Objective To explore the significance of negative expiratory pressure technique in detecting expiratory flow limitation in chronic obstructive pulmonary disease (COPD) patients. Methods Negative expiratory pressure technique was performed in 13 special COPD patients who did not accomplish routine pulmonary function tests. Results Negative expiratory pressure technique was executed successfully in 13 special COPD patients without any side-effects. Expiratory flow limitation was detected in 12 special COPD patients. 5-point expiratory flow limitation score was significantly correlated with Medical Research Council (MRC) dyspnea score, which was a predictor of dyspnea. Conclusions Negative expiratory pressure technique provides a test which is simple, rapid, noninvasive and does not require any initiative cooperation from the patients, it can be applied in special COPD patients who can not accomplish routine pulmonary function tests.

Objective To compare negative expiratory pressure (NEP)technique with conventional test in detecting expiratory flow limitation (EFL)in chronic obstructive pulmonary diseases( COPD) patients. Methods EFL was measured with NEP technique and conventional method respectively in 72 COPD patients;EFL was measured with NEP technique in 20 COPD patients who failed to perform conventional test. Results EFL was detected in 54 of the 72 COPD patients. NEP test was successfully performed on the 20 patients, and 19 of them were found with EFL. The level of forced expired volume in one second percentage( FEV_1 % ) of the patients with 2-score group (46. 92 ± 12. 74) % and 3-score group (33. 35 ± 8.96)% were significantly lower than that of the 1-score group(63. 60 ±16.65)%. Area under curve of NEP technique and conventional test in ROC is 0. 903 and 0. 761 respectively. Conclusions As compared with conventional test, EFL detected with NEP technique is more reliable in evaluating dyspnea of COPD patients. It is simple and doesn't require any cooperation of the patients. NEP technique can be applied in COPD patients who fail to receive conventional test.

Objective To explore the clinical significence of three alternative ways in assessing bronchodilator reversibility in patients with severe chronic obstructive pulmonary disease (COPD).Methods 18 clinically stable patients with severe COPD were collected. Pulmonary ventilation function and capacity of lung were measured after inhaling compound ipratropium bromide solution before and after nebulised saline, and at intervals. Expiratory flow limitation (EFL) was detected by negative expiratory pressure technique concurrently. Results Compared with placebo,bronchodilator caused a significant increase in forced expiratory volume in one second (FEV1)%Pred,forced vital capacity (FVC)%Pred and inspiratory capacity (IC)%Pred and a significant decrease in residual volume (RV)%Pred, functional residual capacity (FRC)% Pred and Borg scale. But there were no changes in total lung capacity (TLC)% Pred, 5-point EFL score and breathing pattern variables. The increase of IC was correlated with the reduction of Borg scale, but such correlation did not exist between the increase of FEV1 and the reduction of Borg scale. When ROC curve was applied to assess the significance of IC, 5-point EFL score and FEV1 in evaluating the effects of broncholilator,the area under curve (AUC) of which was 0. 868,0. 681 and 0. 557 respectively.Conclusions Compared with FEV1, IC has higher sensitivity and reliability to evaluate the clinical response of bronchodilator in patients with severe COPD. The 5-point EFL score is not an appropriate measurement of acute bronchodilator response.

BACKGROUND:To ensure the catheter position is very important for interventional catheters. In emergency, rapid and accurate catheter insertion is required. Ultrasound can real-time track the movement of catheters in vivo. It is safe to patient, which has exhibited a bright future in catheter placement. OBJECTIVE: To compare the current methods for improving ultrasonic localization methods and to prospect the future development and improvement of real-time ultrasonic localization of catheters in vivo. METHODS: Literature search was carried out based on PubMed (1990-01/2015-04) and Espacenet with the key words of catheter, ultrasonic guidance, ultrasound localization, enhanced localization for the initial retrieval of relevant articles. RESULTS AND CONCLUSION:To improve the image quality and increase the accuracy of catheter placement by ultrasound, recent efforts have been focused on two paths. One is to improve the resolution of ultrasonic images by enhancing ultrasound equipment or ultrasonic guidance system. The other is to modify catheter itself to obtain high acoustic impedance differential and improve its echogenicity. The latter approach can be potentialy applied in al kinds of catheters and is more economical and practical. Therefore, in future researches, innovation and design of catheter materials for catheter fabricating wil play an important role in promoting the real-time ultrasonic localization of catheters.

Objective To study the expression of apolipoprotein H (ApoH) in childhood primary nephrotic syndrome (PNS) and to discuss its role in PNS. Methods Immunohistochemistry staining and real-time quantitative polymerase chain reaction(RT-PCR) were performed to evaluate the expression of ApoH in renal tissues of 78 patients with PNS and 14 cases of normal controls. Serum albumin, serum lipid, proteinuria and urinary retinol binding protein (RBP) were tested before renal biopsy in all patients. Tubulointerstitial lesions were investigated. Results (l)There was positive expression of ApoH in renal tissues of PNS patients and normal controls,mainly in the proximal tubules by immunohistochemistry staining. ApoH mRNA was also shown in all renal tissues by RT-PCR. ApoH protein expression was positively correlaed with its mRNA expression(r=0.264, P 0.05) whereas these data displayed no significant difference between two groups. Above expression in mesangial proliferative glomerulonephritis (MsPGN) and focal segmental glomersclerosis (FSGS) down-regulated significantly (3.30?0.28,2.82?0.36, and 10.13?3.09,10.12?1.02, respectively), as compared to those in MCNS,MN and the controls, P

Objective To evaluate the reproducibility of Negative Expiratory Pressure(NEP)technique in detecting expiratory flow limitation (EFL) on chronic obstructive pulmonary disease (COPD) patients. Methods EFL was evaluated with NEP technique in 72 subjects having stable COPD on two occasions. Agreement between testing occasions was assessed with the κ statistic for the 3-point and 5-point EFL scores, and with paired t-test for FL index. Results On the first testing occasion, 18 subjects had no EFL, 18 subjects had EFL in the supine position, and 36 subjects in the sitting and the supine position. Using the 3-point score, agreement was present in 58 of the 72 subjects at time 2 (κ =0.69, P＜0.001 ), indicating a substantial agreement was found. Using the 5-point score, agreement was seen in 52 of the 72 subjects (κ =0.65, P＜0.001 ), also indicating a substantial agreement. The difference of FL index between the first and the second occasion was significant in both the sitting (P＜0.05) and supine (P＜0.05) positions. Conclusion Both 3-point and 5-point scores provided a reproducible assessment of EFL on COPD patients but the FL index seemed less reproducible. More research were needed before NEP technique was promoted to be used clinically.

Objective:To evaluate the effect of paclitaxel on the mast cell-CCL2-macrophage axis in rats with pulmonary hypertension.Methods:Thirty SPF-grade healthy male Sprague-Dawley rats, aged 8-10 weeks, weighing 180-220 g, were divided into 3 groups ( n=10 each) using a random number table method: control group (group C), pulmonary hypertension group (group PH), and paclitaxel group (group PTX). The model of pulmonary hypertension was established by subcutaneous injection of monocrotaline 60 mg/kg in rats.At 25 days after establishing the models, paclitaxel 2 mg/kg was injected via the tail vein once every four days, for 4 times in total in group PTX.The equal volume of normal saline was injected in the remaining 2 groups.The mean pulmonary artery pressure (mPAP) was performed at 40 days after establishing the model.The heart was removed and dried, the right ventricle (RV) and left ventricle plus ventricular septum (LV+ S) was weighed, and the Fulton index [RV/(LV+ S)] was calculated.The inferior lobe of left lung was taken, the ratio of media wall thickness of pulmonary vessels was calculated by HE staining, the number of Tryptase + , CD68 + , CD163 + , and Ki67 + cells was recorded by immunohistochemistry, the mean value was calculated, the percentage of Ki67-positive cells in blood vessels was recorded, and the proportion of muscularized blood vessels was calculated.The content of CCL2 was measured by enzyme-linked immunosorbent assay, and the expression of cleaved caspase-3 and Cyclin D1 was detected by Western blot. Results:Compared with group C, the mPAP, Fulton index, ratio of media wall thickness, proportion of muscularized blood vessels, the number of Tryptase + , CD68 + and CD163 + cells and percentage of Ki67 + cells were significantly increased, and the expression of cleaved caspase-3 was down-regulated in PH and PTX groups ( P<0.05), the expression of Cyclin D1 was significantly up-regulated in group PH ( P<0.05), and no significant change was found in group PTX ( P>0.05). Compared with group PH, the mPAP, Fulton index, ratio of media wall thickness, percentage of muscularized blood vessels, the number of Tryptase + , CD68 + and CD163 + cells and percentage of Ki67 + cells were significantly decreased, the expression of CCL2 and Cyclin D1 was down-regulated, and the expression of cleaved caspase-3 was up-regulated in group PTX ( P<0.05). Conclusion:The mechanism by which paclitaxel alleviates pulmonary hypertension is related to inhibiting the mast cell-CCL2-macrophage axis in rats.

Objective To evaluate the diagnostic value of MRI in brachial plexus injury.Methods Total 98 patients with brachial plexus injury were examined by MRI before operation.Fifty-four of 98 patients MR imaging were obtained by 0.5 Tesla scanner and other 44 patients were obtained by 1.5 Tesla scanner.The scanning sequences include: SE T_1WI,T_2WI,FFE T_2WI and T_2WI SPIR. Exploration of the supraclavicular plexus was carried out and the MR imaging were compared with the operative finding in 63 patients.Thirty-five patients who had not surgery were followed-up.Results MR imaging found pre-ganglionic injuries in 45 patients and post-ganglionic injuries in 56 patients.Pre-and post-ganglionic injuries simultaneously in 16 patients among them.MR imaging can not find injury sings in 13 patients.The positive rate was 86.73%.MR imaging finding of pre-ganglionic injuries include:(1) Spinal cord edema and hemorrhage,2 patients (4.44% ).(2)Displacement of spinal cord,17 patients (37.78%).(3)Traumatic meningoceles,37 patients (82.22%).(4)Absence of roots in spinal canal, 25 patients(55.56% ).(5)Scarring in the spinal cnanl,24 patients (53.33%).(6)Denervation of erector spine,13 patients (28.89%).MR imaging finding of post-ganglionic injuries include:(1)Trunk thickening with hypointensities in T_2WI,23 patients (41.07%).(2)Nerve trunk complete loss of continuity with disappeared of nerve structure,16 patients (28.57%).(3)Continuity of nerve trunk was well with disappearance of nerve structure,14 patients(25.00%).(4)Traumatic neurofibroma,3 patients (5.36%).Conclusion MR imaging can reveal Pre-and post-ganglionic injuries of brachial plexus simultaneously.MR imaging is able to determine the location (pre-or post-ganglionic)and extent of brachial plexus injury,provided important information for treatment method selection.

Objective To improve recognition and imaging diagnosis of aneurysmal bone cyst secondary to a giant cell tumor.Methods To collect the dates of 12 patients with aneurysmal bone cyst secondary to a giant cell tumor were proved by operation and pathology from January 2003 to October 2006. Analyzed and summarized their imaging manifestations and correlation with pathohistology.Results Six lesions were located in epiphysis and metaphysic regions of long bone.Six lesions were located in pelvis.All cases showed a cystic lesion with expanded and osteolytic,eccentric 10 cases and centric 2 cases.Four cases display trabeculate,the margin is well define with a rim of bone sclerosis in 2 cases.Magnetic resonance imaging(MRI)scans were available in 10 patients.All case showed cystic,dilated lesions with solid areas. Eight cases manifested single or multitude solid nodules in big cystic wall.Two cases appeared solid masses with multitude cysts.The sign of multitude fluid-fluid level,best seen on T_2-weighted images,was present in all patients.Seven cases emerged soft-tissue masses.MR found indicative of large amounts of hemosiderin in one cases.Eight cases were examined by spiral CT with plain scanning and enhancement scanning. Reconstructed image were CTA and 3D-MPR(three dimensions multiplanar reconstruction)imaging.All cases showed cystic,dilated lesions with solid areas.The sign of multitude fluid-fluid level was present in 6 patients.The solid areas and cystic-wall of lesions showed contrast enhancement in 8 patients.3D-MPR imaging showed supply blood vessel of tumors in 3 cases.Arteriovenous malformation did not found in all patients.The surgeons'operative findings and the gross specimens were studied in all patients.All lesions were composed of solid areas and cystic areas.The diagnosis of pathology were ABC with GCT(grade Ⅱ)in 10 cases and ABC with GCT(grade Ⅲ).Conclusion Aneurysmai bone cyst secondary to a giant cell tumor is not rare.Adequately recognizing the pathologic basis of ABC,and selecting imaging techniques correctly (X-ray and MRI,or X-ray and CT)is especially important to diagnose a giant-cell tumor with secondary aneurysmai bone cyst.When an eccentric,expanded,lytic tumor with a cystic-solid lesion in epiphysis of long bone or pelvis shows multiple fluid levels,a giant-cell tumor with secondary aneurysmai bone cyst components should be sufficiently considered.

Epidemiological and animal studies indicate that pre-existing diabetes increases the risk of Parkinson's disease(PD).However,the mechanisms underlying this association remain unclear.In the present study,we found that high glucose(HG)levels in the cerebrospinal fluid(CSF)of diabetic rats might enhance the effect of a subthreshold dose of the neurotoxin 6-hydroxydopamine(6-OHDA)on the development of motor disorders,and the damage to the nigrostriatal dopaminergic neuronal pathway.In vitro,HG promoted the 6-OHDA-induced apoptosis in PC12 cells differentiated to neurons with nerve growth factor(NGF)(NGF-PC12).Metabolomics showed that HG promoted hyperglycolysis in neurons and impaired tricarboxylic acid cycle(TCA cycle)activity,which was closely related to abnormal mito-chondrial fusion,thus resulting in mitochondrial loss.Interestingly,HG-induced upregulation of pyruvate kinase M2(PKM2)combined with 6-OHDA exposure not only mediated glycolysis but also promoted abnormal mitochondrial fusion by upregulating the expression of MFN2 in NGF-PC12 cells.In addition,we found that PKM2 knockdown rescued the abnormal mitochondrial fusion and cell apoptosis induced by HG+6-OHDA.Furthermore,we found that shikonin(SK),an inhibitor of PKM2,restored the mito-chondrial number,promoted TCA cycle activity,reversed hyperglycolysis,enhanced the tolerance of cultured neurons to 6-OHDA,and reduced the risk of PD in diabetic rats.Overall,our results indicate that diabetes promotes hyperglycolysis and abnormal mitochondrial fusion in neurons through the upre-gulation of PKM2,leading to an increase in the vulnerability of dopaminergic neurons to 6-OHDA.Thus,the inhibition of PKM2 and restoration of mitochondrial metabolic homeostasis/pathways may prevent the occurrence and development of diabetic PD.