Objective To investigate the association bewteen endothelin B receotor(EDNRB )gene polymorphisms and susceptibility to chronic obstractive pulmonary disease(COPD).Methodes SNP site was detected on EDNRB-30G/A with PCR-RFLP technology,and the frequencies of genotype and allele were analysed between COPD group and control group respectively.Whether the genetic polymorphism of EDNRB genes was associated with the degree of airway obstruction were investigated.Results The frequencies of genotype in EDNRB -30G/A site had significant difference between COPD group and control group(P0.05),but no statistically significant difference in the frequencies of allele between two groups.In COPD patients,the maximal mid-expiratory flow (MMEF) in AA genotype goup(0.51±0.44) was significant lower than in GG group(1.49±1.70) (P0.05).Conclusion EDNRB -30G/A polymorphisms might be correlate with the susceptibility to COPD and AA genotype is related to a low MMEF in COPD patients.

Objective To construct RNAi lentiviral recombinant vector of rat β-defensin-2 (rBD2) gene, detect its silencing effect by transfecting cultured cells, and to identify the RNAi lentiviral vector with best silencing effects. Methods Three siRNA sequences binding to CDS region of rBD2 gene were designed with software and used to generate single stands which formed double-stranded DNA by annealing. Three RNAi lentiviral recombinant vectors were constructed by connecting these DNAs to enzyme- digested lentivirus vectors and were identified by sequencing after transfecting into bacteria. Recombinant vector was transfected into cells by liposome. Expressions of rBD2 mRNA and protein were tested with fluorescence RTPCR and Western blotting. Recombinant vector with best silencing effect was screened as LV-shrBD2. The virus- like particles of LV- shrBD2 was packed with lentiviral packaging system and the viral titer was determined by slow-gradient dilution. Results Gel electrophoresis showed that the PCR products of three siRNAs were 316 bp in size with correct sequences. RT-PCR and Western blotting indicated that the recombinant vector with siRNA sequence 1 exhibited the best interference effect with an inhibition rate of 82%, and was therefore identified as rBD2 gene RNAi lentiviral vector LV-shrBD2. The lentiviral vector particle packaging was complete, and the virus titer was adjusted to 1×105 ifu/μl. Conclusion The RNAi lentiviral expression vector of rBD2 gene LV-shrBD2 that exhibits best gene-silencing effect is successfully constructed, which may provide evidences for further research of rBD2.

Objective To study the plasma levels of endothelin-1(ET-1) and endothelin receptor B (EDNRB) in patients with chronic obstructive pulmonary disease(COPD).To investigate whether smoking will lead alterations of ET-1 and EDNRB.Methods ET-1 and EDNRB in plasma were measured by ELISA.Results Patients with acute exacerbation of COPD demonstrated higher plasma levels of ET-1 and EDNRB than healthy subjects(P0.05).The changes of plasma ET-1 were positively correlated with EDNRB(r = 0.284,P0.05).Smoking did not lead to significant alterations in ET-1 and EDNRB.Conclusion ET-1 and EDNRB are likely involved in acute phase of COPD.

Objective To investigate the effect of endothelin on mechanism of exercise-induced bronchoconstriction.Methods 1) In animal experiment 19 pathogen-free Hartley guinea pigs were divided into 2 groups randomly.(A) Bosentan group: bosentan were administered prior to isocapnic hyperpnea challenge; (B) Control group: the control group was given 0.9% NaCI at same condition.Lung resistance (RL) and dynamic compliance (Cdyn) of 2 groups were measured before isocapnic hyperpnea challenge,the ventilator were provided by animal breathing machine using dry mixture gas contained 5%CO2,95%O2,volume of bronchial alveolar lavage fluid (BALF) was collected.2) In clinical experiment asthmatics (n=14)and healthy subjects (n=14) took part in the experiment.Respiratory impedance was measured with IOS.Exercise challenge with an ergometer.After the challenge,measurement with IOS was made immediately again.After IOS measurement,the blood samples from both groups for ET-1 concentration were taken.decrease in Cdyn(49.9%) in the control group.In bosentan group,RL and Cdyn did not change significantly.clinical experiment the maximal increase of respiratory impedance occurred at 5min-10min after exercise and the increment magnitude of peripheral resistance was more than that of central resistance in asthmatics.After challenge,R5,R5-R20,Zrespir and X5 from patients changed significantly in patients.The increment change value of R5-R20 from all asthmatics≥0.032kPa/L/s).The change ratio of X5 from 71.4% asthmatics≥41%.Air trapping was expressed in VT-Zrespir graph in 57.1% patients.The serum concentration of ET-1 from asthmatics was (66.6±12.1) ng/mL,which of control group was (40.7±5.6) ng/mL (P=0.022).In asthmatics,there is a significant correlation between the change value of airway resistance and the serum concentration of ET-1.Conclusion Endothelin receptor antagonist bosentan can restrain bronchoconstriction elicited by isocapnic hyperpnea in guinea pigs.The endothelin-1 may be an important factor in the pathogenesis of the peripheral bronchoconstriction elicited by exercise challenge.

BACKGROUND:Traditionally, forced expiratory volume in one second (FEV1) was used to evaluate exercise response of patients with asthma; however, patients obviously had panting after exercise, so FEV1 was affected commonly. Impulse oscillometry (IOS) is a new technique for measuring respiratory impedance that do not require maximal inspiration and forced expiration.OBJECTIVE: To study airway resistance with IOS before and after exercise in healthy and asthmatic patients and investigate the significance of exercise excitation and IOS assessment.DESIGN: Synchronically non-randomized case contrast study.SETTING: Department of Respiratory Medicine, East Hospital Affiliated to Tongji University.PARTICIPANTS: A total of 14 male patients with bronchial asthma who were regarded as the asthmatic group were selected from Department of Respiratory Medicine of Shanghai East Hospital from January to October 2006. They were in a clinical stationary phase. Another 14 male healthy subjects were selected as the control group and ages of all subjects ranged from 29 to 50 years. All subjects provided the confirmed consent.METHODS: IOS was used to measure basic value of respiratory resistance, and then subjects underwent exercise challenge. Nose of subjects was clipped breathing through mouth. Within 3-4 minutes, heart rate was increased to 90% and maintained for 6 minutes during challenge. Respiratory resistance was repeatedly measured at 1, 5, 10, 15 and 20 minutes after exercise, including airway hyperresponse (AHR), total respiratory resistance, central resistance, peripheral resistance and resonance frequency at 5, 20 and 35 Hz of pulse frequency, elasrtic resistance and inertia resistance (X5 and X35) at 5 and 10 Hz of pulse frequency. In addition, difference of AHR at 5 and 35 Hz was calculated, and change ratios of both Rcentral and Rperipheral were calculated as (highest value after exercise-baseline value)/baseline value × 100%.MAIN OUTCOME MEASURES: Basic value of respiratory resistance by using IOS and exercise challenge test.RESULTS: All 14 patients with bronchial asthma and 14 healthy subjects were involved in the final analysis. Peripheral resistance (Rperiphera) was significantly higher than central resistance (Rcentral) in asthmatic patients (P ＜ 0.01). The maximal increase of respiratory impedance occurred from 5 minutes to 10 minutes after exercise in asthmatics. Resonance frequency (Fres) of asthmatics before and after exercise was significantly increased than that of controls (P ＜ 0.01).Change ratios of Fres from asthmatics were higher than that from control group (P ＜ 0.01). After challenge, R5, R5-R20,Zrespir and X5 from asthmatics changed significantly than that from controls (P ＜ 0.01). The increment change value of After exercise Zrespir increased significantly, because obstruction of small bronchi during expiration and impedance increased abruptly. Air trapping was expressed in VT-Zrespir graph in 57.1% patients. There was no difference in the VT-Zrespir graph of controls before and after exercise.CONCLUSION: The main site of airflow obstruction was in small airways in asthmatics after exercise challenge. The general acceptance of IOS method was good among the asthmatic patients. The airway response of exercise challenge may be assessed more accurately with IOS that do not require a maximal inspiration and forced expiration.

化疗是治疗恶性肿瘤的重要手段.诺维本(NVB)又名异长春花碱,是半合成第三代长春花碱,对晚期非小细胞肺癌(NSCLC)疗效优于其他长春碱类药物[1].其主要的毒副反应是对血管的严重损伤,导致化学性静脉炎的发生,使用不当可引起严重非外渗性静脉炎[2],因此护理人员根据不同病人的情况选择有效的防治静脉炎的方法,并进行了对比性研究.

目的通过逆转录-DNA聚合酶链反应(RT-PCR)技术检测豚鼠哮喘模型气管上皮内皮素-1(ET-1)mRNA表达,检测哮喘患者气管上皮内皮素-1(ET-1)和内皮素转换酶(ECE) mRNA表达.方法 (1)动物实验部分:Hartley株豚鼠用卵蛋白腹腔注射致敏,雾化吸入激发,提取气管上皮细胞RNA,逆转录将RNA逆转为cDNA,PCR扩增DNA.(2)临床实验部分:设对照组和哮喘组.一步法提取总RNA,逆转录合成cDNA,PCR扩增β-actin片段、ET-1片段和ECE片段.PCR产物的鉴定和半定量.计算ET-1/β-actin值和ECE/β-actin值.结果 (1)动物模型检测:在电泳缓冲液内,紫外灯下可见ET-1为333bp左右条带,与标记DNA条带相对应.(2)临床实验:哮喘组ET-1mRNA表达量明显高于对照组(P＜0.05).哮喘组ECEmRNA表达量与对照组比较差异无显著性(P＞0.05).结论 RT-PCR技术检测出卵蛋白致敏激发的豚鼠气管上皮细胞ET-1mRNA表达.哮喘患者支气管粘膜ET-1mRNA表达明显增高,而ECEmRNA表达量与对照组比较差异无显著性.

目的:观察吉西他滨(健择)联合顺铂(GP方案)对晚期非小细胞肺癌的疗效.方法:自1999年6月～2001年11月,对26例晚期非小细胞肺癌采用21天GP方案治疗.结果:26例病例中,无CR,PR 11例,SD 12例,PD 3例,总有效率CR+PR为42.3%(11/26).中位生存期(MST)为9.3个月.Ⅲ～Ⅳ度白细胞下降占23.1%(6/26).结论:治疗晚期非小细胞肺癌,吉西他滨联合顺铂21天方案是有效、经济和安全的.

机械通气可大大降低因各种因素引起的急性呼吸窘迫综合征(ARDS)患者的病死率.但部分患者在长时间(>72 h)接受人工通气后,即使原发诱因已经消除,但撤离呼吸机仍较为困难,主要是因为患者通气功能不良和呼吸肌疲劳,但只要采取相应的措施支持患者的通气,就可避免呼吸肌过度疲劳,即可以进一步改善病情.因此,在ARDS患者病情改善过程中及时拔除气管内插管,改用经鼻面罩无创性机械通气(BiPAP),可望有效地避免经人工气道所致下呼吸道感染和呼吸机相关肺炎(VAP).

我们应用随弃式硅胶面膜通气鼻(面)罩取代传统的鼻(面)罩,以探讨其在无创通气中的安全性、有效性及可依从性,并评价其应用价值. 1 资料与方法 1.1 病例选择 1998年7月～2000年5月因呼吸衰竭收住本院呼吸监护室(RICU)的患者42例,均采用经鼻(面)罩机械辅助通气.年龄24～91岁,其中男性34例,女性8例.根据采用鼻(面)罩通气时间的先后随机分为两组,随弃式组(21例)采用随弃式ZS-MZ-A(B)型硅胶面膜通气鼻(面)罩(中山医疗科技开发公司提供),普通组(21例)采用临床常用的普通鼻(面)罩(上海蓝海实业有限公司提供).