated by peripheral blood mononuclear cells in asthma subjects and asthmatic rat models play a role in the development of airway inflammation in bronchial asthma dynamically. Th1 cytokines dominate at the early stage of airway inflammation, whereas Th2 cytokines achieves the major effects at later stage of the inflammation. It suggests that using different strategy in treatment of asthmatics in early stage and late stage may be necessary to control asthma.

T lymphocytes play an important role in the development of asthmatic airway inflammation. By observing the production of interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) released by peripheral T lymphocytes in asthmatic rat models, this study was designed to clarify the changes of T lymphocytes during the course of airway inflammation. The influence of dexamethasone pre-treatment on the production of IFN-gamma and IL-4 by T lymphocytes was also investigated in the study.Twenty-four rats were divided into the study group (group A) and the control group (group B). In the study group, rats were subdivided into two groups with 8 rats in each group. one group (group A(2)) received pre-treatment with intraperitoneal injection with dexamethasone (10 mg/kg), and another group (group A(1)) did not receive dexamethasone pre-treatment, The control group was matched with the study group with regard to both age and weight. Rats were sensitized and challenged by ovalbumin (OVA), and blood samples were obtained and the percentage of IFN-gamma(+)CD(4)(+), IFN-gamma(+)CD(8)(+) and IL-4(+)CD(4)(+) cells were assessed by intracellular cytokine staining and flow cytometric analysis at 2 h, 4 h, 6 h, 8 h, 10 h, 12 h, 24 h, 36 h, 48 h, 72 h, 6 d, 9 d, 12 d, and 15 d after OVA challenge.In group A(1), the peripheral IFN-gamma(+)CD(4)(+) cells, IFN-gamma(+)CD(8)(+) cells, and IL-4 CD(4)(+) cells increased 2 h after OVA challenge [(5.7 +/- 1.6)%, [(11.5 +/- 5.1)%, (1.66 +/- 0.95)%] compared with group A(2) [(2. 6 +/- 1.3)%, (6.1 +/- 1.8)%, (0.77 +/- 0.37)%, P0.05 respectively] and group B [(1.8 +/- 0.7)%, (3.9 +/- 1.5)%, (0.65 +/- 0.12)%, P0.05 respectively]. The peripheral IFN-gamma(+)CD(4)(+) cells and IFN-gamma(+) CD(8)(+) cells in group A(1) reached their maximal level at 10 h [(9.9 +/- 4.4)%, (38.7 +/- 6.3)%] compared with group A(2) [(4.9 +/- 1.7)%, (15.7 +/- 8.7)%, P0.05 respectively and group B [(1.5 +/- 0.5)%, (6.4 +/- 1.5)%, P0.05 respectively], and then decreased afterward. The IL-4(+) CD(4)(+) cells in group A(1) at 10 h after challenge was (2.16 +/- 0.75)%. There was no statistical difference compared with group A(2) [(1.39 +/- 0.77)%, P0.05], but it was higher than group B [(0.68 +/- 0.15)%, P0.05]. The highest level of IL-4(+) CD(4)(+) cells of group A(1) was observed at 36 h [(4.0 +/- 1.6)%], and there was a statistical difference compared with group A(2) [(1.5 +/- 1.0)%, P0.05] and group B [(0.7 +/- 0.3)%, P0.05].Both IFN-gamma and IL-4 generated by peripheral blood T cells in the rat asthmatic models played a role in the development of airway inflammation. INF-gamma dominated at early stage of the airway inflammation, whereas IL-4 took the major effect at the late stage of inflammation. The production of IFN-gamma and IL-4 by T lymphocytes in the asthmatic model was inhibited significantly by dexamethasone.

To investigate the pulmonary function in severe acute respiratory syndrome (SARS) patients during the convalescent period.Followup 89 outpatients of SARS. The follow-up study included interview, physical examination, and pulmonary function test.The interval between hospital discharge and functional assessment was 1.75 +/- 0.53 months (0.5-3.4 months). Mild to moderate abnormalities in pulmonary function were found in 48 patients (53.9%). Diffusion capacity for carbon monoxide (DLco) was impaired in 38 patients (42.7%); in 7 patients (7.9%), lung function was restrictive defect combined DLco impairment; Other patterns of impairment were revealed in 3 patient. Dyspnea during acute phase and CT during the convalescent period were found to have significant influences on DLco and total lung capacity (TLC).Diffusing capacity impairment as well as restrictive defect persist in convalescence SARS.