Objective To assess the clinical value of conventional contrast enhanced CT(CECT),multi parameter energy spectrum CT,and contrast enhanced MR(CEMR)imaging methods in evaluating hepatocellular carcinoma(HCC)after TACE treatment.Methods The clinical data of 66 HCC patients,who underwent TACE treatment at authors' hospital and received CECT,multi parameter energy spectrum CT and CEMR in 1-3 months after treatment,were retrospectively analyzed.Taking DSA results as the gold standard,the recurrent or residual lesions detected by DSA were classified as positive lesions,while the lesions having no obvious recurrence or residues were classified as negative lesions.The positive lesions that were detected by both DSA and other imaging methods were regarded as true positive lesions.The accuracy,sensitivity,specificity,Kappa value were used to compare the values of CECT,multi parameter energy spectrum CT and CEMR in evaluating the positive/negative lesions of HCC after TACE treatment,and the number of detected lesions and accuracy rate were used to evaluate the values of the above imaging methods in demonstrating the iodine oil deposition status and in diagnosing true positive lesions.Results A total of 133 positive lesions and 35 negative lesions were detected by DSA.The accuracy of CEMR in diagnosing lesions was highest,the accuracy rate was 88.70％(both P＜0.05);CEMR and energy spectrum CT had the highest diagnostic efficiency,the sensitivity for positive lesions was 92.31％and 81.95％respectively,and the difference between the two methods was not statistically significant(P＞0.05).No statistically significant difference in the ability of diagnosing negative lesions existed between each other among the three groups(all P＞0.05).The Kappa value suggested that the ability for diagnosing lesions after TACE treatment of CEMR was stronger than that of energy spectrum CT(Kappa value was 0.68 and 0.56 respectively,both P＜0.05).CECT and multi parameter energy spectrum CT had the same accuracy in evaluating the iodine oil deposition status(both were 91.7％).No statistically significant difference in diagnosing even iodine oil deposition of the true positive lesions existed between each other among the three groups(all P＞0.05).For diagnosing uneven iodine oil deposition of the true positive lesions,CEMR had the highest accuracy(92.50％,all P＜0.05).Conclusion CEMR and multi parameter energy spectrum CT have more reliable diagnostic performance than conventional CECT,besides,CEMR has the highest diagnostic performance.However,multi parameter energy spectrum CT and CECT are the better choice for evaluating the deposition status of iodine oil.

Six novel compounds,comprising three quinolones(1a,1b,and 2)and three flavanones(3-5),along with seven known analogs(6-13),were isolated from the 95％EtOH extract of the stems and leaves of Glycosmis craibii var.glabra.The structures of the new compounds were elucidated using HR-ESI-MS,UV,and 1D and 2D nuclear magnetic resonance(NMR)data analysis.The ab-solute configurations were determined through Mosher ester and electronic circular dichroism(ECD)spectral analysis.Compounds 2,6,9,and 10 demonstrated inhibition of nitric oxide(NO)production stimulated by lipopolysaccharide in BV-2 microglial cells,with IC50 values ranging from 13.5 to 20.1 μmol·L-1,comparable to the positive control,dexamethasone.

Humans ; Asthma/drug therapy* ; Biological Therapy

Objective To explore the effect of lung water management guided by pulse indicator continuous cardiac output (PICCO) in noninvasive-invasive-noninvasive sequential mechanical ventilation to severe acute pancreatitis (SAP) caused acute respiratory distress syndrome (ARDS).Methods The patients with ARDS caused by SAP in the department of critical care medicine in this hospital from January 2012 to January 2015 were selected as the research subjects and divided into the treatment group (lung water management guided by PICCO) and control group(without lung water management guided by PIC CO) according to different lung water management modes.The noninvasive ventilation time,invasive ventilation time,total mechanical ventilation time,mortality rate,incidence rate of pulmonary edema,incidence rate of ventilator associated pneumonia (VAP) and ICU stay time were compared between the two groups.Results The invasive ventilation time in the treatment group was (3.54 ± 1.78)d,which was lower than (4.31 ±2.42)d in the control group(P＜0.05);the occurrence rate of pulmonary edema in the treatment group was 13.64 ％,which was lower than 35.42％ in the control group;the VAP occurrence rate in the treatment group was 6.82 ％,which was lower than 22.92％ in the control group;the mortality rate was 11.36％,which was lower than 29.17％ in the control group;the ICU stay time was (7.21 ± 1.13)d,which was lower than (8.19 ± 1.28)d in the control group,the differences were statistically significant(P＜0.05).Conclusion The lung water management guided by PICCO in SAP caused ARDS sequential mechanical ventilation is more accurate and effective,which is related to accurate liquid management,conduces to the patient's treatment,and is worthy of popularization and application.

BACKGROUNDIncreased proinflammatory cytokines and chemokines might contribute to infiltration of inflammatory cells and remodeling in airways of asthma. Although these molecules may be associated with asthma, there is lack of systemic evidence showing which and how important these events are in the disease. We aimed to analyze the concentrations of these molecules in the airways and relationships with disease severity and with airway infiltration of inflammatory cells in a large cohort of asthmatics (n = 70, including 37 mild and 33 moderate/severe asthmatics) compared with controls (n = 30).

METHODSMeso scale discovery system and commercial ELISA kits were used to measure the concentrations of proinflammatory cytokines interleukin (IL)-1β; tumor necrosis factor-alpha (TNF-α); IL-6; and IL-17 and CC and CXC chemokines CCL2, CCL4, CCL11, CCL13, CCL17, CCL22, and CCL26 and CXCL8, CXCL9, CXCL10, and CXCL11 in bronchoalveolar lavage fluid of asthmatics and controls.

RESULTSThe concentrations of IL-1, TNF-α, IL-6, CXCL8 and CXCL10, and CCL4, CCL11, CCL17, and CCL22 were significantly elevated in asthmatics compared with controls (P < 0.05). The concentrations of TNF-α and CXCL8, but not others, were negatively correlated with severity of disease (lung function forced expiratory volume in 1 s) (TNF-α vs. total: r = -0.359, P= 0.002 vs. moderate/severe: r= -0.541, P= 0.001; CXCL8 vs. total: r = -0.327, P= 0.006 vs. moderate/severe: r = -0.625, P= 0.0001, respectively). In addition, concentrations of these two molecules were also correlated with the absolute numbers of infiltrating eosinophils and neutrophils in asthmatic airways.

CONCLUSIONSIncreased concentrations of TNF-α and CXCL8 are associated with pathogenesis of asthma. Targeting these molecules might provide an alternative therapeutic for this disease.

China ; Chronic Disease ; prevention & control ; Humans ; Respiration Disorders ; prevention & control

BACKGROUNDCombined emphysema and pulmonary fibrosis, including idiopathic pulmonary fibrosis (IPF), is a distinct disorder described with upper-lobe emphysema and lower-lobe fibrosis on chest computed tomography. Smoking appears to be the predominant risk factor for this disorder. We aimed to compare clinical features, smoking history, physiological and radiological findings between IPF with and without emphysema.

METHODSA sample of 125 IPF patients over a period of 48 months were evaluated. High resolution CT scans were reviewed blinded to clinical data. The IPF patients with or without emphysema were classified accordingly.

RESULTSThe prevalence of emphysema in this IPF sample was 70/125. IPF with emphysema was significantly associated with smoking status (OR 63; 95% CI 4.4 to 915; P = 0.002) and smoking pack year (OR 1.1; 95% CI 1.05 to 1.13; P = 0.000). The patients with IPF and emphysema had a higher decrease in carbon monoxide diffusing capacity adjusted for alveolar volume ((58±19)% pred vs. (66±21)% pred; P = 0.021) and a higher prevalence of pulmonary hypertension (24/70 vs. 7/55; P = 0.006). The two groups of patients had similar forced and residual volumes. No significant differences were found in cell differentials of bronchoalveolar lavage or the scores of fibrosis on chest CT. Survival of the patients with emphysema was significantly less than that of patients with IPF alone.

CONCLUSIONSCigarette smoking induces IPF combined with emphysema. Emphysema further impairs physiological function and increases the prevalence of pulmonary hypertension that leads to poor prognosis. The inclusion of the patients with combined pulmonary fibrosis and emphysema in IPF clinical trials may lead to under evaluation of the effect of treatment in patients.

Aged ; Female ; Humans ; Idiopathic Pulmonary Fibrosis ; etiology ; physiopathology ; Male ; Middle Aged ; Pulmonary Emphysema ; complications ; physiopathology ; Smoking ; adverse effects

Objective To investigate the correlations between eosinophil counts in induced sputum and lung function (FENO) and evaluate these parameters in medication adjustment in patients with asthma.Methods Sixty-five outpatients with mild to moderate persistent asthma ( mild,32 ; moderate,33 ) from January to August 2008 were enrolled in the study.All were treated with combined medications comprising inhaled corticosteroids plus long-acting β2 agonists for 1 year.Lung function (FEV1％ and PEF％ ),eosinophil counts in induced sputum,FENO,and Asthma Control Test (ACT) scores were obtained at regular follow-up intervals.Twenty-one healthy volunteers served as controls,and lung function,eosinophil counts in induced sputum,and FENO were also obtained.Results Sixty-three subjects completed 1-year or longer follow-up.Lung function of 63 subjects recovered quickly in the early days and improved slowly during the following 6 months.FENO decreased from (61 ± 25 ) nmol/L at baseline to ( 32 ± 19 ) nmol/L by the third month (q =7.32,P＜0.05) and to (22 ± 12) nmol/L by the sixth month,which showed significant difference from normal controls [ ( 13 ± 8) nmol/L; q =6.63,P ＜ 0.05 ].Eosinophil counts in induced sputum of the asthma group at baseline were (0.093 ±0.023) × 109/L and decreased to (0.032 ±0.011)× 109/L by the third month,which was significantly different from baseline and normal controls [ (0.005 ±0.003) × 106/ml; q =5.49,P ＜0.05 and q =5.87,P ＜0.05,respectively].FENO showed a significantly positive correlation with eosinophil counts in induced sputum in the first 6 months (r1 =0.612,r2 =0.558,r3 =0.675; all P＜0.05) and a negative correlation with FEV1 (r1 =-0.537,r3 =-0.658,r6 ＝ -0.623,r9 =-0.537,r12 =-0.597 ; all P ＜0.05 ) at any time point of the study.The ACT score of 63 subjects at baseline was 14 ±3,and the scores after treatment for 1,3,6,9,and 12 months were 18 ±5,19 ±7,23 ±2,24 ± 1,and 24 ± 1,respectively; at the same time,significant difference was found ( F =5.72,P ＜ 0.05).Effectiveness was found according to the ACT score only 1 month after treatment.Conclusion The parameters of FENO and eosinophil counts in induced sputum were sensitive in the detection of airway inflammation and may be useful in evaluation of the efficacy of treatment and adjustment of medication regimens.

Objective To evaluate the effects of clinical center-based health management on quality of life (QOL) of patients with asthma. Methods A total of 642 patients who had received standard antiasthma treatment over 3 years in our clinical center from September 2005 up to now were randomly assigned to the good compliance group ( group A, n = 326 ) and bad compliance group ( group B, n = 316 ). A questionnaire was used to estimate the awareness about asthma,medical therapy and disease control. Levels of QOL were compared at 6 months and 1 and 3 years after health education. Results In group A,uncontrolled,partly controlled, and completely controlled asthma were found in 21%, 47%, and 32% participants, respectively. Significant difference of QOL was shown between the 2 groups after the intervention ( P ＜ 0. 05 ). At 6 months, forced expiratory volume in one second ( FEV1 ), percentage of predicted FEV1 ( FEV1 % pre) ,and peak expiratory flow rate ( PEF)were significantly improved in group A ( all P ＜0. 05 ),although acute attack and hospitalization were largely reduced. In comparison with baseline,6 months and 1 year,self-reported QOL, limitation of motion, stimulus avoidance and response, and disease concerns were significantly changed at 3 years. Conclusions Clinic center-based health management could benefit disease control and QOL of patients with asthma.

Objective To evaluate the efficacy of Budesonide/formoterol to control asthma under real-life conditions.Methods A muhi-center, open label, non-interventional study was conducted.Asthma control after 12 week therapy with Budesonide/formoterol was assessed by Asthma Control Questionnaire (ACQ) and modified Asthma Control Questionnaire (ACQ5).Results A total of 360 asthma patients were recruited,including 228 adult patients and 132 child patients.After 12 weeks' therapy,all the patients' medium value of ACQ was decreased significantly from 2.03 (adults 2.20, children 1.74) at baseline to 0.60 (adults 0.78, children 0.29) (P < 0.0001), and the medium value of ACQ5 was also decreased significantly from 2.4 (adults 2.24, children 1.76) at baseline to 0.47 (adults 0.62, children 0.20) (P < 0.0001).Conclusion Budesonide/formoterol is effective in asthma treatment, by which most asthma patients obtain and maintain clineal control.