Specific dermatoglyphic traits of patients with occupational allergic bronchitis

Dermatoglyphic traits proved to be closely associated with chronic mechanic bronchitis (CMB). With the most informative traits identified, it is possible to estimate the individual predisposition to this occupational disorder and thereby to increase the efficiency of preliminary and follow-up medical examinations. Comparison with data on dermatoglyphic traits predisposed to various types of pneumoconiosis supported the hypothesis on a single mechanical lung disease or "general dust lung disease".     

Function of external respiration in patients with systemic scleroderma (according to roentgenopneumopolygraphic data)

External respiratory function was investigated in 33 patients with systemic scleroderma+ using roentgenopneumopolygraphy (RPPG). Respiratory changes consisted in diffuse and regional ventilation disturbance (after emphysematous, hypoventilation or mixed type), disorders of respiratory kinetics of the diaphragm, ribs and mediastinum. External respiratory functional disturbance showed direct correlation with the patients' age, period of disease and a degree of pathological activity. The type of external respiratory functional disturbance was unchanged during observation over time. The use of exercise testing showed the presence of signs of latent ventilation insufficiency in most of the patients.     

CHRONIC DISABLING RESPIRATORY DISEASE—Ends and Means of Study

In the program of research into the natural history of coalworkers'' pneumoconiosis now being carried out in Great Britain, emphasis is being put upon the importance of sharpening and validating means for early diagnosis, and upon the need for follow-up studies upon properly selected population samples. Existing information from morbidity and mortality figures from chronic bronchitis and emphysema in Great Britain suggests that atmosphere pollutants are important etiological factors. A parallel is drawn between the course of events in pneumoconiosis, in which dust retention in the lungs does not greatly disable until complicated by tuberculous infection, and a hypothesis that bronchitis is a hypersecretion of bronchial mucus caused by atmospheric irritants and does not disable but encourages secondary infection which may cause emphysema. This hypothesis requires testing by follow-up studies of population samples exposed to various environmental influences. It is suggested that in order to bring this common and disabling disease under control, clinicians must widen their interests beyond the confines of the hospital walls.     

The present status of tranquilzing drugs

In the program of research into the natural history of coalworkers' pneumoconiosis now being carried out in Great Britain, emphasis is being put upon the importance of sharpening and validating means for early diagnosis, and upon the need for follow-up studies upon properly selected population samples. Existing information from morbidity and mortality figures from chronic bronchitis and emphysema in Great Britain suggests that atmosphere pollutants are important etiological factors. A parallel is drawn between the course of events in pneumoconiosis, in which dust retention in the lungs does not greatly disable until complicated by tuberculous infection, and a hypothesis that bronchitis is a hypersecretion of bronchial mucus caused by atmospheric irritants and does not disable but encourages secondary infection which may cause emphysema. This hypothesis requires testing by follow-up studies of population samples exposed to various environmental influences. It is suggested that in order to bring this common and disabling disease under control, clinicians must widen their interests beyond the confines of the hospital walls.     

Changes in adenosine deaminase and antioxidative enzyme activity in patients with lung diseases of dust etiology]

Activity of purine metabolism enzyme, adenosine deaminase (ADA) in lymphocytes and erythrocytes from patients with pneumoconiosis and chronic bronchitis was determined. ADA activity decrease was found in lymphocytes and erythrocytes for both decreases. The observed decrease of ADA activity indicates that after the long term work in mineral dust industry damage of purine metabolism takes place, that is similar to the disturbance observed under secondary immunodeficiency. Changes in activity of superoxide dismutase and catalase show some decrease of functional activity of anti-radical protection. Therefore the results obtained can be used for the selection of a group with highest risk of predisposition to these diseases.     

Etiological structure of respiratory infections in different variants of acute bronchitis

The microbiological and virological examination of 87 acute bronchitis patients (36 patients with the prolonged course and 31 patients with the relapsing course of the disease) was carried out. All forms of bronchitis were characterized by a high degree of infection with respiratory viruses and pneumococci. Haemophilus influenzae (type b) infection was registered rather rarely and only in combination with pneumococcal one. The highest characteristics of viro-bacterial associations were found in patients with acute bronchitis and with prolonged form of acute bronchitis, viral associations--with the prolonged and relapsing forms of the course of acute bronchitis in the presence of the bronchoobstructive syndrome.     

Cost-Effectiveness of Coal Workers' Pneumoconiosis Prevention Based on Its Predicted Incidence within the Datong Coal Mine Group in China

We aimed to estimate the economic losses currently caused by coal workers’ pneumoconiosis (CWP) and, on the basis of these measurements, confirm the economic benefit of preventive measures. Our cohort study included 1,847 patients with CWP and 43,742 coal workers without CWP who were registered in the employment records of the Datong Coal Mine Group. We calculated the cumulative incidence rate of pneumoconiosis using the life-table method. We used the dose-response relationship between cumulative incidence density and cumulative dust exposure to predict the future trend in the incidence of CWP. We calculate the economic loss caused by CWP and economic effectiveness of CWP prevention by a step-wise model. The cumulative incidence rates of CWP in the tunneling, mining, combining, and helping cohorts were 58.7%, 28.1%, 21.7%, and 4.0%, respectively. The cumulative incidence rates increased gradually with increasing cumulative dust exposure (CDE). We predicted 4,300 new CWP cases, assuming the dust concentrations remained at the levels of 2011. If advanced dustproof equipment was adopted, 537 fewer people would be diagnosed with CWP. In all, losses of 1.207 billion Renminbi (RMB, official currency of China) would be prevented and 4,698.8 healthy life years would be gained. Investments in advanced dustproof equipment would be total 843 million RMB, according to our study; the ratio of investment to restored economic losses was 1:1.43. Controlling workplace dust concentrations is critical to reduce the onset of pneumoconiosis and to achieve economic benefits.     

Noninvasive radiodiagnosis of left ventricular diastolic dysfunction in hypertensive patients

To define the informative value of Doppler studies in the early diagnosis of left ventricular (LV) diastolic dysfunction in patients with hypertensive disease (HD), the authors examined 74 patients with grade 1-2 HD, including 65 men and 9 women aged 43 to 63 years. All the patients underwent echocardiography (echoCG), Doppler echoCG (DechoCG), tissue DechoCG (TDechoCG), and treadmill. According to the echoCG LV mass index (LVMI), all the patients were divided into 2 groups: 1) 33 patients with increased LVMI and 2) 41 with normal LVMI. A control group consisted of 20 apparently healthy patients. Groups 1 and 2 showed a preponderance of patients with concentric LV hypertrophy (CLVH) and those with concentric LV remodeling, respectively. In accordance with DechoCG, the signs of primary LV diastolic dysfunction ((E/A = 0.8+/-0.1; IVRT = 103+/-15) were found only in Group 1 patients. TDechoCG displayed the signs of primary LV diastolic dysfunction in both groups (e' or =10 ratio, suggests elevated LV filling pressure as an early stage of diastolic dysfunction.     

The cellular composition of the bronchoalveolar washing in experimental anthracosis

Bronchoalveolar lavage (BAL) was performed in albino random-bred adult male rats with pneumoconiosis. Fibrotic reaction in the lungs was induced by inhalation coal dust during 6 months. BAL comprised 90.9 +/- 1.2% of macrophages; 4.4 +/- 0.8% of neutrophils and 4.5 +/- 1.0% of lymphocytes. The total cell number in BAL was higher (over 59%) in animals with pneumoconiosis. The number of cells on alveolar surface of the lungs was also higher. Fibrotic reaction in the lungs is probably directly related with the increased number of vital macrophages in the lung.     

Diabetic polyneuropathy. 4. Synopsis of electroneurographic findings in diabetics]

Sensory conduction velocity of the median nerve, motor conduction velocity of both median and tibial nerves, and corresponding distal laterncies are sufficient parameters to establish the diagnosis of polyneuropathy almost with certainty. Considering these six parameters yielded in detection of peripheral nerve dysfunction in 22% of diabetic patients who were free from clinical signs of polyneuropathy. Electroneurographical findings in 340 out of 677 patients with diabetes mellitus were interpreted as evidence of segmental demyelination. Within this group there was the majority of patients with clinical signs of polyneuropathy and with subclinical signs of peripheral nerve dysfunction. There existed a positive correlation between signs of nerve dysfunction with angiopathy, age and duration of the disease. A second group consisting of 243 diabetics with signs of incipient segmental demyelination with or without signs of axonaal degeneration mainly included juvenile patients with a short duration of the disease and with a low frequency of angiopathy.     

Clinical value of the pudendal somatosensory evoked potential

The pudendal evoked potential was recorded in 126 patients who had presented with various uro-genital complaints. The patients were divided into two groups depending on whether or not there were clinical signs of neurological disease. Group I consisted of 83 patients (66%) who on clinical examination were neurologically normal. In group 11 there were 43 patients (34%) who had physical signs suggesting underlying neurological pathology. The pudendal evoked potential was abnormal in 10 patients from the group with neurological signs (group 11) but only 1 patient from group I (a man who had made an excellent recovery from previous transverse myelitis). The conclusion of this study is that the pudendal evoked potential is of no greater value than the clinical examination in the assessment of patients with uro-genital dysfunction. The recommendation that the potential should be recorded as part of the routine assessment of patients suspected of having a neurogenic disorder of the bladder and sexual function should be reconsidered.     

Daily exposure to dust alters innate immunity

Pig farmers are exposed to organic material in pig barns on a daily basis and have signs of an ongoing chronic airway inflammation and increased prevalence of chronic inflammatory airway diseases, predominantly chronic bronchitis. Interestingly, the inflammatory response to acute exposure to organic dust is attenuated in farmers. The aim of the study was to closer characterize innate immunity features in blood and airways in farmers and in naïve, non-exposed, controls. The expression of pattern recognition receptors (TLR2, TLR4 and CD14) whose ligands are abundant in pig barn dust and adhesion proteins (CD11b, CD62L and CD162L) on blood and sputum neutrophils in pig farmers and soluble TLR2 and CD14 (sTLR2 and sCD14) in blood and sputum were assessed in pig farmers and previously unexposed controls. The release of pro-inflammatory cytokines from blood cells stimulated with LPS ex vivo was measured in the absence and presence of anti-ST2. We also examined, in a separate study population, serum levels of soluble ST2 (sST2), before and after exposure in a pig barn and a bronchial LPS challenge. Farmers had signs of ongoing chronic inflammation with increased number of blood monocytes, and decreased expression of CD62L and CD162 on blood neutrophils. Farmers also had lower levels of sTLR2 and sCD14 in sputum and reduced expression of CD14 on sputum neutrophils than controls. Exposure to organic dust and LPS induced increase of serum sST2 in controls but not in farmers. In conclusion, farmers have signs of local and systemic inflammation associated with altered innate immunity characteristics.     

Grain dust and the lungs.

Grain dust is composed of a large number of materials, including various types of grain and their disintegration products, silica, fungi, insects and mites. The clinical syndromes described in relation to exposure to grain dust are chronic bronchitis, grain dust asthma, extrinsic allergic alveolitis, grain fever and silo-filler''s lung. Rhinitis and conjunctivitis are also common in grain workers. While the concentration and the quality of dust influence the frequency and the type of clinical syndrome in grain workers, host factors are also important. Of the latter, smoking is the most important factor influencing the frequency of chronic bronchitis. The role of atopy and of bronchial hyperreactivity in grain dust asthma has yet to be assessed. Several well designed studies are currently being carried out in North America not only to delineate the frequency of the respiratory abnormalities, the pathogenetic mechanisms and the host factors, but also to establish a meaningful threshold limit concentration for grain dust.     

慢性阻塞性肺疾病不同表型患者CAT评分与肺功能及预后的相关性分析

摘要 目的：探讨慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）不同表型评估测试问卷（COPD assessment test,CAT）评分与肺功能及预后的关系。方法：收集361例COPD患者临床资料、CAT评分、肺功能检查结果及肺外合并症、肺内并发症等情况,按临床表型分为肺气肿组（n=200）和支气管炎组（n=161）,分析肺气肿组200例和支气管炎组161例COPD患者CAT评分与肺功能及预后的关系。结果：肺气肿组CAT评分高于支气管炎组（P<0.05）,一秒用力呼气容积（FEV₁）占预计值百分比（FEV₁%）、FEV₁/用力肺活量（FVC）低于支气管炎组（P<0.05）,吸气分数（IC/TLC）低于支气管炎组,残总比（RV/TLC）高于支气管炎组（P<0.05）;肺气肿组肺间质性病变、肺动脉高压发生率均高于支气管炎组（P<0.05）;支气管炎、肺气肿组CAT评分均与FEV₁%、FEV₁/FVC、IC/TLC呈负相关（P<0.05）,与RV/TLC呈正相关（P<0.05）,肺气肿各参数相关度更高（P<0.05）;肺气肿组不同CAT评分患者肺间质性病变、肺动脉高压发生率比较差异有统计学意义（P<0.05）,支气管炎组不同CAT评分肺动脉高压发生率比较差异有统计学意义（P<0.05）,随CAT评分的升高,肺气肿组肺间质性病变、肺动脉高压发生率上升,支气管炎组肺动脉高压发生率上升。结论： COPD肺气肿表型CAT评分较支气管炎表型高,肺功能降低更明显,呈现肺过度通气,气流受限特点,更易并发肺间质纤维化、肺动脉高压,且与CAT评分变化密切相关。     

Impact of heterozygote CFTR Mutations in COPD patients with Chronic Bronchitis

Background

Cigarette smoking causes Chronic Obstructive Pulmonary Disease (COPD), the 3rd leading cause of death in the U.S. CFTR ion transport dysfunction has been implicated in COPD pathogenesis, and is associated with chronic bronchitis. However, susceptibility to smoke induced lung injury is variable and the underlying genetic contributors remain unclear. We hypothesized that presence of CFTR mutation heterozygosity may alter susceptibility to cigarette smoke induced CFTR dysfunction. Consequently, COPD patients with chronic bronchitis may have a higher rate of CFTR mutations compared to the general population.

Methods

Primary human bronchial epithelial cells derived from F508del CFTR heterozygotes and mice with (CFTR+/-) and without (CFTR+/+) CFTR heterozygosity were exposed to whole cigarette smoke (WCS); CFTR-dependent ion transport was assessed by Ussing chamber electrophysiology and nasal potential difference measurements, respectively. Caucasians with COPD and chronic bronchitis, age 40 to 80 with FEV₁/FVC < 0.70 and FEV₁ < 60% predicted, were selected for genetic analysis from participants in the NIH COPD Clinical Research Network’s Azithromycin for Prevention of Exacerbations of COPD in comparison to 32,900 Caucasian women who underwent prenatal genetic testing. Genetic analysis involved an allele-specific genotyping of 89 CFTR mutations.

Results

Exposure to WCS caused a pronounced reduction in CFTR activity in both CFTR (+/+) cells and F508del CFTR (+/-) cells; however, neither the degree of decrement (44.7% wild-type vs. 53.5% F508del heterozygous, P = NS) nor the residual CFTR activity were altered by CFTR heterozygosity. Similarly, WCS caused a marked reduction in CFTR activity measured by NPD in both wild type and CFTR heterozygous mice, but the severity of decrement (91.1% wild type vs. 47.7% CF heterozygous, P = NS) and the residual activity were not significantly affected by CFTR genetic status. Five of 127 (3.9%) COPD patients with chronic bronchitis were heterozygous for CFTR mutations which was not significantly different from controls (4.5%) (P = NS).

Conclusions

The magnitude of WCS induced reductions in CFTR activity was not affected by the presence of CFTR mutation heterozygosity. CFTR mutations do not increase the risk of COPD with chronic bronchitis. CFTR dysfunction due to smoking is primarily an acquired phenomenon and is not affected by the presence of congenital CFTR mutations.     

Cross sectional study on cytokine production (TNF-α, IL-8) in German coalminers with progressive massive fibrosis and in control miners using a rapid wholeblood assay

Whole-blood release of tumour necrosis factor (TNF-α) and interleukin 8 (IL-8) was studied in 26 German ex-coalminers with progressive massive fibrosis (≥A, ILO 1980; cases) and 26 ex-miners free of pneumoconiosis (≤ 0/1; controls) using a simple wholeblood assay. Cases and controls were matched individually by age and duration of coalmine dust exposure (5-year window). Whole-blood cytokine release was determined (blinded to case control status) in incubations without additions (spontaneous) and with endotoxin (LPS, 3 ng ml^-1) or with coalmine dust (CMD; 5 mg ml^-1). CMD-stimulated TNF-α release was significantly increased and LPS-induced IL-8 release was significantly decreased in cases (matched t-tests: p < 0.01). No effect of duration of exposure was detectable in an unmatched analysis. No clear relationship with lung function parameters independent from case/control-status was observed, although a possible positive association with central airway resistance was indicated by multiple regression for both CMD stimulated TNF-α and LPS-stimulated IL-8. This study on individually matched coalminers validates previous findings on monocyte TNF release as a marker for pneumoconiosis using a method (whole-blood assay) that is more feasible for epidemiological studies. The different response of TNF-α and IL-8 may be useful in studying the occurrence of different endpoints like pneumoconiosis and lung function decrease.     

Pneumoconiosis and chronic bronchitis.

Data from a major long-term epidemiological survey in the British coalmining industry were examined to determine whether bronchitis offered any protective action against the development of pneumoconiosis. No evidence of such an effect was found.     

Characterization of alveolar macrophage eicosanoid production in a non-human primate model of mineral dust exposure

The relative activation of eicosanoid production which results from the exposure of the alveolar macrophage (AM) to mineral dusts is thought to be a key factor in the pathophysiology of occupational lung disease. We compared in vitro basal and silica-stimulated production of prostaglandin E₂ (PGE₂) and thromboxane A₂ (TXA₂) by AM from normal humans and non-human primates (Macaca nemistrina). In addition, we instilled mineral dusts directly into one lung of the non-human primate and evaluated AM eicosanoid production at two week intervals following dust instillation. Unstimulated AM from humans produce more PGE₂ and TXA₂ than do AM from M. nemistrina. However, in vitro exposure of AM from both species to silica dust produced a qualitatively similar increase in TXA₂ production accompanied by no change in PGE₂ production. Sequential analysis of AM eicosanoid production following a single bolus exposure to bituminous or anthracite coal dusts, titanium dioxide (TiO₂) dust or crystalline silica showed marked variability among individual non-human primates in qualitative and quantitative aspects of dust-induced eicosanoid production. However, the rank order of potency of the different dusts (silica > anthracite > bituminous) correlated with epidemiological evidence relating the type of dust mined to the incidence of pneumoconiosis. These studies suggest that the non-human primate may serve as a model for the study of both the role of eicosanoids in the etiology of dust-induced occupational lung disease and the biochemical basis for individual variability in the response of lung cells to mineral dust exposure.     

12 例多系统萎缩患者的临床特点和诊断分析

目的:研究12例多系统萎缩(multiple system atrophy MSA)患者的临床特点,分析诊断要点。方法:回顾性分析12例多系统萎缩病例,探讨其临床特点和早期诊断的要点。结果:本组病例均为慢性、隐袭性起病,男性居多,男:女=1.4:1。平均发病年龄49.2岁(35.0岁～72.0岁)。平均病程33个月(6个月～60个月)。MSA-P亚型4例,MSA-C亚型8例,以MSA-C亚型占优势。MSA-P亚型中以行动迟缓为主要首发表现(75%),主要体征分别为肌张力增高(100%)、直立性低血压(75%)、锥体束征(75%);MSA-C亚型以行走不稳为主要首发表现(62.5%),主要体征为共济失调(100%),直立性低血压、小脑性语言、锥体束征(分别为62.5%)。结论:多系统萎缩是一种散发性的神经系统变性疾病,成年起病,临床表现多样。对于早期单纯以帕金森综合征、小脑功能障碍或自主神经功能紊乱为主要症状的患者,特别是无家族史者,要注意甄别有无其他系统受累的症状或体征,同时结合影像学检查、左旋多巴类药物治疗反应性等临床特点,对于早期正确诊断MSA有一定帮助。     

TUBERCULOUS BRONCHITIS IN CHILDREN

Of 63 children with primary pulmonary tuberculosis who were examined bronchoscopically without particular regard for the usual criteria for the procedure, 18 (28.5 per cent) had visible tuberculous bronchitis.Certain endobronchial lesions resolved spontaneously, others responded to bronchoscopic treatment, and still others persisted despite all efforts.X-ray observations and clinical signs were of limited value in determining prior to bronchoscopy which child would have visible bronchial disease.Bronchoscopy is essential for both diagnosis and treatment of these lesions.Tuberculous bronchitis should be suspected whenever a child who is being treated for pulmonary tuberculosis by conservative means does not improve.