Chest tightness variant asthma(CTVA)is an atypical form of asthma with chest tightness as the sole or predominant symptom.The underlying receptors for chest tightness are bronchial C-fibers or rapidly adapting receptors.The nerve impulses are transmitted via the vagus nerve and processed in different regions of the cerebral cortex.Chest tightness is associated with sensory perception,and CTVA patients may have heightened ability to detect subtle changes in lung function,but such sensory perception is unrelated to respiratory muscle activity,lung hyperinflation,or mechanical loading of the respiratory system.Airway inflammation,pulmonary ventilation dysfunction(especially involving small airways),and airway hyperresponsiveness may underlie the sensation of chest tightness.CTVA patients are prone to comorbid anxiety and depression,which share similar central nervous system processing pathways with dyspnea,suggesting a possible neurological basis for the development of CTVA.This article examines the recognition and mechanisms of chest tightness,and explores the pathogenesis of CTVA,focusing on its association with airway inflammation,ventilation dysfunction,airway hyperresponsiveness,and psychosocial factors.

Humans ; Asthma/drug therapy* ; Biological Therapy

Objective:To analysis of clinical and imaging characteristics of pulmonary cryptococcosis.Methods:The clinical and imaging characteristics of 113 patients with pulmonary cryptococcosis who were admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2014 to March 2019, were retrospectively analyzed.Results:Among 113 patients, 74 cases (65.5%) were males, and 71 cases (62.8%) were at a age of 40-60 years. The imaging manifestations showed a nodular-infiltrating patchy mixed type ( n=44,38.9%), accompanied by halo sign ( n=48, 42.5%) and bronchial air sign ( n=48, 42.5%). All patients were treated with fluconazole and the follow-up at 3 months after discharge showed their conditions were all improved. Subgroup analysis showed that patients with complications had older average age [(54.28±10.64)y vs. (46.52±12.12)y, t=-5.05, P<0.001], longer hospital stay [(10.42±6.11)d vs. (7.09±5.63)d, t=-4.28, P=0.007], lower white blood cell count [(6.02±2.16)×10 9/L vs. (6.96±2.29)×10 9/L, t=2.44, P=0.027]. The symptomatic group had fewer male patients [56.2% (45/80) vs. 87.9% (29/33), χ 2=19.54, P<0.001], and imaging was more likely to show infiltrative patchy [32.5%(26/80) vs. 9.1%(3/33), χ 2=18.25, P=0.031]. There was no significant difference in clinical and imaging manifestations between antigen positive group and antigen negative group(all P>0.05). Conclusions:Most of the patients with pulmonary cryptococcosis are middle-aged men, and have nodular-infiltrating patchy mixed type in imaging; the complications would prolong the length of hospital stay.

The revision inincludes both the diagnosis of asthma and the control-based asthma management. It points out that asthma is a heterogeneous disease, and the diagnosis of asthma should be based on the characteristic pattern of symptoms and evidence of variable airflow limitation, emphasizing the diagnosis of atypical asthma. Besides, the epidemiology of asthma, assessment of asthma, management severe asthma, special type of asthma and asthma in special populations have been added in this version. The revised guideline provides an important reference for the standardized management of asthma.
Asthma ; diagnosis ; epidemiology ; prevention & control ; therapy ; Guidelines as Topic ; Humans

[ Abs tratc ] The revision in 2016 asthma management and prevention guideline includes both the diagnosis of asthma and the control-based asthma management .It points out that asthma is a heterogeneous disease , and the diagnosis of asthma should be based on the characteristic pattern of symptoms and evidence of variable airflow limitation, emphasizing the diagnosis of atypical asthma .Besides, the epidemiology of asthma, assessment of asthma , management severe asthma , special type of asthma and asthma in special populations have been added in this version .The revised guideline provides an important reference for the standardized management of asthma .

Objective To investigate the clinical significance of early lactate clearance rate in respect of the prognosis of patients with severe chronic obstructive pulmonary disease (COPD) . Methods A total of 108 COPD patients with respiratory failure were studied prospectively. The patients were divided into survival group ( n = 82) and the death group ( n = 26) , and the survival group further divided into the conventional treatment subgroup ( n = 55 ) and the invasive ventilation subgroup ( n = 27 ) . Arterial blood lactate, arterial gas analysis, APACHE Ⅱ score and the 6-hour clearance rate were measured before and 6 hours after treatment in 3 groups. The high lactate clearance rate group (n =71 ) was defined as a lactate clearance rate ＞ 10% , and the low lactate clearance rate group (n = 37) with a lactate clearance rate ＜ 10%. The correlation between 6-hour lactate clearance rate and prognosis in patients was analyzed. Results Compared the survival patients in invasive ventilation group with the death group, there were no statistical differences in arterial blood lactate, pH value, PaCO2, PaO2, oxygenation index and APACHE Ⅱ score before the treatment. The 6-hour lactate clearance rate in survival patients in conventional treatment group or invasive ventilation group was significantly higher than that in the death group (t =31.2, P＜0. 01; t =34.6, P＜0. 01, respectively), while there were no statistical differences in APACHE Ⅱ score and pH value between these 3 groups. Between the conventional ventilation treatment group and the invasive ventilation treatment group, there was no statistical difference in 6-hour lactate clearance rate ( P ＞ 0. 05 ) . There was no statistical difference in APACHE Ⅱ score between before treatment and after treatment in 3 groups. Mortality in high lactate clearance rate group (4. 2% ) was significantly lower than that in low lactate clearance rate group (62. 2% ) (x2 = 121.9, P ＜ 0. 01 ) .Conclusions The early (6h) lactate clearance rate could be used as a marker for evaluating the severity,therapeutic efficacy and prognosis of patients with severe COPD.

Primary tracheobronchial amyloidosis (TBA) is a rare pulmonary disease. A systematic review was performed on 64 cases of primary TBA in China and progress in the diagnosis and treatment of this disease is discussed. The Chinese biological and medical databases from 1970 to 2010 were searched and 75 cases of complete clinical and pathological data were identified. The clinical characteristics of the disease were summarized and longitudinal comparisons were made of diagnostic and treatment methods over time. The results showed that the morbidity associated with primary TBA has increased over recent years. The clinical manifestations were non-specific. Progressive dyspnea, cough and sputum were the most common symptoms. The percentage of patients undergoing computed tomography (CT) scan has increased over the years. The bronchoscopy and transbrochial lung biopsy (TBLB) were usually sufficient to establish the diagnosis. Treatment was reported for a total of 44 cases. Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration such as steroids and colchicines were reported to be effective in some patients. It is concluded that the demographic characteristics and clinical manifestations of primary TBA patients in China are largely consistent with findings reported in other countries. Dramatically more cases were reported in recent years, mainly due to the extensive application of bronchoscopy since 1990s. Chest CT scan provides important clues for the diagnosis of the disease. The definite diagnosis was confirmed by bronchoscopic findings and Congo red staining of biopsy specimen. Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration, such as steroids and colchicines were reported to be effective in some patients.

Primary tracheobronchial amyloidosis (TBA) is a rare pulmonary disease. A systematic review was performed on 64 cases of primary TBA in China and progress in the diagnosis and treatment of this disease is discussed. The Chinese biological and medical databases from 1970 to 2010were searched and 75 cases of complete clinical and pathological data were identified. The clinical characteristics of the disease were summarized and longitudinal comparisons were made of diagnostic and treatment methods over time. The results showed that the morbidity associated with primary TBA has increased over recent years. The clinical manifestations were non-specific. Progressive dyspnea, cough and sputum were the most common symptoms. The percentage of patients undergoing computed tomography (CT) scan has increased over the years. The bronchoscopy and transbrochial lung biopsy (TBLB) were usually sufficient to establish the diagnosis. Treatment was reported for a total of 44 cases. Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC)and drugs administration such as steroids and colchicines were reported to be effective in some patients. It is concluded that the demographic characteristics and clinical manifestations of primary TBA patients in China are largely consistent with findings reported in other countries. Dramatically more cases were reported in recent years, mainly due to the extensive application of bronchoscopy since 1990s. Chest CT scan provides important clues for the diagnosis of the disease. The definite diagnosis was confirmed by bronchoscopic findings and Congo red staining of biopsy specimen.Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration,such as steroids and colchicines were reported to be effective in some patients.

Objective To investigate the signaling mechanisms underlying up-regulation of nontypeable Haemophilus influenzae(NTHi)-induced MUC5AC mucin expression. Methods The expression of MUC 5AC at mRNA level was measured by reverse transcriptase-polymerase chain reaction (RT-PCR)and real-time fluorescent quantitative PCR.Immunoprecipitation and Western blot were performed tO examine the phosphorylation of p38 mitogen-activated protein kinase(p38MAPK)and epidermal growth factor receptor(EGFR)or the effect of dominant negative mutant of EGFR on the phosphorylation of p38MAPK in HM3 cells treated with NTHi.Luciferase assay was also performed to examine the effect of p38MAPK and EGFR inhibitors or dominant negative mutant of EGFR on NTHi-induced MUC5AC expression at transcription level.Results NTHi induced MUC5AC mucin expression at both mRNA and transcription levels.Phosphorylation of p38MAPK and EGFR were observed in HM3 cells treated with NTHi.Either SB203580,a specific inhibitor for p38MAPK or AGl478,a specific inhibitor for EGFR.inhibited NTHi-induced MUC5AC up-regulation at transcription level. Furthermore,Overexpressing dominant negative mutant of EGFR also inhibited NTHi-induced MUC5AC upregulation at transcription 1evel in a dos-dependent manner.EGFR inhibitor reduced NTHi-induced p38MAPK phosphorylation in HM3 cells.Conclusion Bacterium NTHi up-regulates MUC5AC mucin transcription via EGFR-p38MAPK signaling pathway.

Objective To study the effect of anti-IL-5 monoclony antibody (TRFK-5) on migration of Eos from BM to the airways in sensitized mice. Methods Male C57BL/6 (6-8wk of age) murine model of Asthma and control group were estabolished with routine method. The outcome measurements include white blood cell (WBC) total count, differential count of bronchoalveolar lavage fluid (BALF) and peripheral blood (PB), nuclear cell count and eosinophil percentage of BM. These parameters were collected 12 h after the final allergen challenge. To cheek Eos infiltration, the histology of lung tissues was also observed. Further, the effects of intranasal TRFK-5 on above changes were investigated. Results Eosinophil numbers of BALF, PB, BM and the infiltration of Eos in pulmovnary tissues were increased considerably 12 h after final OVA challenge compared with negative group(P