Objective To analyze the plasma procalcitonin (PCT) as a predictor of the severity of community acquired pneumonia (CAP) in elderly patients.Methods Totally 90 elderly patients hospitalized with community acquired pneumonia from 2010 to 2011 were analyzed retrospectively for the relation between plasma procalcitonin and severity of pneumonia.All cases were divided into two groups,the severe group (n=36) and the non-severe group (n=54) according to diagnostic criteria.Results The level of plasma PCT was much lower in the severe group (median 2.44 μg/L) than that in the non-severe group (median 0.11 μg/L) (U=335.50,P=0.000).Among all patients,when PCT was lower than 0.5 μg/L,the incidence of non-severe CAP was 76％,however,when PCT was equal or above 2.0 μg/L,the incidence of non-severe CAP was reduced to 9％.In Binary logistic regression analysis,PCT was a risk factor of aged person with severe community acquired pneumonia independent of age and CRUB-65 scores [OR =1.328 (95 ％ confidential interval:1.072,1.645)].PCT had a positive correlation with CRUB-65 scores (U=10.162,P=0.006).In all cases,the patients who improved well had lower PCT value than the remaining (median 0.21 μg/L,17.0μg/L; U=10.000,P=0.000),which also happened in severe cases (median 1.47 μg/L,17.0 μg/L;U=8.000,P=0.000).The area under the receiver operating characteristic curve was 0.872 (95％ confidential interval:0.741,0.914).At a PCT cut-off level of greater than or equal to 2.0 μg/L,the sensitivity and specificity to predict the severity of aged person with CAP was 55.6％ and 98.9％ respectively.Conclusions Plasma PCT may be a good predictor to evaluate the severity of CAP in elderly patients.

ObjectiveTo investigate changes of the cellular immune function in the elderly patients with nonsmall-cell lung cancer (NSCLC) after chemotherapy.Methods T-lymphocyte subsets and natural killer cell were detected in 29 elderly patients with NSCLC,20 adults with NSCLC and 22 healthy elderly,and their levels were compared between pre-chemotherapy and at the end of 2 cycles of chemotherapy in the elderly patients with NSCLC.ResultsThe levels of CD3,CD4,CD8,CD4/CD8andNK cell were (58.9±15.8),(32.3±12.7),(22.0±9.8),(1.3±0.7),(21.6± 7.7),respectively in the elderly patients with NSCLC,(65.9 ± 7.2),(38.5 ± 7.6),(23.1 ± 9.2),(1.5±0.7),(16.8±6.2),respectively in adults with NSCLC and (67.3±9.0),(39.0±7.8),(23.9±9.3),(2.0±1.6),(22.5±5.8),respectively in healthy elderly.The levels of CD3 and CD4 were decreased (t=2.109,2.159,P＜0.05) and NK cell was increased (t=2.273,P＜0.05) while CD8 and CD4/CD8 had no difference(t = 0.406,0.736,P＞ 0.05 ) in the elderly patients with NSCLC as compared with adults with NSCLC.The levels of CD3,CD4,and CD4/CD8 were lower (t = 2.234,2.200,2.016,all P＜ 0.05) in elderly patients with NSCLC than in healthy elderly,with no significant change in the levels of CD8 and NK cell(t= 0.700,0.474,P＞0.05) between the two groups.The levels of CD3 (51.6 ±10.3)was reduced(t=2.067,P＜0.05) and CD4 (31.7 ± 11.7),CD8(21.6 ± 6.5),CD4/CD8 (1.3 ± 0.7),NK cell (26.0 ±12.7)had no remarkable difference (t =0.186,0.180,0.289,1.570,all P＞ 0.05)after chemotherapy in elderly patients with NSCLC.ConclusionsThe cellular immune function in the elderly patients with NSCLC is lower than in adults with NSCLC and healthy elderly,and further decreases after chemotherapy.

Objective To explore the difference of the clinical manifestations between the elderly and non-elderly patients with non-massive pulmonary thromboembolism (PTE) and the significance of D-dimer in the diagnosis of PTE and its dynamic change after anticoagulant therapy.Methods The clinical manifestations of 83 cases with PTE were retrospectively analysed and divided into two groups:39 elderly and 44 non-elderly.The dynamic changing of D-dimer content was determined by immunoturbidimetry(ITM) method before and 3 d after anticoagulant therapy in the two groups.Results There were no significant statistical differences in the incidence of the main symptoms:dyspnea,cough,emptysis,syncope,palpitations between the elderly and the non-elderly (x2 =2.74,0.06,0.10,0.49,0.01,P＞0.05) except for the incidence of chest pain [14 cases (35.9 ％) vs.30 cases (68.2 ％),x2 =4.95,P ＜ 0.05].No differences were found in the the main signs:shortness of breath,tachycardia,accentuation or split of second pulmonary valve sound,cyanosis,and engorgement of neck veins between the two groups (x2 =2.60,0.03,0.61,0.06,0.33,0.11,P＞0.05).D-dimer content was lower in the elderly than in the non-elderly [(1.89±1.21) mg/L vs.(4.93±3.88) mg/L,Z=-2.55,P=0.01] before anticoagulant therapy.But there was no difference in D -dimer content between the two groups 3 d after anticoagulant therapy [( 1.28 ±1.11) mg/L vs.(2.09±2.22) mg/L,Z=-7.07,P=0.50].The decreasing level of D-dimer was less prominent in the elderly than in the non-elderly [(0.61±1.01) mg/Lvs.(2.84±2.95) mg/L,Z=-3.54,P=0.001].Conclusions The main clinical manifestations are similar between the elderly and non-elderly with non-massive PTE,but the incidence of chest pain is less in the elderly than in the non-elderly.The content of D-dimer is lower in the elderly than non-elderly after PTE and its decrements are less prominent in the elderly than the non-elderly after anticoagulant therapy.

Objective To investigate the cellular immune function changes and the effect of thymosin alpha-1 on the changes in elderly patients with severe pneumonia. Methods T cell subset and natural killer (NK) cell were detected in 66 elderly patients with severe pneumonia and 34 elderly patients with common pneumonia. The severe pneumonia patients were randomly divided into 2 groups: the treatment groups (34 cases) and the control group (32 cases). All patients received conventional therapy of pneumonia. The treatment group received 1.6 mg of thymosin alpha-1 through subcutaneous injection once a day for a week and twice a week later. Results The levels of CD3, CD4, CD8 and NK cell were lower in elderly patients with severe pneumonia than in patients with common pneumonia [(43.54%±18.97%) vs. (45.46%±10.43%), (25.43%±12.72%) vs. (38.47%±8.20%), (16.68%±9.30%) vs. (22.36%±8.06%), (13.52%±4.66%) vs. (17.87%±7.11%), t=-6.779、-5.85、-3.161、-3.285 respectively all P＜0.05]. The levels of CD3, CD4, CD4/CD8 and NK cell increased significantly after treatment in treatment group [(64.22%±5.53%) vs. (61.53%±13.41%), (31.70%±4.38%) vs. (26.07%±4.31%), (1.27%±0.91%) vs. (0.97%±0.22%), (17.67%±4.56%) vs. (15.44%±3.82%), F=5.591,11.526,8.934,4.564 respectively, all P＜0.05]. The duration of antibiotic injection and length of stay were lower in treatment group than in control group [(14.17±2.51) d vs. (14.42±2.79) d, (12.69±2.80) d vs. (15.04±3.58) d, t=-3.152、-2.690 respectively, all P＜0.05]. Conclusions The immune function of the elderly patients with severe pneumonia is lower. Thymosin alpha-1 can improve the immune function of the elder patients with severe pneumonia and is helpful for controlling an infection.

Objective:To investigate the effects of microRNA(miR)-133b on epithelial-mesenchymal transition(EM)of human small airway epithelial cells induced by cigarette smoke extracts(CSE)and its regulatory mechanisms.Methods:The miR-expression profiles with microarray in airway epithelial cells of patients with chronic obstructive pulmonary disease were searched in the Gene Expression Omnibus(GEO)database, and the differentially expressed miRs were searched and verified by a real-time fluorescence quantitative method(qRT-PCR). Human small airway epithelial cells(HSAEpiC)were divided into the control group, the CSE group, the CSE+ miR-133b inhibitor transfection group(inhibitor group)and the CSE+ miR-133b inhibitor negative control transfection group(inhibitor control group)according to different intervention methods.Levels of miR-133b and mRNA levels of transforming growth factor(TGF)-β1, Smad2, E-cadherin and vimentin were detected by RT-PCR; Protein levels of E-cadherin and vimentin were detected by enzyme-linked immunosorbent assays(ELISA)and Western blotting.Results:Nine differentially expressed miRs were found in GSE53519, with miR-133b showing the most significant differential in thee HSAEpiC cell model after verification.CSE induced morphological changes in HSAEpiC cells, and miR-133b inhibitors could partially reverse the morphological changes in cell mode.mRNA and protein expressions of E-cadherin were decreased and expression of Vimentin mRNA and protein were increared in CSE induced HSAEpiC cells( F=9.09、12.35、7.57、101.87, P=0.015、0.007、0.023、0.000); miR-133b inhibitors partally reversed the mRNA and protein expressions of E-cadherin and Vimentin( F=40.59、27.74、15.87、20.42, P=0.000、0.001、0.004、0.002). CSE induced incresed expression of TGF-β1 mRNA and Smad mRNA in HSAEpiC cells, and miR-133b inhibitors partially reversed the changes in TGF-β1 mRNA and Smad mRNA( F=17.25、64.15, P=0.003、0.000). Conclusions:miR-133b may regulate CSE-related HSAEpiC cell EMT through the TGF-β1/Smad pathway.