Objective To investigate the alterations of pulmonary dead space,pulmonary shunt fraction (Qs/Qt) and gas exchange after thromboembolism of lungs in swines and to evaluate the mechanism in respect of pathophysiology and implication.Methods Swine model of pulmonary thromboembolism was made by injection of thrombus into pulmonary artery.Eight swine were used for study of physiologic dead space (VDphy),alveoli dead space (VDalv),airway dead space (VDaw),Qs/Qt,pulmonary arterial pressure (PAP),oxygen partial pressure in arterial blood (PaO2 ),carbon dioxide partial pressure in arterial blood (PaCO2 ),alveolar-arterial O2 gradient (PA-aDO2) determined 30 min before thromboembolism and 0 min,30 min,60 min,120 min after thromboembolism.Results The results showed that VDphy,VDalv,Qs/Qt,PAP,PA-aDO2 increased markedly after thromboembolism in comparison with pre-thromboembolism (P ＜ 0.01 ),while PaO2 declined significantly (P ＜ 0.01 ),and the differences in VDaw and PaCO2 were not significant ( P ＞ 0.05 ).SNK test showed that VDphy and VDalv declined to be smaller at 60 min,120 min than those at 30 min,and PAP declined to be lower at 30 min,60 min,120 min than that at 0 min.Other variables did not change at different intervals after thromboembolism.Hemodynamics did not change significantly after embolization.Conclusions After pulmonary thromboembolism,a various of changes in pathophysiology happened such as increase in dead space,Qs/Qt and PA-aDO2 and decrease in PaO2,but PaCO2 did not change.

Objective To assess diagnostic value of Wells and Geneva seales in patients with suspected pulmonary embolism(PE).Methods Clinical data of 958 consecutive cases of suspected PE admitted to Shanghai Pulmonary Hospital form January 1,1995 to January 1,2009,were analyzed retrospectively,and all patients were assessed with Wells and Geneva scales,respectively for likelihood of PE,as compared to those diagnosed by lung imaging Results Three hundred and forty-seven patients with PE were diagnosed with lung imaging as gold standard,sensitivity,specificity,and positive and negative predictive values for Wells scale and Geneva scale in diagnosis for PE were 82.4%,58.1%,52.8%and 85.3%.and 88.8%,55.3%,53.1%and 89.7%,respectively,with positive and negative likelihood ratios.Youden index and crude agreement of 1.97,0.30,0.41 and 0.21,and 1.99,0.20,0.44 and 0.25.respectively.Area under the receiver operating characteristic(ROC) curve of Geneva scale(0.79)was significantly more than that of Wells scale(0.73)(Z=2.25,P＜0.05).As compared to Wells scale,sensitivity and specificity for Geneva scale in diagnosis for PE was significantly higher(χ2=7.12 and 6.84,respectively,P＜0.05).Conclusions Although there is a considerable gap in accuracy between clinical scales and lung imaging in diagnosis for PE.both Wells and Geneva scales can be used in clinical screening for PE to save unnecessary cost.however,Geneva scale is more practical and accurate than Wells scale,worthwhile to be popularized clinically.

To retrospectively analyze the clinical data of 48 patients with allergic bronchopulmonary aspergillosis (ABPA) at Shanghai Pulmonary Hospital.There were 23 males and 25 females with a mean age of (36 ± 15) years.Their clinical manifestations included wheeze,cough,sputum production,sputum plugs,fever,hemoptysis,weight loss,chest pain,weakness and night sweats.They had a high peripheral blood eosinophilia,a higher serum total IgE,a higher level of aspergillosis fumigatus-specific IgE and positive immediate skin-prick test to aspergillus fumigatus.Aspergillus species were detected in sputum samples of 26 patients.Chest computed tomography (CT) was performed in 48 patients.There were patchy infiltrations (n =45),transient infiltrations (n =40),central bronchiectasis (n =35) and mucoid impaction (n =18).Obstructive ventilation dysfunction was confirmed by lung function test.

Objective To study the value of Geneva score assessment combined with simplified rapid plasma D-dimer assay(SRPDDA)for early diagnosis of pulmonary embolism(PE).Methods Clinical data of 658 suspected cases of PE hospitalized at Shanghai Pulmonary Hospital during January 1,1995 to November 30,2007 were retrospectively analyzed.The patients were divided into three categories based on their Geneva score assessment,highly suspected with equal to or greater than 9 scores,intermediately suspected with 5-8 scores and mildly suspected with equal to or less than 4 scores,respectively.Clinical diagnosis for PE of the patients was made based on their probability Geneva score developed by Wicki,SRPDDA,and both Geneva score assessment and SRPDDA,respectively,and compared with results of lung imaging.Results Finally,PE diagnosis was established in 267 cases.Sensitivity for Geneva score and SRPDDA to diagnose PE was 88.4%and 90.3%,with negative predictive value(NPV)of 88.9%and 90.2%and Youden Index(YI)of 51.7%and 51.4%,respectively.And,sensitivity of both Geneva score assessment combined with SRPDDA wag 97.8%,with NPV and YI of 97.3%and 53.8%,respectively,with a likelihood ratio(LR)for both positive test results of 2.62 and a LB for both negative test results of 0.04,respectively.Conclusions As a routine and non-invasive diagnostic test,Geneva score assessment,as well as SRPDDA,play a screening role in early diagnosis for PE,which can help to save unnecessary cost of imping,and complement each other so to improve accuracy of diagnosis and reduce misdiagnosis.

Humans ; Nitrogen Oxides ; poisoning ; Pulmonary Edema ; chemically induced

Objective To investigate the mechanism and significance of low density nitric oxide (NO) in-halation combined with urokinase (UK) in treatment of pulmonary thromboembolism in swine. Method PIE model was estabhshed in 12 healthy infant swines, which were subsequently assigned to UK group or UK+NO ter establishment of the PIE model;in the UK+NO group, swines received continuous NO inhalation of 10 ppm NO for two hours in addition to administration of UK no done in the UK+NO group. Volume of physiological dead space (VDphy), volume of alveolar dead space (VDalv), intrapoulmonary shunt (Qs/Qt), mean ptdmonary arteri-al pressure (PAP), systolic blood pressure (SBP), heart rote (HR), cardiac output (CO), arterial blood pH val-ue, arterial partial pressure of carbon dioxide (PaCO2) and arterial partial pressure of oxygen (PaO2) were mea-sured at 30 min before and 0 min, 30 min, 60 rain, 120 min and 180min after establishment of pulmonary em-bolism.All date were analyzed by ANOVA (SNK-q test),and P<0.05 was considered as significantly differet. Results After PE, VDphy, VDalv, Qs/Qt and PAP of both groups increased markedly compared with the pre-PE values (P<0.01), but the post-PE PAP showed a tendency of decline as time passed. Post-PE PaO2 of both groups decreased significantly (P<0.05 and P<0.01). There were no significant differences in HR, SBP, CO, pH or PaCO2 between pre-PE and post-PE (P>0.05). Both pre- and Post-PE PAP of UK+NO group were markedly less than those of the UK group (P<0.05 and P<0.01). No significant difference was found in other measurements between the two groups. Conclusions UK combined with low density NO inhalation may lower pul-monary arterial pressure promptly to alleviate PIE without distur bance in hemodynamics or gas exchange status and without pulmonary raterial pressure rebound.

Objective To explore the inflammatory mechanisms of pulmonary embolism ( PTE ) and/or deep venous thrombosis ( DVT ) in elders secondary to chronic obstructive pulmonary disease ( COPD) exacerbation.Methods A total of 26 elders with acute exacerbation of high-risk COPD secondary PTE and/or DVT and 26 patients with low-risk COPD during stable phase diagnosed during the period of January 2008 to December 2012 were enrolled.The relevant parameters of routine blood examination , blood viscosity, D-dimer, fibrinogen ( FIB), arterial blood gas, blood cytokine, erythrocyte sedimentation rate ( ESR ) and C-reactive protein ( CRP ) were retrospectively analyzed.Results The major nonspecific symptoms were cough, sputum and dyspnea.The mean of neutrophile percentage (N%), D-dimer, FIB, interleukin-6 (IL-6), tumor necrosis factor (TNF), C-reactive protein (CRP), low and high shear blood viscosity in blood samples of patients with acute exacerbation of high-risk COPD secondary PTE and ( or ) DVT were higher than those of the control group ( t =3.339, 2.700, 2.207, 2.431, 2.257, 2.143, 2.223, 2.797, all P<0.05).However arterial partial pressure of oxygen ( PaO2 ) was lower than that of lower-risk COPD patients (t=4.312, P<0.05).IL-6 in blood of patients with acute exacerbation of high-risk COPD secondary PTE and ( or) DVT was positively correlated with low-shear blood viscosity , D-dimer and FIB (r=0.437, 0.624, 0.429, all P<0.05).TNF in blood of patients with acute exacerbation of high-risk COPD secondary PTE and ( or ) DVT was positively correlated to FIB , low and high cut blood viscosity ( r =0.624, 0.519, 0.513, all P <0.05 ).Plasma CRP in blood of patients with acute exacerbation of high-risk COPD secondary PTE and/or DVT was positively correlated with D-dimer, FIB, IL-6 and TNF ( r=0.478, 0.541, 0.533, 0.491, all P<0.05).Conclusions Inflammation may exist in elders with acute exacerbation of high-risk COPD secondary thrombotic disease.IL-6 and TNF may promote thrombosis secondary to acute exacerbation of COPD disease.Early screening and/or prophylactic anticoagulation are necessary for prevention.

Objective: To study the airway inflammation feature difference in the patients with occupational pulmonary thesaurosis induced by iron. Methods: Induced sputum samples were obtained from 20 healthy men, 20 patients with stable asthma, 25 patients with occupational pulmonary thesaurosis induced by iron. Differential cell counts in induced sputum were examined. The levels of supernatant IL-8 were measured by ELISA. Results: The pulmonary function result was normal in the patients with pulmonary thesaurosis., their FVC (4.1±1.2) L was similar to FVC (4.3±0.9) L in mal group; but their FEV_1.0 (2.9±0.9) L、FEV₁/FVC (71.9%±5.4%) were lower than normal group’s FEV_1.0 (3.2±0.7 L) 、FEV_1.0/FVC (79.2%±9.9%) , and were hirher than asthma group’s FEV₁ (2.5±0.8) L and FEV_1.0/FVC (68.7%±6.1%) . In induced sputum, macrophages percentage in patients with pulmonary thesaurosis (54.3%±9.7%) was higher than asthma group and normal group (48.4±6.4, 51.9±7.3, P<0.05) , neutrophils percentage in patients with pulmonary thesaurosis group (43.9%±7.6%) was higher than asthma group and normal group (41.3%±7.1%, 39.8%±6.9%, P<0.05) , eosinophils percentage in patients with pulmonary thesaurosis group (0.3%±0.1%) was lower than asthma group (2.8±0.3, P<0.05) , lymphocytes percentage in patients with pulmonary thesaurosis group (2.0%±0.4%) was lower than asthma group (4.7±0.6, P<0.05) ; the sputum levels of IL-8 in patients with pulmonary thesaurosis group (914.7±24.3) pg/ml was higher than asthma group and normal group (747.9%±16.8 pg/ml, (405.4±13.7) pg/ml, P<0.05) . Conclusion Macrophages and IL-8 may play an important role in the pathogenesis of airway inflammation after long-term inhalation of iron and its compounds, the airway function in patients of occupational pulmonary thesaurosis was found damaged.