Objective To observe sputum cytology counts, the levels of nerve growth factor (NGF) and IL-4 in cough variant asthma (CVA) patients and the change of their levels after using glucocorticoids combined with β2-adrenergic agonists one month, and to investigate CVA's characteristics of airway inflammation. Methods Totally 36 patients with untreated CVA were selected, as well as 23 healthy controls. Coughed up sputum cells were obtained and HE strained for differential cell counting in each enrolled patient. In induced sputum's supernatant, the levels of NGF and IL-4 were determined by ELISA.Results Before treatment, CVA patients had a median eosinophils (EOS) percentage of 8%, which was significantly higher than that after treatment (2%, P＜0.05) and in healthy control group (1%, P＜0. 001). The levels of NGF and IL-4 in induced sputum of CVA group were (9. 50 ± 1.69) ng/L and (257.37 ± 53.57) ng/L. After treatment, they were (8.78±1.02) ng/L and (228.60 ±52.93)ng/L in CVA group, (6.98±0.69) ng/L and (166.44±24.75) ng/L in healthy control group. The levels of NGF and IL-4 before and after treatment in the CVA group , as compared with the healthy control group, had statistically significant differences (all P＜0.001). In CVA group before and after treatment, the level of NGF and IL-4 paired difference was significant (P＜0.001). The percentage of induced sputum EOS correlated with sputum supernatant concentrations of NGF and IL-4 (P ＜ 0.01). In induced sputum supernatant, the concentrations of NGF and IL-4 were significant correlated (P＜0.01). Conclusions Glucocorticoid joint long-term β2 agonist inhaled treatment significantly reduced NGF, IL-4 and EOS levels and reduced eosinophilic inflammation, which are closely related with the nerve-immune mechanism, NGF as well as IL-4 participated the inflammation. Induced sputum examination is non-invasive, economical,simple, easily accepted by patients, and repeatable, widely used in clinical.

Objective Analysis the treatment and management of thirty-six out-patients of asthma,in order to share the new experience in the implementation of the strategy.Methods Janaury 2007 36 newly diagnosed or diagnosed bronchial asthma patients in Department of Respiratory Medicine,the first affiliated hospital of China Medical University inhaled budesonide/formoterol dry powder inhalation treatment.Clinical symptoms,rescue medication,lung function and assessment questionnaire score of Asthma Control Test(ACT),Asthma Control Questionnaire(ACQ)were investigated during six months.Results After 6 months' thearopy,the majority of patients showed significant improvement.symptoms and signs got Marked improvement,indicators related to lung function increased in different degrees than before,ACQ score showed a downward trend,with the ease and alleviate symptoms of drug use reduction agreement,ACT score and an upward trend that the condition persistly revived.Conclusion When doctors institut eindividual treatment programme to patients with asthma,they should help patients learn to self-management,so as to make for the condition continued revived and long-term controlled.

Bronchial asthma is defined as a chronic inflammatory airway disease in response to a wide variety of provoking stimuli.Over 200 million people in the world are affected with asthma.Because the incidence of asthma appears to be increasing,the importance of proper perioperative management of persons with asthma will also continue to increase.Patients with asthma are thought to be at high risk for pulmonary complications to develop during the perioperative period,and these complications may lead to serious morbidity.So it is very important to control asthma,to prevent and treat pulmonary complications for increasing operational success rate.

Objective To constitute a correlation with the subjective indicators by investigation of the causes and clinical features in patients with chronic cough.Methods Totally 100 patients with chronic cough were recruited followed a diagnostic program.Airway responsiveness[by methacholine challenge test (MCT)],Leicester cough questionnaire(LCQ),visual analogue scale(VAS),cough score,age,gender and disease duration were all recorded for analysis.Results The top five causes of chronic cough in these patients were variant asthma,post infectious cough,atopic cough,eosinophilic bronchitis and upper airway cough syndrome.LCQ total score was negatively correlated with age and the VAS score(r=-0.239 and -0.470 respectively,all P<0.05),while no difference was found among patients with different causes of disease or gender(F=1.233,t=1.918,all P>0.05)and no correlation was found with BMI(r=-0.029,P>0.05).The physiological and psychological field score in female patients significantly reduced(t=2.174,1.990,P<0.05),and LCQ total score of MCT positive patients obviously reduced than negative ones(t=-2.22,P<0.05).After the treatment of two weeks,LCQ three component field and total score could be improved significantly(all P<0.01).Conclusion Gender and age may have some impact on the quality of life in patients with chronic cough.LCQ,VAS and cough score should be used to assess cough severity and evaluate therapeutic effect in patients with chronic cough.

Objective To investigate the prevalence of occupational asthma,airway inflammation and analyze the risk factors for workers exposed to isocyanates.Methods A cross-sectional study was applied.Totally 429 isocyanates exposed workers were surveyed and the prevalence of occupational asthma and airway inflammation situation were examined by questionnaire,physical examination and laboratory tests.Multivariate logistic regression was applied to analyze the possible risk factors of isocyanate-induced occupational asthma.Results (1) A total of 366 patients with complete data were included in the study,and finally 11 cases were diagnosed as isocyanate-induced occupational asthma with a prevalence of 3.0％.(2) Neutrophil percentage in the induced sputum of occupational asthma increased significantly [42.00％ (34.00％-55.00％) before work and 59.00％ (51.00％-70.00％) after work (Z =-2.940.P ＜ 0.05)].(3) Length of service (OR =3.096,P =0.025) and rhinitis (OR =1.901,P =0.008) were independent dangerous factors,and protective measures (OR =0.074,P =0.015) was protective factors to isocyanateinduced occupational asthma.Conclusions Neutrophilic inflammation can be triggered by isocyanate exposure.Regular health examinations,effective protective measures can reduce the prevalence of isocyanateinduced occupational asthma.

Objective To investigate the therapeutic effects of givinostat , a histone deacetylase inhibitor (HDACI), on the development of chronic asthma with airway inflammation , airway remodeling and airway hyperresponsiveness ( AHR) .Methods BALB/C mice were randomly divided into control group , asthma group, dexamethasone group and givinostat group (n=12 per group).AHR was assessed.Total cell numbers and differential counts , interleukin-4 ( IL-4 ) , interleukin-5 ( IL-5 ) and interferon-γ( IFNγ) levels in the bronchoalveolar lavage fluid ( BALF) were measured in the above 4 groups.The pathology of lung tissue was evaluated .Immunohistochemical ( IHC) staining and Western blot were used to detect αsmooth muscle actin(α-SMA) and transforming growth factor-β1(TGFβ1).Results Compared with the asthma only group, givinostat treatment relieved airway resistance (2.96 ±1.01 vs 6.50 ±0.79,P<0.05).Total inflammatory cells [(33.04 ±5.62) ×104/ml vs (98.04 ±9.27) ×104/ml,P<0.01], eosinophil cells [(9.17 ±2.33) ×104/ml vs(37.64 ±6.98) ×104/ml, P <0.01], IL-4 [(10.12 ±2.98)ng/ml vs (16.88 ±2.78)ng/ml,P<0.05] and IL-5 [(27.09 ±3.62)ng/ml vs (37.86 ±7.34)ng/ml, P<0.05] levels were all reduced in givinostat group , while IFNγ[ ( 91.86 ±23.73 ) pg/ml vs ( 60.49 ±11.88 ) pg/ml, P>0.05] was enhanced in BALF.Inflammatory cell infiltration around the airway was reduced , with decreased inflammatory cell score [(1.60 ±0.69) points vs (3.40 ±0.68) points, P <0.01] and inflammatory cell number (111.65 ±31.41 vs 601.25 ±186.85, P<0.01).The goblet cell metaplasia [(26.36 ±2.33)%vs (57.21 ±11.56)%] and collagen deposition area [(52.77 ±7.58)μm2/μm vs (111.81 ±12.40)μm2/μm] were obviously reduced (P<0.01).The expressions of α-SMA and TGFβ1 in the lung tissue were both significantly decreased ( P<0.01 ) .Conclusion Givinostat treatment can reduce airway inflammation , airway remodeling and airway hyperresponsiveness in chronic asthma .Its effect is comparable to that of glucocorticoid hormone treatment .

Objective To study the prevalence and characteristics of gastroesophageal reflux disease (GERD) in patients with idiopathic pulmonary fibrosis(IPF).Methods A total of 48 patients with diffuse parenchymal lung disease(DPLD) including 25 IPF and 23 other DPLD were enrolled from Department of Respiratory Disease in the First Affiliated Hospital of China Medical University.All patients were subjected to 24-hour esophageal pH monitoring.Pulmonary function test and HRCT of lung were performed at the same time.Results The prevalence of GERD in IPF patients was 64.0％,which was significantly higher than that in other DPLD patients.DeMeester scores were significantly higher in IPF patients than those in non-IPF group[(22.8 ± 21.5) score vs (15.7 ± 14.0) score respectively P ＜ 0.05].Numbers of reflux longer than 5 minutes [(3.8 ± 4.1) time vs (2.1 ± 2.1) time respectively) and reflux index (1.8 ± 1.7 vs 1.3 ± 1.2) in IPF group were higher than those in non-IPF group,yet without statistical significance.Patients with IPF had significantly higher values of following parameters than those in non-IPF patients including percentage of total reflux time(pH ＜ 4.0) (9.2 ± 5.1) ％,percentage of upright reflux time (8.5 ± 5.2) ％,percentage of supine reflux time (10.8 ± 10.7) ％,numbers of reflux (54.2 ± 22.7) time,numbers of regurgitation longer than 5 minutes (6.3 ± 4.2) time,thelongest reflux time (14.5 ± 15.3) min,reflux index 2.5 ± 1.7 and DeMeester scores (34.9 ± 20.3) time (P ＜ 0.05).DeMeester score was positively correlated with gastroesophageal reflux diseases questionnaire (GerdQ) score (r =0.667,P ＜ 0.01).The prevalence of typical GERD sympotoms in the IPF-GERD patients was higher (heartburn 7/16,regurgitation 6/16) than that in IPF patients without GERD (heartburn 2/9,regurgitation 1/9).Conclusion Patients with IPF have a high prevalence of GERD,but usually without typical GERD symptoms.In the hospitals 24-hour esophageal pH monitoring not available,GerdQ can be used to identify GERD in IPF patients.

Purpose To study the clinic-pathological features, differential diagnosis and prognosis of extragastrointestinal stromal tumor ( EGIST) arising in the vulva and the rectovaginal septum. Methods Clinical manifestations, pathological features, immunohisto-chemistry, gene mutations, treatment and prognosis were analyzed in 1 case of EGIST arising in the vulva and 2 cases of EGIST arising in the rectovaginal septum with review of related literature. Results Case 1 was a 59-years-old woman who was found to have a 4. 4 cm × 3 cm × 3 cm recurrent mass in the right vulva after 6 months of the first resection. Case 2 was a 58-years-old woman who presen-ted with a 7. 3 cm × 6. 1 cm × 4. 6 cm mass in the rectovaginal septum. Case 3 was a 41-year-old woman who presented with an 8. 6 cm × 7. 4 cm × 6. 7 cm mass in the rectovaginal septum. Histologically, the uniform spindle cells showed the interlacing fascicular, whirl-pool and palisade patterns with high cellular density. Mitotic figures were readily identified. Immunohistochemical evaluation revealed that the tumor cells exhibited strong and diffuse staining for CD117, CD34, NES, H-Caldesmon and DOG-1. Molecular analysis showed the gene mutation of c-Kit exon 11 in all 3 cases. Conclusion EGIST should be considered in the differential diagnosis of the mesenchymal tumors arising in the vulva and the rectovaginal septum. The immunohistochemical evaluation and molecular genetic tes-ting are crucial tools for the differential diagnosis and assessment of the prognosis and targeted therapy of EGIST.

AIM: To investigate relationship between activity of matrix metalloproteinases - 2 ( MMP - 2, 72 kD) and invasion, metastasis of breast cancer. METHODS: Useing zymography and computer software assisted analysis, the activitive levels of MMP- 2 (72 kD) in tissues from breast cancer were measeured. RESULTS: Mean activitive levels of MMP- 272 kD (13.93 + 3.60) in breast cancer were lower than those in benign disease (21.43 + 8.31), P < 0.05. There was no difference (P > 0.05) in MMP - 2 62 kD + 72 kD of benign and malignant dis ease, but MMP - 262 kD ( 13.83 + 4.53) and MMP - 262 kD/62 kD + 72 kD (0.48) respectively were significantly higher in malignant disease (P < 0.01). It was also found that MMP- 262 kD/62 kD + 72 kD were apparently higher in invasive carcinomas (0.48) and lymph node metastases (0.61), P < 0.01, respectively. CONCLUSION: These results demonstrated that a clear relationship between MMP - 2 activity and the invasion and metastasis of breast carcinoma.