Abstract:Respiratory tract infection,as a common disease with high morbidity and mortality, has endangered human life and health, and exerted a big burden on families and the whole society. Because of lacking specific laboratory indicators, its diagnosis and treatment mainly relies on clinical symptom. Early diagnosis and prognosis evaluation is important for rational allocation of medical resources. This article mainly introduced clinical values and prospects of biological markers in helping management of lower respiratory tract infection.

Abstract:Chronic obstructive pulmonary disease (COPD) is a common chronic disease. In contrast to previously limited know-ledge, it is now apparent that COPD is a disease process with obvious complexity and heterogeneity clinically and biologically. Herein, based on the concerning findings from several large-scale cohort studies conducted in the United States and Europe, we reviewed the progresses of COPD and put forward for some consideration in its identification, diagnosis, assessment and treatment.

Abstract:Bronchial asthma (also called asthma) is a chronic airway inflammatory disease, with involvement of a variety of inflammatory cells and cellular components. Nowadays, asthma, and severe asthma in particular, is increasingly recognized as a heterogeneous disease. Based on its pathogenesis, clinical manifestations, biomarkers, and so on, precise classification and individualized treatment have become current research hotspot for severe asthma patients. Only in this way, these patients can be well-controlled. The article reviewed the phenotypes and endotypes of severe asthma.

Abstract:Because winter air pollution becomes heavier and heavier in the northern regions of China, more and more older people, especially those suffering from pulmonary diseases, just as migratory birds fly south every winter, have been going to southern cities in winter time for a more pleasant environment with higher temperature and cleaner air. So we call them migratory birds population (MBP). In Sanya, these people had better quality of life and activity tolerance than living in the north, which may be associated with environmental change. Remote sensing technology is an effective way to continually, rapidly and dynamically monitor the large-scale environment, so it can provide a basis for selecting a suitable place for MBP.

Abstract:Older patients are the main population suffering from lower respiratory infections, which is of high incidence and mortality. Because of the increasing age, presence of one or more co-morbidities, colonization of bacteria in the oral cavity and upper respiratory tract, and high incidence of dysphagia, all these factors increase the occurrence of aspiration pneumonia. Thus, the distribution of causative agents for lower respiratory infection in the older people is different from general population. The percentages of Gram-negative Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus and anaerobic bacteria become larger. Based on the characteristics of the elderly population, this paper focused on the features of pathogens and bacterial resistance in lower respiratory tract infection, and provided the best antibiotic treatment options according to the relative guidelines so as to provide references to the clinicians.

Abstract:Objective To determine whether there are biologic differences in the Pseudomonas aeruginosa strains isolated from respiratory specimens among the elderly patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) or those with ventilator associated pneumonia (VAP). Methods A total of 48 strains of Pseudomonas aeruginosa isolated from the respiratory specimens of the elderly with acute exacerbation of COPD and VAP who admitted in our department from January 2012 to March 2014 were collected; and among them, 22 were from the COPD patients and 26 from the VAP patients. Biofilm formation was quantified and classified with crystal violet staining. The production of pyocyanin was measured with chloroform extraction method, and the elastase activity was determined with elastin-congo red staining. Results Biofilm formation abilities were similar in the strains isolated from respiratory specimens of COPD group and VAP group (P>0.05), but there existed individual differences. No obvious differences were observed in the production of main virulence factors (pyocyanin and elastase) between the 2 groups (P>0.05). ConclusionPseudomonas aeruginosa strains from the elderly with acute exacerbation of COPD and VAP have similar biofilm formation abilities and production of main virulence factors.

Abstract:Objective To investigate the clinical characteristics of pulmonary nocardiosis in order to improve its awareness for physicians. Methods Clinical data of 13 pulmonary nocardiosis patients admitted in our hospital and the Hainan Branch of our hospital from August 2009 to June 2016 were collected and retrospectively analyzed. Clinical characteristics were summarized and relevant literature was reviewed. Results There were 12 out of 13 patients having underlying diseases, and 7 patients had received corticosteroid and/or immunosuppressive agents. Cough was the most common symptom (84.6%). Radiological findings showed that 11 cases (84.6%) were manifested as lung nodules/masses, 9 (69.2%) as consolidation, and 8 as cavitary lesions (61.5%). Among them, 84.6% were misdiagnosed initially. The mortality was quite high in those with multiple organ dissemination. Combination therapy based on sulfanilamide resulted in sound clinical outcomes. Conclusion Pulmonary nocardiosis has no specific clinical manifestations, and its diagnosis can be frequently missed or delayed. The patients with multiple organs dissemination involved have poor prognosis. So for the patients having susceptible factors, this disease should be considered when conventional therapy is not effective.

Abstract:Objective To compare the bleeding risk and curative effect in the elderly (≥75 years old) and middle-aged patients (<60 years old) suffering from acute coronary syndrome (ACS) treated with different regimens of dual antiplatelet therapy (DAPT), aspirin combined with clopidogrel or with ticagrelor. Methods A total of 416 consecutive ACS patients admitted in our hospital from March 2014 to May 2015 were enrolled in this study. And all of them underwent thromboelastography (TEG). According to their age and antiplatelet regimen, they were divided into 4 groups, that is, ＜60 years old and treated with aspirin+clopidogrel (＜60C group), ≥75 years old and treated with aspirin+clopidogrel (≥75C group), ＜60 years old and treated with aspirin+ticagrelor (＜60T group), and ≥75 years old and treated with aspirin+ticagrelor (≥75T group). All the patients were followed up for 1 year. The occurrences of major adverse cardiovascular events (MACE) and bleeding events were recorded and compared in the groups. Results There were no significant differences in the occurrence of MACE, maximal amplitude (MA) value obtained with TEG, and inhibitory rate of arachidonic acid (AA)-induced platelet aggregation (AA-IPA) in each group (P>0.05). The inhibitory rate of adenosine diphosphate-induced platelet aggregation (ADP-IPA) was obviously higher in the same-aged patients treated by aspirin combined with ticagrelor than those with clopidogrel (P＜0.05), but no difference was found in the ＜60T group and ≥75T group (P=0.828), and the ADP-IPA rate was remarkably lower in the ≥75C group than the ＜60C group (P=0.011). The occurrence of bleeding risk was significantly higher in the same-aged patients treated with aspirin+ticagrelor than with clopidogrel (P＜0.05), but most of them was type Ⅰ non-fetal bleeding events. There was no difference in bleeding risk between the ＜60T group and the ≥75T group (P=0.392). Cox regression analysis revealed that blood glucose level (B=0.111, RR=1.117,95%CI:1.014-1.231, P=0.025), estimated glomerular filtration rate (eGFR, B=-0.023, RR=0.977,5%CI:0.961-0.993, P=0.005), and heart rate (B=0.040, RR=1.041,5%CI:1.013-1.070, P=0.004) were risk factors for MACE. Logistic regression analysis showed that different strategies of DAPT (B=3.527, OR=34.025,5%CI:9.560-121.101, P<0.001) and sex (B=1.126, OR=3.085,5%CI:1.083-8.788, P=0.035) were risk factors for bleeding events. Conclusion The clinical efficacy of aspirin+ticagrelor is not superior to that of aspirin+clopidogrel, and the former regimen is associated with higher risk of type Ⅰ bleeding. No difference is observed in the bleeding risk in the patients treated with aspirin+ticagrelor at different age period.

Abstract:Objective To analyze the clinical outcomes of one-stage anterior debridement, dura splitting decompression, one-stage kyphosis correction, bone grafting and internal fixation in the treatment of thoracolumbar tuberculosis. Methods Clinical data of 32 cases with thoracolumbar tuberculosis who underwent above surgeries in our hospital from January 2007 to January 2015 were collected retrospectively. The time of bone graft fusion, and the changes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphotic angle (Cobb angle) and American Spine Injury Association (ASIA) grade before and after treatment were collected and analyzed. Results The average operation time was (177.3±14.5)min, and the mean amount of intraoperative blood loss was (492.5±170.1)ml. During the postoperative follow-up of (36.9±12.7)months (ranging from 18 to 72 months), no recurrence of thoracolumbar tuberculosis was found in all the patients. The time of bone graft fusion was (5.5±1.1)months (3-8 months). The levels of ESR and CRP were gradually declined to normal levels at 3 months after operation. Their ASIA grades also went back to normal at the last follow-up. The average angle of kyphosis was decreased from (17.6°±6.4°) preoperatively to (2.5°±1.3°) post-operatively, and then to (3.8°±1.5°) at the last follow-up. No significant loss of correction angle (1.3°±0.6°) was observed, but the angle was greatly improved postoperatively and at the last follow-up when compared with that before operation (P<0. 5). At the last follow-up, all patients got solid bony fusion and had no evidences of internal fixation and fracture. Conclusion Anterior operation is suitable to one-stage anterior debridement, dura splitting decompression, one-stage kyphosis correction, bone grafting and internal fixation and reconstruction of spinal stability for thoracolumbar tuberculosis, with satisfying clinical outcomes.

Abstract:Objective To determine the effect of curcumin (Cur) on the process of visfatin-induced injury in human umbilical vein endothelial cells (HUVECs), and investigate the underlying mechanism of signal pathway induced by Cur treatment in the improvement of endothelial functions. Methods After the HUVECs were induced by 1×10-5mol/L visfatin, the cells were treated by Cur. Then cell viability was determined by MTT assay, the expression levels of monocyte chemoattractant protein-1 (MCP-1) and E-selectin were detected by enzyme linked immunosorbent assay (ELISA), and the levels of intercellular cell adhesion molecule-1 (ICAM-1), inositol-requiring transmembrane kinase/endonuclease 1 (IRE1), glucose-regulated protein 78 (GRP78) were measured by Western blotting. Results MTT assay showed that Cur treatment had no effect on cell viability. Compared with the normal control group, 1×10-5mol/L visfatin significantly increased the protein expression levels of MCP-1 and E-selectin (P＜0.05), and obviously enhanced the protein expression of ICAM-1, IRE1 and GRP78 (P＜0.05). However, different doses of Cur treatment exerted inhibitory effects on the above phenomena induced by visfatin (P＜0.05). Conclusion Cur may mitigate visfatin-induced injury in HUVECs via the inhibition of endoplasmic reticulum stress.

Abstract:Objective To determine the effect of vitamin K metabolize associated gene CYP4F2 on the activation of vitamin K dependent coagulation factor Ⅸ (FⅨ). Methods The pIRES plasmid containing CYP4F2-cDNA fragment and FⅨ-cDNA fragment was constructed, and enzyme digestion was used to verify the products. The plasmids pIRES-FⅨ-CYP4F2, pIRES-FⅨ and pIRES(control plasmid) were transfected into LO2 cells respectively with Lipofectamine 2000 transfection reagent. Western blotting was used to detect the expression of CYP4F2 and FⅨ.The activity of FⅨa was detected by FⅨa activity assay kit. Results The results of enzyme digestion indicated that the pIRES-FⅨ-CYP4F2 plasmid was successfully constructed. The plasmids pIRES-FⅨ and pIRES-FⅨ-CYP4F2 were successfully transfected into LO2 cells. FⅨa activity was significantly higher in the supernatants and cell lysates from the FⅨ-overexpressed LO2 cells than the control cells, but the activity was significantly reduced in the LO2 cells with the over-expression of FⅨ and CYP4F2 than the cells with the over-expression of FⅨ. Conclusion The over-expression of CYP4F2 exerts inhibitory effect on the activation of vitamin K dependent FⅨ.

Abstract:Objective To study the changes of the permeability of blood-brain barrier (BBB) in the early stage after cerebral ischemia-reperfusion (I/R) injury in rats. Methods Thirty rats were randomly divided into 6 groups:sham group, ischemia for 1 h group (I1h), ischemia for 2 h group (I2h), ischemia for 2 h followed by reperfusion for 0.5 h (I2h/R0.5h), ischemia for 2 h followed by reperfusion for 1 h (I2h/R1h), and ischemia for 2 h and then reperfusion for 2 h (I2h/R2h). The cerebral ischemia-reperfusion model of middle cerebral artery occlusion (MCAO) was established by middle cerebral artery occlusion. The BBB structure was observed with transmission electron microscopy. After I¹²⁵ labeled nerve growth factor (I¹²⁵-NGF) was injected into the rats by tail vein, its permeation through the BBB was determined by counting γ-rays. Autoradiography was used to observe the distribution of I¹²⁵-NGF in the involved areas in the frozen section of brain coronal tissues. Results Compared with that in rats of the sham group, the content of I¹²⁵-NGF was significantly higher in the rats from the I1h, I2h, I2h/R0.5h, I2h/R1h, and I2h/R2h groups (P<0.05). Compared with sham group, the I2h group displayed that the number of microvilli on the luminal surface of endothelial cells was increased significantly, and the endothelial cells were slightly shrunken, with the pinocytotic vesicles formed in the cytoplasm and slightly swollen mitochondria. And the astrocytes were observed with mild swollen foot processes and wilder extracellular space. In the I2h/R2h group, the endothelial cells were swollen and blurred, with wrinkled nucleus and larger gap, and the astrocytes were with mild swollen foot processes, wilder extracellular space, and accumulated edema fluid. I¹²⁵-NGF was slightly infiltrated into the ventricle of the sham group, moderately into the ventricle and involved cortex of the I2h group, but largely into the ventricle, involved cortex and subcortical tissues in the I2h/R2h group. Conclusion BBB is impaired at the early stage of cerebral ischemia-reperfusion injury in rats. With the elapse of ischemia/reperfusion duration, the integrity of the BBB has deteriorated more severely.

Abstract:In this article, we retrospectively reported the successful diagnosis and treatment for a 88-year-old primary biliary cirrhosis patient with chylothorax. He initially presented with fever, cough, hemoptysis and shortness of breath, then he was found with pleural effusion and diagnosed with real chylothorax after admission. After exclusion of some common reasons, such as tumor, tuberculosis and so on, he was considered to be diagnosed as chylothorax secondary to primary biliary cirrhosis with the aids of abdominal CT scanning and positive anti-mitochondrial antibody M2. Surgical treatment was given in the case that conservative treatment of internal medicine was not effective. After surgical treatment, the patient recovered well and chylothorax was not recurrent in multiple chest X-ray examinations. This report aims to promote the physician’s awareness for chylothorax in the elderly, so that the early diagnosis and general treatment is performed to prolong the patient’s survival time.

Abstract:Reperfusion therapy can also lead to the new injury in the patients with acute myocardial infarction (AMI), which was known as ischemic reperfusion injury (IRI). The pathogenesis of IRI is complex, and there is still no effective treatment. Recent studies showed that the endoplasmic reticulum stress (ERS) plays an important role in IRI, and is expected to be a new target to reduce IRI. It is of great significance to investigate the role of ERS in the occurrence and development of IRI and its relationship with the cardiomyocyte death in the improvement of the prognosis of AMI patients.

Abstract:Dual antiplatelet therapy (DAPT) has been widely used in the treatment of coronary artery diseases, especially in the patients with acute coronary syndrome (ACS) and those after percutaneous coronary intervention (PCI). Data indicate that a significant percentage of individuals treated with clopidogrel do not receive the expected therapeutic benefit because of a decreased responsiveness of their platelets. This phenomenon is called “clopidogrel resistance”. In present years, many studies focused on the effects of types, dosages and combinations of statins and other factors on clopidogrel efficacy, while not enough evidence shows that statins directively and independently affect platelet inhibition by clopidogrel. But these studies provided references for the underlying mechanism of clopidogrel resistance and the interactions between the 2 agents, and furthermore, guided the clinicians to adjust the anti-platelet treatment timely so as to avoid the occurrence of life-threatening thromboembolism. This article summarized the interactions of statins and clopidogrel.

Abstract:Idiopathic pulmonary fibrosis (IPF) is an idiopathic interstitial pneumonia with poor survival and poor prognosis. But, there are very limited clinical treatments for the disease. In 2011, the American Thoracic Society (ATS), the European Respiratory Society (ERS), the Japanese Respiratory Society (JRS) and the Latin American Thoracic Society (ALAT) published idiopathic pulmonary fibrosis:evidence-based guidelines for diagnosis and management, and provided treatment proposals. But afterwards, the results of some clinical trials were in conflict with the recommendations in the 2011 guideline. In 2015, the agency issued an update of the 2011 clinical practice guideline. In this paper, we reviewed the drugs for the treatment of IPF in the guidelines in 2011, and the recommendations for each drug in the 2015 update.

Abstract:“Clinicopathological Conference” column wins warm praise from readers. The success of this column in medical journals is very significant in servicing health care career, educating young medical trainees, and advancing journals influence. In this paper, we summarized the experiences in establishment, development and perfection of “Clinicopathological Conference” column in Chinese Journal of Multiple Organ Diseases in the Elderly. The “Clinicopathological Conference” column can be successfully developed by balancing the interests of readers, authors, and journals. It may offer some suggestions for developing special column in journals.