[Improve the clinical research and standardize the management of pleural diseases]

Based on the clinical evidence obtained during the past decade, we reviewed herein the evidences in the treatment of 5 types of common pleural diseases. (1) Therapeutic pleural interventions are not recommended for patients with malignant pleural effusion (MPE) who are asymptomatic. In patients with symptomatic MPE, large-volume thoracentesis should be performed in MPE patients to figure out if the patient's symptoms are related to the effusion and/or if the lung is expandable; if so, indwelling pleural catheters and/or talc pleurodesis can be used as first-line definitive intervention. Indwelling pleural catheters, but not pleurodesis should be used in those with symptomatic MPE with nonexpandable lung, failed pleurodesis, or loculated effusion. (2) Randomized controlled trials concerning tuberculous pleurisy management are always scarce. Based on the data from pulmonary tuberculosis trials, it can be accepted that anti-tuberculosis treatment regimen for tuberculous pleurisy with isoniazid, rifampin, and pyrazinamide for two months followed by four months of two drugs, isoniazid and rifampin. (3) A combination of tissue plasminogen activator and deoxyribonuclease can be instilled intrapleurally as the initial treatment, or as a follow-up treatment after surgery for pleural infection. The recommended dosages are as follows: tissue plasminogen activator 10 mg, twice a day, deoxyribonuclease 5 mg, twice a day. (4) The randomized controlled trial has provided evidence that conservative management is an acceptable alternative to interventional management for moderate-to-large primary spontaneous pneumothorax. (5) For patients with malignant pleural mesothelioma, nivolumab plus ipilimumab is capable of significantly improving the overall survival of patients versus platinum plus pemetrexed chemotherapy, supporting the use of this regimen as the first-line treatment for these patients, regardless of histological subtype.

[Use of fibrinolytics and deoxyribonuclease in patients with pleural infection]

Just over a decade ago, it was widely accepted that intrapleural instillation of fibrinolytics was ineffective in treatment of pleural infection. Due to the accumulation of clinical study evidence, an expert team from several countries developed an international consensus and recommended that tissue plasminogen activator and deoxyribonuclease should be instilled intrapleurally at the same time as the initial treatment, or as a follow-up treatment after surgery for pleural infection. The recommended dosages are as follows: tissue plasminogen activator 10 mg, twice a day, deoxyribonuclease 5 mg, twice a day. The future researches should focus on optimizing the tissue plasminogen activator and deoxyribonuclease schemes and developing more effective fibrinolytics.

[Value of PET/MRI in the diagnosis of malignant pleural effusion in comparison with PET/CT]

Objective: To investigate the diagnostic value of PET/MRI for malignant pleural effusion (MPE), and compare its diagnostic difference with PET/CT. Methods: The data of 57 patients with suspected MPE admitted into Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from October 2017 to January 2020 was analyzed. A total of 53 patients were included in the prospective study, and the whole body PET/CT and thoracic PET/MRI were performed on them respectively. Two physicians used a blind method to evaluate the morphological features of PET/CT and PET/MRI images, delineate the region of interest (ROI), obtain the maximum standard uptake value (SUVmax) of the ROI in the PET/CT and PET/MRI images. The target-to-background ratio (TBR) of the lesion was calculated. The diffusion-weighted imaging (DWI) characteristics of the pleura in PET/MRI images were analyzed. Taking pathological diagnosis as the gold standard, the diagnostic effect of PET/CT and PET/MRI on MPE were evaluated. Results: The 53 patients who were finally included were (62.8±1.7) years old, consisting of 31 males. Pathological results showed that 41 cases were MPE and 12 cases were benign pleural effusion (BPE). There were no statistical differences in age, gender and smoking history between the two groups (P>0.05). Bland-Altman analysis showed that the SUVmax of pleural lesions by PET/MRI was higher than that by PET/CT (6.4±0.6 vs 5.3±0.5, P<0.001). The TBR of PET/MRI was higher than that of PET/CT (2.2±0.2 vs 1.8±0.2, P<0.001). The sensitivity, specificity, and accuracy of PET/MRI in the diagnosis of MPE by combining imaging features such as SUVmax and DWI of pleural lesions were 75.6%, 100%, and 81.1%, respectively. The sensitivity, specificity, and accuracy of PET/CT combined with SUVmax and imaging features of pleural lesions in the diagnosis of MPE were 85.4%, 83.3%, and 77.4%, respectively. There was no statistically significant difference between PET/MRI and PET/CT in the area under the curve (AUC) for diagnosing MPE (0.934 vs 0.873, P>0.05). Conclusions: PET/MRI and PET/CT have the equivalent diagnostic efficiency for MPE. However, PET/MRI shows higher SUVmax and TBR for pleural lesions, and has specific pleural DWI imaging characteristics, which is worthy of further clinical research.

MicroRNA-362 inhibits cell growth and metastasis in glioblastoma by targeting MAPK1

OBJECTIVE

Glioblastoma (GBM) is a deadly brain cancer that seriously threatens the lives of patients. Moreover, various microRNAs (miRNAs) have been found to be involved in the progression of GBM. The purpose of this study is to preliminarily elucidate the regulatory mechanism of miR-362 in GBM.

PATIENTS AND METHODS

The abnormal expression of miR-362 and MAPK1 was detected by RT-qPCR or Western blot analysis in GBM tissues and cells. CCK-8 and transwell assays were performed to measure cell proliferation, migration and invasion. The relationship between miR-362 and MAPK1 was confirmed by luciferase reporter assay.

RESULTS

MiR-362 expression was reduced in GBM tissues and cells. The decreased expression of miR-362 predicted poor prognosis in GBM patients. Functionally, overexpression of miR-362 inhibited the proliferation and metastasis of GBM cells. In addition, miR-362 directly targets MAPK1. MAPK1 was negatively correlated with miR-362 expression in GBM. Moreover, MAPK1 was upregulated and served as a tumor promoter in GBM. More importantly, the upregulation of MAPK1 weakened the inhibitory effect of miR-362 on cell proliferation and metastasis in GBM.

CONCLUSIONS

MiR-362 restrains cell proliferation and metastasis in GBM by targeting MAPK1, indicating that miR-362 functions as a tumor suppressor in GBM.

The diagnostic and prognostic values of serum and urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin in sepsis induced acute renal injury patients

OBJECTIVE

The kidney injury molecule-1 (uKIM-1) and neutrophil gelatinase-associated lipocalin (uNGAL, sNGAL) have been demonstrated to be diagnostic biomarkers for acute kidney injury (AKI) in a variety of diseases. However, both of them were not well validated in sepsis patients with acute kidney injury.

PATIENTS AND METHODS

This was a prospective and observational study which was performed in the three intensive care units of the Beijing Chao-Yang Hospital. Over a 12-month period, 174 patients (70 sepsis patients, 69 sepsis with AKI and 35 controls) were enrolled. Blood and urinary specimens were collected at admission as soon as possible (within 24 hours) and KIM-1 and NGAL levels were tested.

RESULTS

Levels of uKIM-1, uNGAL, sNGAL were significantly higher in the sepsis patients who developed AKI compared to those sepsis with no-AKI (0.88 ng/ml (0.37, 2.14) vs. 1.21 ng/ml (0.67, 3.26) p=0.003, 63.54 ng/ml (21.66, 125.45) vs. 249.85 ng/ml (86.60, 585.97) p<0.001, and 108.08 ng/ml (67.74, 212.22) vs. 200.01 ng/ml (102.76, 300.77) p=0.001, respectively). sKIM-1 also had significant differences between the two groups (83.98 pg/ml (54.00,147.08) vs. 193.41 pg/ml (106.90, 430.60) p<0.001). The four biomarkers (uKIM-1, sKIM-1, uNGAL, sNGAL) all could be predictive for AKI, and the areas under the receiver operating characteristic curves (AUROC) were 0.607, 0.754, 0.768, 0.658, respectively. The uNGAL was an independent risk factor for septic AKI, and the AUROC was 0.768 (95% CI: 0.689 to 0.835). The uNGAL and sNGAL were related to the prognosis of sepsis.

CONCLUSIONS

Our results showed that NGAL was a promising biomarker of septic AKI. Like the uKIM-1, the sKIM-1 could early predict the occurrence of septic AKI too, but both of them did not have the predictive value in judging the severity of AKI and the prognosis of sepsis.

Extracellular Vesicles of GMSCs Alleviate Aging-Related Cell Senescence

Healthy aging is a complex biological process with progressive accumulation of senescent cells characterized by stable cell cycle arrest, resulting in impaired homeostasis, regenerative potential, and gradual functional decline in multiple tissues and organs, whereby the aberrant activation of mammalian target of rapamycin (mTOR) signaling networks plays a central role. Herein, we explored the effects of extracellular vesicles (EVs) released by gingiva-derived mesenchymal stem cells (GMSC-EVs) on oxidative stress-induced cellular senescence in human endothelial cells and skin fibroblasts and their antiaging potentials. Our results showed that GMSC-EVs robustly abrogated oxidative stress-induced upregulation in the expression of cellular senescence-related genes, such as β-galactosidase, p21, p53, and γH2AX, and mTOR/pS6 signaling pathway, in human umbilical vein endothelial cells (HUVECs) and skin fibroblasts. Meanwhile, GMSC-EVs restored oxidative stress-induced impairment in proliferation and tube formation by HUVECs. Systemic administration of GMSC-EVs attenuated aging-associated elevation in the expression levels of p21, mTOR/pS6, interleukin 6, and tumor necrosis factor α in skin and heart tissues of aged mice. These findings suggest that GMSC-EVs could be a potential alternative source of cell-free product for attenuation of aging-related skin and vascular dysfunctions due to their potent inhibitory effects on oxidative stress-induced cellular senescence in endothelial cells and skin fibroblasts.

miR-135a inhibits glioma cell proliferation and invasion by directly targeting FOXO1

OBJECTIVE

To investigate the potential function of miR-135a in glioma.

PATIENTS AND METHODS

A total of 50 pairs of glioma tissue samples and para-carcinoma tissue samples were collected. Human glioma cell line (U251) and normal human astrocyte (NHA) were cultured. The expression of RNA and protein was detected by quantitative Real time-polymerase chain reaction (qRT-PCR) and Western blot, respectively. Cell proliferation assay and transwell assay were used to detect the activities of proliferation and invasion. Luciferase reporter assays were carried out to determine the binding efficiency between forkhead box O1 (FOXO1) and miR-135a in U251 cells.

RESULTS

qRT-PCR results showed that miR-135a expression was significantly reduced while FOXO1 was up-regulated in glioma tissues. miR-135a overexpression in U251 cells could prominently inhibit proliferation and invasion according to the transwell assays. Moreover, FOXO1 was recognized as the target for miR-135a and may partially reverse the functions of miR-135a in U251 cells.

CONCLUSIONS

We showed that miR-135a inhibits glioma cell proliferation and invasion by down-regulating the target gene FOXO1.

MicroRNA-378 acts as a prognosis marker and inhibits cell migration, invasion and epithelial-mesenchymal transition in human glioma by targeting IRG1

OBJECTIVE

Glioma is one common intracranial malignancy. Recently, there has been a large volume of published studies describing the functions of microRNAs as potential diagnostic markers for glioma. Data from several sources revealed that miR-378 played crucial roles in multiple tumors. However, much uncertainty still exists about the functions and underlying mechanism of miR-378. The purpose of the present work was to evaluate the potential effect of miR-378 and verify its influence on the function of IRG1 in glioma.

PATIENTS AND METHODS

The miR-378 expression was examined in 52 pairs of glioma tissues using quantitative Real-Time Polymerase Chain Reaction (qRT-PCR). Transwell assays were conducted to detect the capability of glioma cell migration and invasion with different transfections. Luciferase reporter was used to confirm whether miR-378 could regulate immune responsive gene 1 (IRG1). Western blot was used to measure the expressions of EMT-related markers.

RESULTS

miR 378 expressions were notably reduced in glioma cells and tissues in comparison with controls. The declined miR-378 expressions were correlated with the poor OS and worse clinicopathological parameters of glioma patients. Overexpression of miR-378 repressed glioma cell epithelial-mesenchymal transition (EMT) and metastasis as well as the tumor growth rate and tumor size of glioma mice. Additionally, IRG1 was markedly up-regulated in glioma and was confirmed as a direct target for miR 378 in glioma.

CONCLUSIONS

We showed that the suppressive role of miR-378 in glioma, which was regulated by IRG1, suggested that the miR-378/IRG1 axis may be an effective target for glioma treatment.

[Retrospective analysis of 13 cases of nocardiosis]

Objective: To evaluate the clinical features, chest radiological manifestations, microbiological examination and treatments of nocardial disease. Methods: A retrospective study was conducted to analyze the data of patients with nocardial infection admitted to Beijing Chaoyang Hospital from January 2010 to January 2016. Results: The 13 patients, 6 males and 7 females, aged (51±17) years. Twelve cases were diagnosed with pulmonary nocardiosis, and 1 with disseminated nocardial infection. Most of these patients had complications: autoimmune diseases in 3 (2 with autoimmune hemolytic anemia and 1 with systemic lupus erythematosus), and bronchiectasis in 6 patients. The most common symptoms were cough, expectoration and fever. The main manifestations of CT scans included nodules or masses, bronchiectasis, ground glass opacity, cavity and pleural thickening. Six cases were confirmed by sputum smear microscopy, 4 by bronchoalveolar lavage, 2 by percutaneous lung biopsy and 1 by renal abscess puncture. After diagnosis, antibiotics such as Co-trimoxazole, amikacin, cephalosporins, imipenem, minomycin, or linezolid were used, and the 13 patients were all cured and discharged. Conclusions: Pulmonary nocardiosis was the most common clinical presentation of nocardial infection. Cough, expectoration and fever were the most common symptoms. The main findings of CT scans were nodules or masses, bronchiectasis, ground glass opacity, cavity and pleural thickening. The diagnosis of nocardiosis was not easy because of the non-specific clinical presentations and difficult culture of nocardia spp. Thus, high clinical suspicion of nocardiosis is necessary for earlier diagnosis and treatment.

An experimental system for coiled tubing partial underbalanced drilling (CT-PUBD) technique

To improve the rate of penetration (ROP) in hard formations, a new high-speed drilling technique called Coiled Tubing Partial Underbalanced Drilling (CT-PUBD) is proposed. This method uses a rotary packer to realize an underbalanced condition near the bit by creating a micro-annulus and an overbalanced condition at the main part of the annulus. A new full-scale laboratory experimental system is designed and set up to study the hydraulic characteristics and drilling performance of this method. The system is composed of a drilling system, circulation system, and monitor system, including three key devices, namely, cuttings discharge device, rotary packer, and backflow device. The experimental results showed that the pressure loss increased linearly with the flow rate of the drilling fluid. The high drilling speed of CT-PUBD proved it a better drilling method than the conventional drilling. The experimental system may provide a fundamental basis for the research of CT-PUBD, and the results proved that this new method is feasible in enhancing ROP and guaranteeing the drilling safety.

[Clinical experience in diagnosis and treatment of primary retroperitoneal liposarcoma]

Objective: To summarize the experience in diagnosis and treatment of primary retroperitoneal liposarcoma. Methods: The clinic data of 73 cases of primary retroperitoneal liposarcoma were reviewed. The age of patients was 23 to 75 years old, with a median age of 53 years. Forty-five cases were treated for the first time, and 28 cases were re-treated after local recurrence. All patients underwent ultrasonography, CT or MRI before operation and were diagnosed of primary retroperitoneal liposarcoma. Results: No lymph node and distant metastasis were found in all patients. The maximum diameter of the tumor was 3-40 cm, with a median diameter of 18.9 cm. Of the 45 patients with primary treatment, 6 patients were in T2 stage and 39 in T3 stage. Of the 28 patients with retreatment after local recurrence, 4 patients were in T1, 8 in T2, and 16 in T3 stage. All the 73 patients received surgery, 7 were treated with adjuvant radiotherapy, and 3 received adjuvant chemotherapy. One hundred and ten operations were performed in 73 patients. Sixty-seven cases were diagnosed of well differentiated liposarcoma, with 60 cases of lipoma-like liposarcoma and 7 cases of sclerosing liposarcoma. Nine cases were diagnosed of dedifferentiated liposarcoma, 16 cases were myxoid liposarcoma, and 2 cases were pleomorphic liposarcoma. Sixteen cases were mixed types. A total of 69 cases were followed up for 6 months to 13 years, with an average of 4 years. Sixty-six cases obtained complete resection, 34 cases relapsed, and the recurrence rate was 51.5% (34/66). Distant metastasis occurred in 4 cases. Fourteen cases died of tumor recurrence or distant metastasis and the rest were all alive. Four cases lost follow-up after 3 months. No matter in the initial treatment group or the retreatment group, the recurrence rate of combined organ resection is lower than that of simple tumor resection, and the average recurrence time was longer. Results: Primary retroperitoneal liposarcoma was rare in clinical experience. CT is the most effective method in the diagnosis of retroperitoneal liposarcoma, however pathological examination was still the key to the diagnosis. The main treatment of retroperitoneal liposarcoma was surgical resection. Complete resection was the objective of the operation, and the combined viscera resection was performed for those with invasion of other organs. Retroperitoneal liposarcoma had the characteristics of local recurrence after operation and insensitivity to radiotherapy and chemotherapy, but the recurrent tumor can still be resected.

Sustained Abdominal Aorta Compression Elevates Coronary Perfusion Pressure after Asphyxia-Induced Cardiac Arrest in a Rabbit Model

Objective

To investigate whether sustained abdominal aorta compression (SAAC) can improve coronary perfusion pressure (CPP) during cardiopulmonary resuscitation (CPR) and improve resuscitation outcomes without causing liver laceration.

Design and Setting

Animal study.

Methods

Cardiac arrest was induced by asphyxia in 28 New Zealand rabbits and maintained for 2 minutes before resuscitation. Animals were resuscitated using either standard CPR (STD-CPR group) or standard CPR and SAAC (SAAC-CPR group). Restoration of spontaneous circulation (ROSC), restoration of spontaneous breathing (ROSB) and cerebral performance category score were determined. CPP, mean arterial pressure (MAP) and ROSC were compared in the two groups.

Results

MAP and CPP in the SAAC-CPR group were significantly higher than in the STD-CPR group. However, MAP and blood gas results showed no significant difference between the two groups during ROSC. ROSC was achieved in seven of fourteen animals in the STD-CPR group and in eleven of fourteen animals in the SAAC-CPR group. Five animals in the STD-CPR group and nine in the SAAC-CPR group survived 24 hours after ROSC. No liver injury occurred in the two groups.

Conclusions

SAAC-CPR produces an increased CPP and MAP than traditional CPR and it does not lead to liver laceration/injury.

Calpain-activated mTORC2/Akt pathway mediates airway smooth muscle remodelling in asthma

BACKGROUND

Allergic asthma is characterized by inflammation and airway remodelling. Airway remodelling with excessive deposition of extracellular matrix (ECM) and larger smooth muscle mass are correlated with increased airway responsiveness and asthma severity. Calpain is a family of calcium-dependent endopeptidases, which plays an important role in ECM remodelling. However, the role of calpain in airway smooth muscle remodelling remains unknown.

OBJECTIVE

To investigate the role of calpain in asthmatic airway remodelling as well as the underlying mechanism.

METHODS

The mouse asthma model was made by ovalbumin sensitization and challenge. Calpain conditional knockout mice were studied in the model. Airway smooth muscle cells (ASMCs) were isolated from smooth muscle bundles in airway of rats. Cytokines IL-4, IL-5, TNF-α, and TGF-β1, and serum from patients with asthma were selected to treated ASMCs. Collagen-I synthesis, cell proliferation, and phosphorylation of Akt in ASMCs were analysed.

RESULTS

Inhibition of calpain using calpain knockout mice attenuated airway smooth muscle remodelling in mouse asthma models. Cytokines IL-4, IL-5, TNF-α, and TGF-β1, and serum from patients with asthma increased collagen-I synthesis, cell proliferation, and phosphorylation of Akt in ASMCs, which were blocked by the calpain inhibitor MDL28170. Moreover, MDL28170 reduced cytokine-induced increases in Rictor protein, which is the most important component of mammalian target of rapamycin complex 2 (mTORC2). Blockage of the mTORC2 signal pathway prevented cytokine-induced phosphorylation of Akt, collagen-I synthesis, and cell proliferation of ASMCs and attenuated airway smooth muscle remodelling in mouse asthma models.

CONCLUSIONS AND CLINICAL RELEVANCE

Our results indicate that calpain mediates cytokine-induced collagen-I synthesis and proliferation of ASMCs via the mTORC2/Akt signalling pathway, thereby regulating airway smooth muscle remodelling in asthma.

Epithelial neutrophil-activating peptide-78 recruits neutrophils into pleural effusion

The aim of this study was to investigate the presence of epithelial neutrophil-activating peptide (ENA)-78 in pleural effusions, as well as the chemoattractant activity of pleural ENA-78 on neutrophils. Pleural effusion and serum samples were collected from 75 patients who presented to the respiratory institute (19 with malignant pleural effusion, 21 with tuberculous pleural effusion, 18 with infectious pleural effusion and 17 with transudative pleural effusion). The concentrations of ENA-78, myeloperoxidase and neutrophil elastase were determined, and the chemoattractant activity of ENA-78 for neutrophils both in vitro and in vivo was also observed. The concentrations of ENA-78, myeloperoxidase and neutrophil elastase in infectious pleural effusion were significantly higher than those in malignant, tuberculous and transudative groups, respectively (all p<0.01). Infectious pleural fluid was chemotactic for neutrophils in vitro and anti-ENA-78 antibody could partly inhibit these chemotactic effects. Intrapleural administration of ENA-78 produced a marked progressive influx of neutrophils into pleural space. Compared with noninfectious pleural effusion, ENA-78 appeared to be increased in infectious pleural effusion. Our data suggested that ENA-78 was able to induce neutrophil infiltration into pleural space and might be responsible for pleural neutrophil degranulation.

Diagnostic accuracy of tumour markers for malignant pleural effusion: a meta-analysis

BACKGROUND

The role of tumour markers such as carbohydrate antigen (CA) 125, CA 15-3, CA 19-9 and CYFRA 21-1 (a fragment of cytokeratin 19) in differentiating malignant pleural effusions (MPE) from benign effusions is not yet clear.

METHODS

After a systematic review of English language studies, sensitivity, specificity and other measures of accuracy of pleural concentrations of CA 125, CA 15-3, CA 19-9 and CYFRA 21-1 or their combinations in the diagnosis of MPE were pooled using random effects models. Summary receiver operating characteristic curves were used to summarise overall test performance.

RESULTS

Twenty-nine studies met the inclusion criteria for the analysis. The summary estimates of the sensitivity and specificity of these tumour markers were as follows: CA 125, 0.48/0.85; CA 15-3, 0.51/0.96; CA 19-9, 0.25/0.96; CYFRA 21-1, 0.55/0.91 for diagnosing MPE. The estimated summary receiver operating characteristic curves showed that the performance of pleural CA 125 and CA 19-9 measurement in the diagnosis of MPE was limited, whereas that of CA 15-3 and CYFRA 21-1 was better. When two or more of the above four tumour markers were combined, or combined with carcinoembryonic antigen, the sensitivity and specificity were all increased to different extents.

CONCLUSIONS

The current evidence does not recommend using one tumour marker alone for the diagnosis of MPE, but the combination of two or more tumour markers seems to be more sensitive. The results of tumour marker assays should be interpreted in parallel with clinical findings and the results of conventional tests.

CD28/CTLA-4--CD80/CD86 and ICOS--B7RP-1 costimulatory pathway in bronchial asthma

Costimulatory molecules are cell surface glycoproteins that can direct, modulate and fine-tune T-cell receptor signals. The B7-1/B7-2--CD28/CTLA-4 and ICOS-B7RP-1 pathway provides key second signals that can regulate the activation, inhibition and fine-tuning of T-lymphocyte responses. The expression of B7-1/B7-2--CD28/CTLA-4 molecules on clinical samples from patients with asthma have been well studied, and the results indicate that different extents of these molecules are expressed on the surface of various cells, and that the concentrations of soluble form of these molecules are elevated in the sera of patients with asthma. There is a burst of papers describing an important role for B7-1/B7-2--CD28/CTLA-4 pathway in the Th1/Th2 balance. Similarly, ICOS stimulates both Th1 and Th2 cytokine production but may have a preferential role in Th2 cell development. Moreover, The B7-1/B7-2-CD28/CTLA-4 and ICOS-B7RP-1 pathway has been suggested of being involved in the development of airway inflammation and airway hyperresponsiveness. Further study of the functions of the pathways within the CD28/CTLA-4--CD80/CD86 and ICOS--B7RP-1 superfamily individually and their interplay should provide insights into the pathogenesis of asthma, and has great therapeutic potential for treatment of asthma.

Interleukin-16 in tuberculous and malignant pleural effusions

The aim of this study was to explore the presence of interleukin (IL)-16 in pleural effusions, the correlation between IL-16 levels and cytological parameters, as well as the chemoattractant activity of IL-16 on CD4+ T-lymphocytes. Total nucleated cell and differential counts, and IL-16 concentrations in the pleural effusion from 32 patients with tuberculous pleurisy and 30 patients with lung cancer were determined. Three-colour flow cytometry was performed to determine T-lymphocyte subsets in cell pellets of pleural effusion. The chemoattractant activity of IL-16 for CD4+ T-lymphocytes was also analysed. The levels of IL-16 were significantly higher in tuberculous than in malignant effusions. However, IL-16 levels could not be used for diagnostic purposes due to significant overlap between the two groups. Positive correlations were found between the IL-16 levels and CD4+ T-cells, and pleural fluid was chemotactic for CD4+ T-cells in vitro. Intrapleural administration of IL-16 to patients produced a marked progressive influx of CD4+ T-cells into the pleural space. Compared with malignant pleural effusion, interleukin-16 appeared to be increased in tuberculous pleural effusion. Interleukin-16 levels were positively related to the numbers of CD4+ T-cells, and interleukin-16 could directly induce CD4+ T-cell infiltration into the pleural space.

CD4CD25 regulatory T lymphocytes in allergy and asthma

Allergic asthma is characterized by airway hyper-responsiveness and chronic mucosal inflammation mediated by CD4(+) Th2 lymphocytes. Regulatory CD4(+)CD25(+) T cells are important components of the homeostasis of the immune system, as impaired CD4(+)CD25(+) T cell activity can cause autoimmune diseases and allergy. The mechanism of suppression by CD4(+)CD25(+) T cells remains controversial; different in vivo and in vitro studies raise possible roles for the immunosuppressive cytokines interleukin-10 and transforming growth factor-beta, forkhead transcription factor Foxp3, glucocorticoid-induced tumor necrosis factor receptor, cytotoxic lymphocyte associated antigen-4, 4-1BB costimulator receptor, a CD4-related molecule LAG-3, and neuropilin-1. Current data suggest that Th2 responses to allergens are normally suppressed by CD4(+)CD25(+) T cells. Suppression by CD4(+)CD25(+) T cells is decreased in allergic individuals. Furthermore, CD4(+)CD25(+) T cells play a key role in regulating airway eosinophilic inflammation. The immunomodulatory properties of CD4(+)CD25(+) T cells do extend to Th2 responses, most notably by limiting the development of a proinflammatory CD4(+) Th2 phenotype characterized by reduced cytokine production. An understanding of the roles of CD4(+)CD25(+) T cells in vivo could provide better insight into the design of novel approaches to modulate the chronic airway inflammatory reaction evident in bronchial asthma.

Effects of allergen inhalation and oral glucocorticoid on serum soluble CTLA-4 in allergic asthmatics

BACKGROUND

The serum soluble cytotoxic T lymphocyte associated antigen-4 (sCTLA-4) concentration is significantly elevated in patients with asthma, and sCTLA-4 concentration correlate with the severity of asthma. The aim of the present study was to investigate effects of allergen inhalation and oral glucocorticoid on concentration of serum sCTLA-4 in patients with allergic asthma.

METHODS

Allergen inhalation challenge was conducted in allergic asthmatics with isolated early asthma response and those with dual asthma response. In a randomized, double-blind, placebo-controlled, parallel group fashion, prednisolone or placebo was give orally once a day for 2 weeks. Venous blood samples were collected before and after allergen inhalation or prednisolone administration for obtaining sera. The serum sCTLA-4 concentrations were determined using enzyme-linked immunosorbent assay.

RESULTS

The serum sCTLA-4 concentrations in the dual responder group increased from 29.0 (14.5-43.7) microg/l [median (25-75 percentiles)] before allergen inhalation to 44.0 (24.3-61.3) microg/l 24 h after allergen inhalation. In the isolated early responders, there were no significant increase in serum sCTLA-4 concentrations after allergen inhalation compared with baseline levels. There was a significant decrease in serum sCTLA-4 concentrations after 2 weeks of glucocorticoid therapy [22.0 (15.5-31.0) microg/l] compared with baseline values [37.0 (19.5-53.0) microg/l], whereas there was no significant difference in the placebo group.

CONCLUSION

This study has demonstrated that serum sCTLA-4 concentrations increased after allergen inhalation in sensitized asthmatic subjects, and that serum sCTLA-4 concentrations were downregulated by prednisolone therapy.

The influence of pH on hydrolysis and acidogenesis of kitchen wastes in two-phase anaerobic digestion

Batch and semi-continuous experiments were carried out to determine the effect of pH on hydrolysis and acidogenesis of kitchen wastes in the two-phase anaerobic digestion. The results of the batch experiment showed pH adjustment could improve both hydrolysis and acidogenesis rates of kitchen wastes. Compared with pH at 5, 9 and 11, pH 7 provided an optimum working condition for anaerobic digestion of kitchen wastes. At pH 7, about 86% of the total organic carbon (TOC) and 82% of chemical oxygen demand (COD) were solubilized and the maximum volatile fatty acid (VFA) concentration of 36 g l(-1) was achieved on the fourth day. The total VFA yield was 0.27 g (g total solid (TS))(-1), which almost doubled the yield without pH adjustment (0.15 g (g TS)(-1). The acidified products with lower concentration of lactic acid were more favorable to the subsequent methanogenesis. At pH 7, most of the protein was degraded into ammonia nitrogen (NH4(+)-N), resulting in additional buffer of acidified liquid. According to this, a novel method of pH adjustment applying NH4(+)-N buffer was established. The semi-continuous experiment indicated that adjusting pH to 7 in the acidogenic stage in the two-phase anaerobic digestion process would increase both TS loading rate (16g l(-1) d(-1)) and recovery of biological energy (520 ml methane (CH4) (g TS)(-1)).

Soluble CD86 protein in serum samples of patients with asthma

BACKGROUND

Previous studies have reported that soluble (s) CD86 is involved in the initiation of the immune response. A study was undertaken to investigate the concentrations of sCD86 in serum samples from patients with bronchial asthma and to determine the cell origin of sCD86.

METHODS

Serum sCD86 concentrations were measured in 52 asthmatic subjects and 25 non-atopic normal volunteers using an enzyme linked immunosorbent assay, and the relationship of serum sCD86 concentrations to asthma severity and to total and differential white cell counts was analysed. Each type of white blood cell was purified and cultured in vitro to determine the cell origin of serum sCD86.

RESULTS

Serum samples from patients with an acute asthma exacerbation had much higher levels of sCD86 (585.4 (20.5) IU/ml) than those from stable asthmatics (479.6 (15.7) IU/ml, p<0.001) and healthy individuals (435.1 (13.8) IU/ml, p<0.001), and there was no difference between the latter two groups (p = 0.079). In asthmatic subjects the serum sCD86 level was inversely correlated with airway responsiveness, forced expiratory volume in 1 second, and with arterial carbon dioxide tension. In addition, the serum sCD86 level was positively correlated with numbers of lymphocytes, eosinophils, monocytes, but not neutrophils. The in vitro experiments indicated that sCD86 was produced by monocytes.

CONCLUSIONS

The serum sCD86 protein level was significantly increased in asthmatic subjects during an exacerbation and correlated with the severity of asthma. sCD86 is most probably derived from monocytes in the peripheral blood.

Endobronchial eosinophils preferentially stimulate T helper cell type 2 responses

BACKGROUND

Antigen-loaded eosinophils instilled intratracheally into mice were capable of migrating into local lymph nodes and localize to the T cell-rich paracortical zones where they stimulated antigen-specific proliferation of CD4+ T cells. The aim of the present study was to evaluate whether eosinophils within the tracheobronchial lumen can stimulate Th2 cell expansion by presenting antigen both in vitro and in vivo.

METHODS

Airway eosinophils were recovered from ovalbumin-sensitized and -challenged BALB/c mice, these eosinophils were then co-cultured with sensitized CD4+ cells in the absence or presence of anti-CD80 or/and -CD86 monoclonal antibodies. Airway eosinophils were instilled into the trachea of sensitized mice. At 3 days thereafter, the draining paratracheal lymph nodes were removed and teased into cell suspensions for culture. Cell-free culture supernatants were collected for detection of cytokines.

RESULTS

Our data showed that airway eosinophils functioned as CD80- and CD86-dependent antigen-presenting cells (APCs) to stimulate sensitized CD4+ lymphocytes to produce interleukin (IL)-4, IL-5, and IL-13, but not interferon (IFN)-gamma in in vitro assay. When instilled intratracheally in sensitized recipient mice, airway eosinophils migrated into draining paratracheal lymph nodes primed Th2 cells in vivo for IL-4, IL-5, and IL-13, but not IFN-gamma, production during the in vitro culture that was also CD80- and CD86-dependent.

CONCLUSION

Eosinophils within the lumina of airways could process inhaled antigen function in vitro and in vivo as APCs to promote expansion of Th2 cells. This investigation highlights the potential of eosinophils to not only act as terminal effector cells but also to actively modulate immune responses by amplifying Th2 cell responses.

Measurements of the cross section for e(+)e(-) --> hadrons at center-of-mass energies from 2 to 5 GeV

We report values of R = sigma(e(+)e(-)-->hadrons)/sigma(e(+)e(-)-->mu(+)mu(-)) for 85 center-of-mass energies between 2 and 5 GeV measured with the upgraded Beijing Spectrometer at the Beijing Electron-Positron Collider.

[Application of traditional Chinese medicine in space medical research]

With the development of space medicine, traditional Chinese medicine and Chinese herbs have been widely used in counteracting motion sickness, bone loss, muscle atrophy, and circulation system disorder, improving body's adaptability and protecting the effect of irradiation, hypoxia and noise. This paper summarized the application of basic theories of traditional Chinese medicine, Chinese herbs, acupoint treatment and Qigong in space medical research.

Lymph node trafficking and antigen presentation by endobronchial eosinophils

Because eosinophils recruited into the airways in allergic diseases are exposed to inhaled allergens, we evaluated whether eosinophils within the endobronchial lumen can function in vivo as antigen-presenting cells for inhaled antigens. We recovered eosinophils from the airways after aerosol antigen challenge in sensitized mice or from the peritoneal cavities of IL-5 transgenic mice and fluorescently labeled these cells ex vivo. These labeled cells, instilled intratracheally into normal mice, migrated into draining paratracheal lymph nodes and localized to T cell-rich paracortical areas. The homing of airway eosinophils to lymph nodes was not governed by eotaxin, because CCR3(-/-) and CCR3(+/+) eosinophils migrated identically. Airway eosinophils, recovered after inhalational antigen challenge in sensitized mice, expressed MHC class II and costimulatory CD80 and CD86 proteins and functioned in vitro as CD80- and CD86-dependent, antigen-specific, antigen-presenting cells. Moreover, when instilled into the airways of antigen-sensitized recipient mice, airway eosinophils recovered after inhalational antigen challenge stimulated antigen-specific CD4(+) T cell proliferation within paratracheal lymph nodes. Thus, eosinophils within the lumina of airways can process inhaled antigens, traffic to regional lymph nodes, and function in vivo as antigen-presenting cells to stimulate responses of CD4(+) T cells.

[Effects of 7 d head-down tilt (-20 degrees) immobilization on pharmacokinetics of gentamicin in rabbits]

OBJECTIVE

To observe pharmacokinetic changes under simulated weightlessness in relevant to body flood flow changes.

METHOD

Gentamicin was selected as probe drug in the present study, and rabbits exposed to Head-Down Tilt (HDT, -20 degrees) immobilization were selected as simulated weightlessness animal model. Seven rabbits were treated inf. with 3 mg/kg of gentamicin sulfate pre-HDT and 7 d after HDT. Gentamicin blood samples within 4 h after administration were analyzed by TDxFLx.

RESULT

The distribution of gentamicin postponed significantly: a significant decrease in alpha from (0.1838 +/- 0.1076) min-1 before HDT to (0.0591 +/- 0.0334) min-1 after HDT; a significant increase in t1/2 alpha from (5.30 +/- 3.55) min to (15.04 +/- 7.49) min; a significant decrease in k12 from (0.1025 +/- 0.0721) min-1 to (0.0181 +/- 0.0161) min-1, a increase trend in V(C) and V(D). After HDT, CL(S) of gentamicin increased from (2.2 +/- 0.5) ml min-1 kg-1 to (2.7 +/- 0.3) ml min-1 kg-1.

CONCLUSION

Simulated weightlessness might induce pharmacokinetic changes.

[Counteracting effect of Chinese herbs-compounds on "blood stasis" induced by bed rest]

Objective. To observe the improved effect of syndromes of blood stasis by taking Chinese medicine during bed-rest simulated weightlessness. Method. Ten subjects were randomly divided into two groups: Chinese medicine group and control group. Both of them were exposed to HDBR -6 degrees for a week. The Chinese medicine group took Chinese medicine during the bed rest, and the control group took sugar water. Result. Syndromes of blood stasis of Chinese medicine group had a significant relief. And some physiological parameters, such as blood pressure, pulse graph, and amount of urine, maintained the level of pre-bed rest. While the control group was more severe than the Chinese medicine group in syndromes of blood stasis. Conclusion. Chinese medicine can be a measure in preventing the effect of weightlessness.

[Counteracting effect of Chinese herbs on "insufficiency of spleen qi" induced by simulated weightlessness]

Objective. To observe the counteracting effect of a Chinese herb-compound on "insufficiency of spleen qi" induced by simulated weightlessness. Methods. Animal and human experiment were carried out to the Chinese herb-compound (Dangshen, Baizhu, Fuling etc). Result. This compound protected the tail suspended rats from atrophy of spleen, thymus, soleus and gastrocnemius muscles, prevented excessive decrease of body weight effectively; at the same time it relieved the symptoms of the subjects greatly. Conclusion. It demonstrated that the compound decreased the "insufficiency of spleen qi" of both animals and human subjects.

Effect of inhaled interleukin-5 on number and activity of eosinophils in circulation from asthmatics

The aim of the present study was to examine the effects of interleukin-5 (IL-5) inhalation on changes in the activity and number of circulating eosinophils, as well as concentrations of serum total IgE, in allergic asthmatics. A randomized double-blind, placebo-controlled study design was employed in which each subject acted as his or her own control. Eight nonsmoking patients with allergic asthma were administered recombinant human IL-5 by nebulization. Total white blood cell counts and differentials, as well as concentrations of ECP and total IgE in serum, were determined before and at 2, 24, and 48 h after inhalation. Our results demonstrated that eosinophil numbers increased from baseline (3.6 +/- 1.1 x 10(5)/ml) to 6.3 +/- 1.2 x 10(5)/ml (P < 0.01) at 24 h and to 5.7 +/- 0.9 x 10(5)/ml (P < 0.01) at 48 h after IL-5 inhalation in asthmatics. Accompanying this significantly increased blood eosinophilia were significantly elevated serum ECP levels. Compared with baseline (6.3 +/- 1.1 ng/ml), ECP levels increased with time following IL-5 inhalation, reaching 17.6 +/- 2.8 ng/ml (P < 0.01) at 24 h and remaining elevated at 48 h (18.1 +/- 2.9 ng/ml, P < 0.01). IL-5 inhalation had no significant effect on levels of serum total IgE, however. These findings provide direct evidence that nebulized IL-5 not only induces a significant blood eosinophilia but also results in the activation of circulating eosinophils. Our data further support the importance of IL-5 in the pathogenesis of bronchial asthma in humans.

[Comparison between two anti-motion sickness drugs]

Objective. To test the validity of an animal model in selecting anti-motion sickness drugs, and compare the effects of two drugs. Method. Anti-motion sickness effects of two drugs (Cyclizine and Scopolamin-d-amphetamin compound) were observed in rats with motion sickness (MS) induced by rotatory stimulation and the amount of Kaolin ate by rats was taken as an evaluation criterion. Result. The consumption of Kaolin by the rats decreased significantly after administration of both drugs, and the effect of Scopolamin-d-amphetamin compound was better than those of Cyclizine under the same condition. Conclusion. It suggests that the rat model of motion sickness is practical and useful in studying anti-motion sickness drugs.

Alterations of T-lymphocyte subsets, soluble IL-2 receptor, and IgE in peripheral blood of children with acute asthma attacks

BACKGROUND

T-cell activation and alteration of cytokines are involved in the pathogenesis of atopic asthma. However, the profile of circulating T-lymphocyte subsets, related cytokines, and plasma IgE during acute asthma attacks is still unclear.

OBJECTIVE

In an attempt to illustrate the dynamics of these parameters in asthma attacks, we investigated the changes of T-cell subsets, lymphocyte activation, soluble IL-2R, and IgE in peripheral blood in children during and after acute asthma attacks.

METHODS

This study was carried out in a cohort of Chinese children (n = 59) with acute asthma attacks. Immunoassays were performed when the patients had acute attacks before treatment, and the patients were reexamined in the 4 weeks after the resolution of acute attacks with therapy. Paired t tests were used for the statistical analysis of these patients to compare the data obtained during and after the acute attacks. Twenty healthy, age-matched subjects were used as normal control subjects. Nine children with long-term stable asthma were used as control subjects with stable asthma.

RESULTS

CD3+, CD4+, CD8+, and IL-2R+ (CD25+) cells; plasma soluble IL-2 receptor; and IgE were significantly higher in patients with acute attacks than in control subjects. (P <.05, P <.05, P <.001, P <.05, P <.0001, and P <.0001, respectively). Immunoelectron microscopy exhibited an increased expression of IL-2R on lymphocytes in acute attacks as compared to control subjects. The abnormalities returned to normal, with the exception of IgE, when clinical remission was achieved after treatment. Correlation analyses revealed a positive relationship between plasma IgE and soluble IL-2R in asthma attacks (r = 0.83, P =.0001). Plasma IgE and soluble IL-2R of those who were in remission positively correlated with their production in acute attacks (r = 0.58, P =.001 and r = 0.71, P =.0001, respectively).

CONCLUSION

This study suggests that (1) the percentage of CD4+, CD8+, or IL-2R+ lymphocytes in peripheral blood was significantly elevated during acute attacks and returned to normal ranges after complete remission was achieved; (2) plasma soluble IL-2R is a sensitive marker for asthma activity; and (3) atopic asthmatic children seem to have a hereditary predisposition of having higher levels of soluble IL-2R in asthma attacks, coinherited with the trait of IgE.

Inhaled IL-5 increases concentrations of soluble intracellular adhesion molecule-1 in sputum from atopic asthmatic subjects

BACKGROUND

Both IL-5 and intracellular adhesion molecule-1 (ICAM-1) have been shown to play important roles in the production of allergic inflammation, including atopic asthma.

OBJECTIVE

The aim of this study was to investigate the effects of recombinant human IL-5 on changes of soluble (s) ICAM-1 concentrations in induced sputum from allergic asthmatic subjects.

METHODS

In a randomized, double-blind, placebo-controlled study design, 8 nonsmoking patients with allergic asthma and 6 nonallergic normal subjects were administered recombinant human IL-5 by nebulization, and the concentrations of sICAM-1 in induced sputum from each subject were determined before and at 2, 24, 48, and 72 hours after inhalation.

RESULTS

sICAM-1 levels in sputum within the control group did not appear to change from baseline at any time throughout the study. In allergic asthmatic subjects vehicle challenge was not able to cause any changes in sputum sICAM-1 concentrations. However, there were increases in sputum sICAM-1 concentrations after IL-5 inhalation, which increased with time to significantly greater levels than those at baseline, reaching a maximum at 48 hours and lasting no less than 72 hours. The concentrations of sICAM-1 in sputum after IL-5 challenge exceeded levels that could be accounted for by passive transudation from the circulation on the basis of the magnitude of increases in sputum albumin concentration.

CONCLUSION

Our results indicated that IL-5 inhalation was capable of inducing an elevation of sputum sICAM-1 concentration by stimulating its local release in allergic asthmatic, but not in nonallergic normal, subjects.

Effect of inhaled interleukin-4 on airway hyperreactivity in asthmatics

lnterleukin-4 (IL-4) has been shown to play a crucial role in the pathogenesis of allergic disease including bronchial asthma. In order to investigate the role of IL-4 in airway hyperreactivity, we investigated the effect of inhaled recombinant human IL-4 on airway responsiveness to methacholine and eosinophil numbers in induced sputum in eight patients with allergic asthma using a placebo-controlled study design. Our results demonstrated that in the control experiments receiving vehicle inhalation, methacholine PC20 values did not change nor did the numbers of eosinophils in sputum change from baseline values. In contrast, after IL-4 inhalation, methacholine PC20 fell from baseline (0.43 +/- 1.81 mg/mI) to 0.22 +/- 1.73 mg/mI (p < 0.01) at 24 h, and to 0.21 +/- 1. 74 mg/ml (p < 0.01) at 48 h. Accompanying this increased airway sensitivity was a significant eosinophilia in sputum. Our data indicated that IL-4 increases airway responsiveness by recruiting eosinophils into the airway in patients with allergic bronchial asthma.

Effect of inhaled interleukin-5 on airway hyperreactivity and eosinophilia in asthmatics

In order to investigate the role of interleukin-5 (IL-5) in airway hyperreactivity and eosinophilia, we observed the effect of inhaled recombinant human IL-5 on airway responsiveness to methacholine and cell populations in induced sputum in eight patients with allergic bronchial asthma using a placebo-controlled study design. Our results demonstrated that the inhalation of IL-5 did not alter lung function in allergic asthmatics. In the control experiments receiving either vehicle or 0.4 ng of endotoxin, methacholine PC20 values did not change nor did the numbers of eosinophils or eosinophil cationic protein (ECP) sputum values change from baseline. In contrast, after IL-5 inhalation, methacholine PC20 fell from baseline (0.90 +/- 166 mg/ml) to 0.32 +/- 1.63 mg/ml (p < 0.01) at 24 h, and to 0.55 +/- 1.49 mg/ml (p < 0.05) at 48 h. Accompanying this increased airway sensitivity was a significant eosinophilia and elevated concentrations of ECP in induced sputum. Our data provided direct evidence that IL-5 increases airway responsiveness and infiltration of activated eosinophils into the airway in patients with allergic bronchial asthma. It also could be concluded that the observed airway hyperreactivity and eosinophilia were not endotoxin related.

[Polymerase chain reaction for the diagnosis of tuberculous pleural effusion]

Polymerase chain reaction was applied to detect DNA of mycobacterium tuberculosis in 62 patients with pleural effusion, and result of PCR was compared with those of conventional procedures. It was found that in 34 tuberculous pleural effusion, the positive rates of pleural effusion acid-fast staining, culture and PCR was 5.9%, 8.8% and 52.9%, respectively. The sensitivity of PCR was much higher than those of acid-fast staining and culture (all P < 0.01). The results of acid-fast staining and culture in 28 non-tuberculous effusion were negative, there were, however, 4 PCR positive results within this group (14.3%). Our results suggested that for the diagnosis of mycobacterium tuberculosis PCR is a rapid, sensitive and specific procedure. Some factors that affected the results of PCR were discussed.

[Diagnosis and taxonomy of periodical psychosis]

The concept and taxonomy of periodic psychosis still remains in controversy for the past 100 years. In China, it was first reported by Ji, and thereafter various rinds of terminology and views were given by different authors. In the presentation, clinical investigation and follow up were carried out in 62 cases. In many of these cases, the so-called "periodic psychosis" or "phasophrenia" was early clinical features of schizophrenia or manic-depression. In those cases with apparent symptoms and signs of diencephalic function, differential diagnosis should be carried out from organic brain syndrome. In a small number of cases, their clinical manifestations, conforming to previous diagnostic criteria, might be an uncommon syndrome. It was concluded by the authors that until now periodic could be considered only as a clinical syndrome rather than a disease entity.