Objective To observe the effect of atropine and N-nitro-L-arginine methyl ester (L-NAME) on the pressure of lower esophageal sphincter (LESP) regulated by electro-acupuncturing (EA) at Zusanli acupoint (He-Sea, st 36) of stomach meridian and explore the neural mechanism of EA. Methods Forty-eight rats were divided into six groups:control group, EA group, atropine group, atropine+EA group, L-NAME group and L-NAME+EA group. LESP was observed and recorded by using three-channel perfusion manometric measurement system. Results LESP increased significantly under or after EA at Zusanli acupoint. Cholinergic M receptor blocker partly abolished the influence of EA on LESP, but EA could restore the decreased pressure of cholinergic M receptor blocked rats. Nitric oxide synthase (NOS) inhibitor increased LESP, and EA could make it higher. Conclusions The main efferent pathway of regulating effect of EA at Zusanli acupoint on LESP is via the chlinergic nerve of vagus, and other mechanism possibly exits.

Objective To improve the diagnosis and treatment of pulmonary cryptococcosis.Methods The clinical data of 3 cases of pulmonary cryptococcosis were analyzed and reviewed.Results The cases were tested by percutaneous lung biopsy and were confirmed by histopathologic examination.The sputum cultures were negative and serum latex cryptococcal antigen agglutination tests were positive.Two of them had mild to moderate symptoms and were treated by fluconazol;the other with meningitis had severe symptoms and was treated by amphotericin B.All of them were clinically cured.Conclusion Percutaneous lung biopsy combined with latex cryptococcal antigen agglutination tests is helpful for diagnosis of pulmonary cryptococcosis.Patients with mild to moderate symptoms should be firstly treated by fluconazol and those with severe symptoms or meningitis,by amphotericin B.

SUMMARY Marginal zone B-cell lymphoma of the pulmonary mucosa-associated lymphoid tissue type (pulmonary MALT-MZL), a common kind of primary pulmonary lymphoma, is rare in pulmonary malignant tumors. One patient in our hospital was diagnosed by bronchoscope and the literatures on the subject were reviewed. The patient presented with periodical fever, cough and chest pain, and antibiotic therapy had no use. Chest CT scan showed the consolidation of right middle lobe and left lower lobe with CT angiogram signs, air bronchograms and distended bronchi. Pleural effusion in the left thorax mainly consisted of monocytes. Monoclonal protein was found in the electrophoresis of serum protein. Bronchial stenosis and swollen mucosa were seen with bronchoscope. The tissue section of transbronchial lung biopsy (TBLB) specimens showed diffusedly infiltrated small lymphocytes and a lymphoepithelial lesion. CD20 was positive and CD3, CD5, CD10, CD21, CD23, bcl2, bcl6 were negative in immunohistochemical stain. The clinical manifestations of pulmonary MALT-MZL are nonspecific and misdiagnosis is common, Appropriate invasive biopsy procedures are necessary for early diagnosis. Presentations such as periodical fever, distended bronchi in pulmonary consolidation, monoclonal protein might indicate diagnosis. Treatment includes surgical resection, radiotherapy and chemotherapy. Pulmonary MALT-MZL belongs to inert lymphoma and prognosis is relatively good.

To investigate the clinical characteristics, diagnosis and therapy of influenza pneumonia with staphylococcal infection. One patient in our hospital was diagnosed and the literatures on the subject were reviewed. The patient presented with high fever and dyspnea. Arterial gas analysis indicated type 1 respiratory failure. Chest X ray photographs showed bilateral infiltrations and bilatera encapsulated pleural effusions. Viral separation and culture of pharyngeal swab indicated H3N2 subtype of human influenza virus. Blood, sputum and bronchoalveolar lavage fluid (BALF) cultures showed Staphylococcus aureus. Pleural effusion was complex parapneumonic pleural effusion. After the administration of anti-virus, anti-staphylococcal antibiotics and pleural cavity drainage, the patient was cured. The infection of staphylococcus aureus is a typical characteristic of influenza pneumonia, and anti-staphylococcal antibiotic therapy (with MRSA activity in MRSA endemic regions) should be initiated in hospitalized cases of influenza pneumonia. If complex parapneumonic pleural effusion or empyema complicated, we should perform pleural cavity drainage in time. The oral neuraminidase inhibitor (oseltamivir) could significantly improve prognosis.

To describe the clinical,radiological and pathological characteristics of idiopathic pulmonary alveolar proteinosis(I-PAP)and to evaluate the methods of diagnosis and treatment.Three patients were successfully diagnosed and treated in our hospital and the literature on the subject was reviewed.Three patients,two males and one female(mean age 46 years),were diagnosed averagely in 4 months.Two severe patients presented with progressive dyspnea and type I respiratory failure,and one mild patient only with dry cough and hypoxemia.Chest X-ray radiographs all showed perihilar "butterfly" shadow and chest CT scans showed diffused ground-glass opacities(GGO),typically with "map" changes and "crazy paving" patterns.All the patients underwent bronchoscope,branchoalveolar lavage fluid(BALF)had grossly opaque and/or milky appearance and its sediment was periodic acid-Schiff stain positive.Transbronchoscopic lung biopsy(TBLB)specimens were obtained and under light microscopy alveoli and some of the small bronchioles were filled with eosinophilic proteinaceous material with needle-like clefts.By electron microscopy numerous cellular debris and extracellular multilamellated bodies were found.Two severe patients were successfully treated with sequential whole-lung lavage and one required repeated lavages.I-PAP is rare and prone to be misdiagnosed.The radiological features may indicate the diagnosis and examinations of TBLB and BALF can make the accurate diagnosis.Whole-lung lavage is the most effective therapy by now and granulocyte-macrophage colony-stimulating factor(GM-CSF)may be beneficial in some patients.

Objective:To evaluate the efficacy and safety of talc poudrage pleurodesis via semi-rigid medical thoracoscopy in the treatment of malignant pleural effusions,as well as the factors that may influence the outcomes.Methods:A series of 27 patients with malignant pleural effusion underwent medical thoracoscopic talc poudrage pleurodesis between July 2005 and September 2007 in Peking University First Hospital.Results:There were 16 male and 11 female patients in the series,the average age being 65.2 years.All the patients had documented malignant pleural effusions,including 16 cases of adenocarcinoma,6 of malignant mesothelioma,2 of squamous cell carcinoma,1 of lymphoepithelioma-like carcinoma,1of small cell carcinoma and 1 of undifferentiated lung cancer.Thirty days after the procedures,complete successful pleurodesis was achieved in 22 cases,and partial successful in 4 cases.Pleurodesis was not successful in one case.Overall successful rate was 96.3%(26/27).The average duration of thoracic tubing was 6.85 days.Chest pain,fever and an increase in peripheral WBC after the procedure occurred in 19(70.4%,19/27),21(77.8%,21/27),and 12(44.4%,12/27)cases respectively.No respiratory failure occurred.Conclusion:Medical thoracoscopic talc poudrage pleurodesis is a safe and effective method for the treatment of malignant pleural effusion.

Objective: To analyze the current situation and effect of vertical integrated of rural health services in Dafeng County. Method: Policy documents and data are collected and interviews are implemented for studying the integrated situation. Results: The vertical integration in Dafeng County is virtual joint form with forming 6 city-level medical volunteer service teams and 52 health management teams. With the imple-mentation of fully integrated management, signing service with rural doctor mode is carried out, which pro-mote the establishment of rural unified service standards and regulations. Using health card of residents which promote the regional shared of treatment information. Conclusions: Vertically integrated mode had connection in health management teams, supported by fully integration, developed by signing service with rural doctor and carried by residents’ health card, which could provide reference for implementing vertical integration of rural health service. But strategies needed to be strengthened in improving health services’ ability of township hospitals, clarifying interest relationship as well as integrating health service regulations and strengthen the health information system for sharing and docking.

We reported a case of pulmonary capillary hemangiomatosis (PCH) and introduced its diag-nosis, differential diagnosis, pathogenesis and development of treatment based on the review of Dana Point 2008 Classification of Pulmonary Hypertensiona and current literatures .A 43-year-old female presented progressive dyspnea, elevated pulmonary arterial pressures and CT pulmonary angiography (CTPA) imaging of main pulmonary arterial enlargement and wide spread ill -defined centrilobular nodules of ground-glass opacity.Her histologic features were proliferation of capillary channels within alveolar walls as well as muscularization of arterioles and medial hypertrophy of muscular pulmonary arteries.The treatment with diuretics and warfarin was used promptly , but unfortunately was ineffective. The patient died three months after diagnosis .PCH is a very rare vascular disease with poor prognosis . The diagnosis of PCH rests on the integration of clinical and radiographic information with pathologic fea -tures, however pathology is the most reliable means .Because clinical symptoms, imaging and histological features of pulmonary veno-occlusive disease (PVOD) and PCH broadly overlap, differential diagnosis should be made carefully.Among the various pathologic features proliferation of capillaries within alveolar walls is the key point for diagnosing PCH , which is also the most critical criteria for differentiating PCH from PVOD.So far the only definitive treatment for PCH is lung transplantation , without which the pa-tient will die several months after diagnosis .

Objective:To describe the clinical,radiological and pathological characteristics of idiopa-thic pulmonary haemosiderosis(IPH) in adults and to evaluate the methods of diagnosis and treatment.Methods:Two patients were successfully diagnosed and treated in our hospital and the literature on the subject was reviewed.Results:Two adult patients(19 and 34 years old) diagnosed in our hospital had 5 and 10 years of history of hemoptysis respectively,and chest CT showed bilateral diffuse alveolar opacities over mid and lower zones.Tests of antinuclear antibodies(ANAs),rheumatoid factor(RF),antineutrophilic cytopasmic antibodies(ANCA) and Anti-glomerular basement membrane(anti-GBM) antibody were negative.Haemosiderin-laden macrophages were found in bronchoalveolar lavage fluid(BALF) whose color was yellow.Microscopic examination of the lung tissue specimens obtained by transbronchial lung biopsy(TBLB) revealed hemorrhage and numerous hemosiderin-laden macrophages in the alveoli and no vasculitis or capillaritis were seen.These findings were consistent with a diagnosis of IPH.Steroid therapy had good effects.Conclusion:IPH is a diagnosis of exclusion of other causes of diffuse alveolar hemorrhage(DAH).IPH adults have relatively good drug responses and relatively good prognoses.

Objective To investigate the relationship between pulmonary arterial ( PA) enlargement and pulmonary function in patients with chronic obstructive pulmonary disease (COPD).Methods From December 2012 to June 2016,78 patients with acute exacerbation of COPD in the Eighth People＇s Hospital of Qingdao were selected. According to pulmonary CT findings,they were divided into two groups : PA enlargement group (38 cases) was PA＞3.0cm,normal PA group(40 cases) was PA≤3.0cm.FEV1and FVC of stable phase were compared.Results The FEV1of men in the A enlargement group was (1.08 ±0.44)L,that in the normal PA group was (1.44 ±0.66)L,the difference was statistically significant (t＝2.27,P＝0.028).The FEV1of women in the PA enlargement group was (0.90 ±0.41)L,which in the normal PA group was (1.35 ±0.58)L,the difference was statistically significant (t＝2.28,P＝0.026).Correlation analysis showed that the diameter of PA was negatively related with FEV 1/FVC(r＝-0.509,P＝0.001),PA enlargement was related with lung function decline.Conclusion COPD patients with PA enlargement are more associated with accelerated loss of lung function and should be treated early.