OBJECTIVE To conclude and analyze epidemiology,etiology,diagnostic,treatment and prognostic factors of local adult hospitalized patients with severe pneumonia.METHODS A retrospective analysis with case-control study was designed.All the medical records of consecutive patients aged ≥18 yrs with diagnosis of pneumonia from Sep 2000 to Sep 2005 in the First Affiliated Hospital of Sun Yat-sen University were searched.Contribution of the factors to prognosis was determined by multivariate analysis with Logistic regression.RESULTS In the severe community-acquired pneumonia(SCAP) subgroup,mortality was 45.0%;and in the severe hospital-acquired pneumonia(SHAP) subgroup,mortality was 54.8%.In the SCAP subgroup,there were five factors associated with prognosis on multivariate analysis: age(≥75yrs),heart failure,intubation and septic shock were risk factors;initial combined antibiotic therapy was protective factors.In the SHAP subgroup, factors associated with prognosis on multivariate analysis were heart failure,septic shock and heart rate ≥100bpm;all were risk factors.CONCLUSIONS Septic shock and heart failure are associated with mortality both in SCAP and SHAP,which suggest that severe systemic inflammatory response associated with the pulmonary infection be an important prognostic factor in the outcome of severe pneumonia.Initial appropriate antibiotic empiric therapy was important to the prognosis.

Objective To study pre-thrombosis state in patients with cor pulmonale and analyze the value of treatment with low molecular heparin (LMH). Method 46 patients with cor pulmonale were divided into LMH group and routine one. Von Willebrand factor (vWF), prethrombin F 1+2 fragment (F 1+2 ), Fibrinogen (Fg), granule membrane protein (GMP-140) and D-dimer fragment (DD) were detected separately.Result The concentrations of WF,F 1+2 ,Fg,GMP-140 and DD in the patients with cor pulmonale were significantly higher than control. In LMH group, these variables and PaCO 2 decreased and PaO 2 increased markedly after treatment. In routine group, these blood-gas index slightly improved, but no decrease were observed in coagulation variables. Conclusion Early detection and diagnosis of pre-thrombosis state in patients with cor polmanate and timely treatment with LMH can be beneficial to these patients during acute state.

Some measures about improving the teaching quality in respiratory department training are described in this report,including identifying the aim and importance of major training,raising students'enthusiasm,enhancing the basic major procedure training,performing various teaching,concentrating on the students'response and altering teaching methods continuously

Objective:To investigate the effect of anti-CD134 mAb or CTLA4Ig on ConA induced splenic cell proliferation,Th cytokine secretion and production of anti-dsDNA antibody from splenic lymphtocyte in vitro in lupus-prone BXSB mice. Methods:Eighteen male lupus-prone BXSB mice model and 6 syngeneic normal C57BL/6 male mice were used in the experiment. The model mice were divided into three groups:un-treated group,Lupus recipe(LR) treated group and prednisone(pred. ) treated group. The mice's splenic cell suspension from above groups was culture stimulated by ConA respectively. The splenic cells from un-treated model mice were further divided into Anti-GD134L mAb,CTLA4Ig or Anti-CD134L mAb + CTLA4Ig treated subgroups. The ConA induced splenic cell proliferation was measured by MTT colorimetric assay. The levels of IFN-?, IL-6 and anti-dsDNA antibody in cell supernatant were measured by ELISA. Results; (1 )The splenic cell proliferative reaction and contents of IFN-?,IL-6 and anti-dsDNA antibody in cell supernatant of either spontaneous or ConA induced culture in the un-treated model group were obviously higher than that of the normal control or other groups. (2) The splenic cell proliferative reaction and production of IFN-?,IL-6 and anti-dsDNA antibody in the CD134L/CTLA4Ig treated group,LR treated goup or pred. treated group was not different from the normal control significantly. (3)To compared with CD134L treated group or CTLA4Ig treated gruop,the CD134L/CTLA4Ig and prednisone reduced significantly the splenic cell proliferative reaction and production of IFN-?,IL-6 and anti-dsDNA antibody in cell supernatant of either spontaneous or ConA induced culture,while no difference was found between CD134L treated group and CTLA4Ig treated proup. Conclusion:The lupus-prone BXSB mice might present abnormal lymphocyte proliferation,spontaneously express cytokines and secrete high level of autoantibody during the SLE development. LR and corticosteroids could obviously inhibit the abnormal lymphocyte proliferation;reduce the Th cytokine formation and antoantibody production Blockade of CD134-CD134L or B7-CD28 costimulatory pathway by Anti-CD134L rnAb or CT-LA4Ig could inhibit the activation of T cells and B cells like LR and corticosteroids. Furthermore, by blockade of both CD134-CD134L and CD28-B7 pathways,the frequency of alloreactive T cell was markedly reduced and was maintained at low levels so as to treat SLE effectively.

AIM: To investigate the effects of lupus recipe on immune system and lymphocyte subsets proliferation in splenic cells in BXSB mice. METHODS: Eighteen male BXSB mice model was used in the experiment. The model mice were divided into three groups: un-treated model group, lupus recipe (LR) treated group, and prednisone treated group. All model mice were killed in 10 weeks. The control group consisted of 6 syngeneic normal C57BL/6 male mice. The levels of total IgG and anti-dsDNA antibody in serum were detected by ELISA. The percentages of lymphocyte subsets (CD3+, CD4+, CD8+ T lymphocytes and CD19+, CD23+ B lymphocytes) were detected by using flow cytometry analysis. RESULTS: (1) The serum levels of total IgG and anti-dsDNA antibody in un-treated model group were higher than that in other groups. There was no differences among LR treated group, prednisone treated group and control group. (2) The percentages of CD3+, CD4+, CD8+ T lymphocytes and CD19+, CD23+ B lymphocytes in model group were obviously higher than that in normal control. (3) Compared to un-treated model group, the percentages of CD4+, CD8+ T lymphocytes and CD19+, CD23+ B lymphocytes in LR or prednisone treated group were significantly reduced, which closely reached the levels in normal group. CONCLUSIONS: The immune functions of T and B lymphocytes in BXSB mice are up-regulated. LR inhibits the activation of T and B lymphocytes, reduces the serum levels of IgG and auto-antibody production.

AIM:To study the effect of dexamethasone(Dex)on the expression of aquaporin-1(AQP-1)in cultured rat pleural mesothelial cells and to offer experimental support for the investigation of the mechanisms of pleural fluid treatment.METHODS:Rat pleural mesothelial cells were cultured in vitro.The expression of AQP-1 was detected by immunocytochemistry and reverse transcription-PCR(RT-PCR)after cells were identified,then the cells were treated with Dex for 24 hours at concentrations of 10-8,10-7,10-6,10-5 and 10-4mmol/L,and for 6 h,12 h,24 h,36 h,48 h,72 h at concentration of 10-4 mmol/L.Western blotting was used to analyze the expression of AQP-1 in cultured control and Dex-treated rat pleural mesothelial cells,and image analysis system to analyze the expression of AQP-1.RESULTS:Aquaporin-1 was expressed in cultured rat pleural mesothelial cells.The protein of AQP-1 expressed in rat pleural mesothelial cells was 755.04?19.81,843.72?19.41,862.96?26.53,694.80?32.00,938.08?13.32 in those treated with Dex at concentrations of 10-8,10-7,10-6,10-5 and 10-4 mmol/L,respectively,the levels was 2.02,2.26,2.31,1.86,2.52 fold higher than that in control group(372.90?16.46,P

AIM:To observe the expression of chemokine fractalkine,and its receptor,CX3CR1,in kidneys of lupus-prone BXSB mice,and their changes after treatment with prednisone. The role of fractalkine and CX3CR1 in the pathogenesis of lupus nephritis was also discussed. METHODS:Twelve 12-week-old male BXSB mice were randomly divided into two groups,the prednisone treatment group (BXSB-prednisone group,n=6) and the experimental control group (BXSB group,n=6). Six male C57BL/6J mice at the same weeks of age served as a normal control group (C57BL/6J group). Both the C57BL/6J and the BXSB group of mice received a daily intragastric administration of 0.5 mL normal saline. The BXSB-prednisone group of mice was given a daily intragastric administration of prednisone (0.18 mg/20 g BW) dissolved in 0.5 mL normal saline. All treatments lasted for 10 weeks. The mRNA and protein expressions of fractalkine and CX3CR1 in kidneys of mice were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting analysis respectively. The changes of laboratory index and the kidney histopathology of mice were also investigated. RESULTS:The mRNA and protein expressions of fractalkine and CX3CR1 in kidneys of BXSB mice were significantly higher than those in C57BL/6J mice. The expressions of fractalkine and CX3CR1 in BXSB-prednisone group of mice were much lower than those in BXSB group of mice,accompanied by the lower serum IgG,IgM and anti-dsDNA antibody levels as well as blood urea nitrogen,serum creatinine and urine protein. The glomerular immune complex deposition and the kidney histopathology were also significantly improved in BXSB-prednisone group of mice. CONCLUSION:These results indicate that fractalkine and CX3CR1 participate in the pathogenesis of lupus nephritis in BXSB mice,and the effect of glucocorticoids treatment may be attributed,in part,to its ability to inhibit the expression of fractalkine in kidney.

AIM: To investigate the role of infiltration of macrophages and expression of intracellular adhesion molecule-1 in the pathogenesis of oleic-acid-induced acute lung injury rats. METHODS: The rats were subjected to injection of oleic acid (oleic acid group) or saline solution (control). After injecting oleic acid or saline for 4 hours, the PaO 2 of the left heart, lung permeability index(LPI), the number of macrophage and the levels of soluble intercellular molecule-1 (sICAM-1) in the bronchial alveolar lavage fluid (BALF) were measured. The levels of expression of ICAM-1 mRNA were evaluated by in situ hybridization and the degree of macrophage infiltration and the expression of ICAM-1 were evaluated by double staining immunocytochemistry. RESULTS: The PaO 2 of the oleic acid group was significantly lower than that of the control group (P

AIM: To investigate the protective effect of anti-macrophage migration factor monoclonal antibody (anti-MIF MAb) on oleic-acid-induced acute lung injury (ALI) rats and its influence on the expression level of MIF and intercellular adhesion molecule-1(ICAM-1). METHODS: The rats were subjected to injection of oleic acid (oleic acid group) or saline solution (control group). One hours before administration of oleic acid, the rats were intraperitoneally injected with anti-MIF antibody (5 mg/kg) as the treatment group. After injecting oleic acid or saline for 4 hours, the PaO_2, lung permeability index (LPI), the number of macrophage and the level of soluble ICAM-1 (sICAM-1) in the bronchial alveolar lavage fluid (BALF) were measured. The expression level of MIF mRNA and ICAM-1 mRNA in the lung were detected by in situ hybridization, and the degree of macrophage infiltration and the expression of MIF were evaluated by double staining immunocytochemistry. RESULTS: The PaO_2 of the oleic acid group was far lower than those of the control and treatment group (P

With the advantages of displaying visceral organs intuitively,showing the operative procedure vividly,making and spreading videos conveniently in clinical teaching,electrobronchoscopy image system was adopted in clinical teaching of respiratory medicine to assist the traditional teaching method,to make up for the deficiencies of tradition method and to improve the learning effectiveness of respiratory medicine for medical students at internship.