Previous research indicated that the dysregulation of miRNA-30a-5p has a correlation with cell metastasis of lung adenocarcinoma (LUAD). But the study about the molecular regulatory mechanism of miRNA-30a-5p in LUAD cell metastasis is limited. Thus, we discussed the mechanism of miRNA-30a-5p and its biological function in LUAD cells. By utilizing bioinformatics analysis, how miRNA-30a-5p was expressed in LUAD tissue was determined and its downstream target genes were predicted. The signaling pathways where these target genes enriched were analyzed. Several in vitro experiments were applied for cell function detection: dual-luciferase assay for validating the targeting relationship between miRNA-30a-5p and its target gene; quantitative real-time polymerase chain reaction for testing the expression of miRNA-30a-5p and its target gene in LUAD cells; MTT, transwell, cell adhesion, flow cytometry and immunofluorescence assays for examining the capabilities of LUAD cells to proliferate, migrate, invade, adhere, apoptosis and epithelial-mesenchymal transition (EMT) effect; Western blot for determining the expression of adhesion-related proteins and EMT-related proteins. Down-regulated miRNA-30a-5p was discovered in LUAD cells, but on the contrary, VCAN was upregulated. MiRNA-30a-5p overexpression notably repressed the virulent progression of LUAD cells. Besides, dual-luciferase assay validated the targeting relationship between miRNA-30a-5p and VCAN. MiRNA-30a-5p, by negatively regulating VCAN, was capable of hindering LUAD cell proliferation, migration, invasion, adhesion, viability and EMT. It was illustrated that miRNA-30a-5p could downregulate VCAN to retard the malignant progression of LUAD cells, which provides novel insights into LUAD pathogenesis, suggesting that miRNA-30a-5p/VCAN axis can be a promising anti-cancer target for LUAD.

Objective To explore risk factors of post-ICU syndrome（PICS） in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods From May 2018 to November 2022, 70 patients with AECOPD admitted in intensive care unit（ICU） in Shaoxing People’s Hospital, PICS developed in 27 cases（PICS group） after transferred to the general ward of the respiratory medicine department, and PICS did not develop in the remaining 43 cases（non-PICS group）. The general information, life style, ICU treatment and laboratory tests were compared between two groups; risk factors for developing PICS were analyzed with univariate and multivariate logistic regression. Results Univariate analysis showed that the age, educational level, duration of mechanical ventilation ≥ 7 d, use of vasoactive drugs and quinolone, and oxygenation index level were significantly associated with the development of PICS（all P＜0.05）. Multivariate logistic regression analysis showed that older age, duration of mechanical ventilation ≥ 7 d, quinolone use and decreased oxygenation index were independent risk factors for PICS in AECOPD patients（all P＜0.05）. Conclusion To prevent or reduce the occurrence of PICS, in ICU care more attention should be paid for AECOPD patients with older age, long mechanical ventilation duration,quinolones use and decreased oxygenation index.

淀粉样变是淀粉样物质沉积于细胞、组织内,从而导致靶器官功能障碍的一组疾病.原发性肺淀粉样变是指在无继发或(和)系统性淀粉样变情况下,淀粉样物质沉积于肺内.其临床症状及影像学表现不典型,容易误诊.本文现回顾性分析我院1例经皮肺穿刺活检病理确诊的原发性结节型肺淀粉样变,同时复习相关文献资料,并对该病的临床症状、影像学、病理、诊断及治疗等进行描述,以提高对本病的认识.

目的 探讨早期综合肺康复对脱机后慢性阻塞性肺疾病急性加重(AECOPD)合并肺性脑病患者的疗效及心理状态的影响.方法 选取2017年5月至2018年12月因AECOPD合并II型呼吸衰竭、肺性脑病在绍兴市人民医院呼吸重症监护室经气管插管等治疗脱机后转入呼吸内科的患者63例,采用随机数字表法分为康复组32例和常规组31例,常规组予常规的抗菌药物、支气管扩张剂、糖皮质激素等治疗,康复组是在常规治疗基础上配合肺康复锻炼,随访3个月后比较两组患者肺功能指标[用力肺活量(FVC)、第1秒用力呼气量(FEV1)占预计值比值(FEV1％pred)、FEV1/FVC比值]、6 min步行距离(6 MWD)、慢性阻塞性肺疾病自我评估测试(CAT)评分、呼吸困难指数(mMRC)评分、BODE指数的变化,并采用抑郁自评量表(SDS)评估两组患者精神状态的变化.结果 最终两组患者均有29例获得全部随访.经过3个月的康复锻炼,康复组患者FVC、FEV1％pred、FEV1/FVC比值、6 MWD均明显高于常规组,而CAT评分、mMRC评分、BODE指数及SDS评分均明显低于常规组,差异均有统计学意义(均P<0.05).结论 对于AECOPD合并肺性脑病经机械通气等治疗脱机后的患者尽早进行综合肺康复是可行的,能够缓解临床症状,提高患者运动能力,改善心理状态.

Excessive activation and proliferation of inflammatory cell and uncontrolled release of cytokines and chemokines, also known as cytokine storm, is considered to be the main cause of sepsis. Accumulating evidence has indicated that autophagy may play an important role in regulating immune response and controlling excessive inflammation. Recent studies have showed that minocycline has immunomodulatory effects on cytokine and chemokine production. It has also been reported that minocycline can induce autophagy, suggesting that autophagy may be involved in the process of minocycline regulating inflammation and immune response. However, the precise mechanism is unclear. In the present study, we used enzyme-linked immunosorbent assays (ELISA) to measure the production of cytokines following minocycline treatment of lipopolysaccharide- (LPS-) stimulated THP-1 cells. Western blotting analysis was performed to confirm autophagy and the mTOR signal pathway. Cell proliferation was measured by WST-1 cell proliferation assay. We demonstrated that LPS induced autophagy in a tumor necrosis factor- (TNF-) α-mediated manner, and simultaneously, LPS induced the release of TNF-α to trigger inflammation and activated mammalian target of rapamycin (mTOR) to potentiate cell proliferation. Minocycline, which induces autophagy by inhibiting mTOR, suppresses cytokine production and cell proliferation and protects THP-1 cells from LPS toxicity. Further study demonstrated that there might be an intimate crosstalk between the inhibitor kappa B kinase (IKK)/nuclear factor-kappa B (NF-κB) signaling pathway and autophagy flux in modification of inflammatory responses. In addition, rapamycin, the mTOR inhibitor, has cooperative effect with minocycline on suppression of TNF-α release and induction of autophagy by repressing mTOR. Our data brought a novel clue to evaluate minocycline using as a potential therapeutic medicine for sepsis.

Lung cancer is a common malignant cancer. Kirsten rat sarcoma oncogene (KRAS) mutations have been considered as a key driver for lung cancers. KRAS p.G12C mutations were most predominant in NSCLC which was comprised about 11–16% of lung adenocarcinomas (p.G12C accounts for 45–50% of mutant KRAS). But it is still not clear how the KRAS mutation triggers lung cancers. To study the molecular mechanisms of KRAS mutation in lung cancer. We analyzed the gene expression profiles of 156 KRAS mutation samples and other negative samples with two stage feature selection approach: (1) minimal Redundancy Maximal Relevance (mRMR) and (2) Incremental Feature Selection (IFS). At last, 41 predictive genes for KRAS mutation were identified and a KRAS mutation predictor was constructed. Its leave one out cross validation MCC was 0.879. Our results were helpful for understanding the roles of KRAS mutation in lung cancer.

目的 探讨胸水癌胚抗原(CEA)和糖类抗原125(CA125)水平升高在常见渗出性胸腔积液诊治中的意义.方法 回顾性分析渗出性胸腔积液患者187例,其中良性渗出性胸腔积液患者103例(包括结核性胸腔积液67例、肺炎旁性胸腔积液及脓胸36例两种类型),恶性渗出性胸腔积液患者84例.比较良恶性及不同类型良性渗出性胸腔积液患者胸水CEA、CA125及临床资料的差异.以胸水CEA 0～5ng/L为正常标准,将良性渗出性胸腔积液患者分为胸水CEA水平升高异常21例(胸水CEA异常组)和正常82例(胸水CEA正常组),比较两组患者临床特征及检验指标.结果 恶性渗出性胸腔积液患者年龄、胸水CEA及CA 125水平均高于良性渗出性胸腔积液患者,差异均有统计学意义(均P＜0.05).肺炎旁性胸腔积液及脓胸患者胸水CEA水平高于结核性胸腔积液患者,胸水CA 125水平低于结核性胸腔积液患者,差异均有统计学意义(均P＜0.05).胸水CEA异常组肺炎旁性胸腔积液及脓胸患者比例、胸水中性粒细胞数、胸水腺苷脱氨酶、胸水乳酸脱氢酶、血白细胞和血中性粒细胞数均明显高于胸水CEA正常组,差异均有统计学意义(均P＜0.05).结论 部分肺炎旁性胸腔积液及脓胸患者胸水CEA水平可出现升高,临床工作中需避免误诊;胸水CA 125水平在良恶性渗出性胸腔积液中均可升高,若在良性渗出性胸腔积液中明显升高,需考虑结核性胸腔积液可能大.

Background: Heat shock protein-90 alpha (HSP90 alpha) is more abundant in non-small-cell lung cancer (NSCLC) patients than in control individuals. However, whether it can reflect chemotherapy efficacy remains unknown. This study aimed to investigate the association of HSP90 alpha with chemotherapy in advanced NSCLC. Material/Methods: We retrospectively evaluated data from patients admitted to the Department of Respiratory Medicine, Shaoxing People's Hospital, from September 2016 to September 2018 with stage IIIB or IV NSCLC and administered 4 cycles of third-generation platinum-based combination chemotherapy (2 drugs simultaneously). Based on the RECIST1.1 criteria, complete remission (CR), partial response (PR), and stable disease (SD) in 60 cases were determined before and after chemotherapy. Before chemotherapy and after 1, 2, and 4 cycles of chemotherapy, plasma HSP90 alpha levels were quantitated by ELISA. Chest CT was performed before and after 2 and 4 cycles of chemotherapy. Results: After 1-4 cycles of chemotherapy, plasma HSP90 alpha levels were significantly lower than pre-chemotherapy levels (P<0.05). The sums of the longest tumor diameters after 2 and 4 cycles of chemotherapy were decreased compared with pre-chemotherapy values (P<0.05). Plasma HSP90 alpha levels and tumor size showed no significant correlation before and after chemotherapy (r=0.244, P=0.06). Conclusions: Plasma HSP90 alpha can be considered a valuable predictor of early chemotherapy effectiveness in advanced NSCLC, and is positively correlated with tumor remission after chemotherapy. However, plasma HSP90 alpha level is not correlated with tumor diameter and pathological type.

目的 探讨非小细胞肺癌(NSCLC)患者血和呼出气冷凝液(EBC)中转移生长因子β1(TGF-β1)检测价值.方法 收集NSCLC患者52例,其中鳞癌24例,腺癌28例,TNM分期的Ⅰ期～Ⅱ期18例,Ⅲ期～Ⅳ期34例,同期健康体检者35例为对照组,采集空腹血清和EBC标本,采用ELISA方法检测TGF-β1.结果 NSCLC组血清、EBC中TGF-β1水平均高于对照组,差异有统计学意义(P＜0.01).腺癌组血清和EBC中TGF-β1水平均高于鳞癌组,差异有统计学意义(P＜0.01).Ⅲ期～Ⅳ期血清和EBC中TGF-β1均高于Ⅰ期～Ⅱ期,差异有统计学意义(P＜0.01);Ⅰ期～Ⅱ期血清和EBC中TGF-β1水平均高于对照组,差异有统计学意义(P＜0.01).结论 检测血及EBC中TGF-β1水平对肺癌有辅助诊断价值,有助于病理分型,可作为预后参考指标.

目的 分析老年稳定期慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者呼出气冷凝液(EBC)及血清可溶性髓样细胞触发受体-1(sTREM-1)水平及其与肺动脉压之间的相关性.方法 选择2017年6月～2018年5月在我院呼吸科门诊及住院确诊的老年稳定期COPD患者132例,以肺动脉压力水平为分界,分为单纯COPD组、轻度PH组和中重度PH组,测定三组患者的EBC及血清sTREM-1水平,并分析其与PH的相关性.结果 轻度PH组、中重度PH组患者EBC及血清sTREM-1、超敏C反应蛋白(hs-CRP)水平高于单纯COPD组(P<0.05);中重度PH组患者EBC及血清sTREM-1、hs-CRP水平高于轻度PH组(P<0.05);EBC及血清sTREM-1、hs-CRP水平与COPD患者的PH严重程度呈正相关(P<0.05).结论 EBC中sTREM-1可能与COPD患者PH形成有关,EBC中sTREM-1可在一定程度上反映肺动脉压水平.

肺癌是世界上发病率和病死率最高的恶性肿瘤[1].而肺炎型肺癌(PTCL)是肺癌的一种特殊表现形式,因其与肺炎的影像学表现极为相似,且咳嗽、咳痰、胸痛、咯血及呼吸困难等临床症状无特异性,常被误诊及漏诊.现笔者对浙江省绍兴市人民医院呼吸内科最近收治的2例PTCL患者的临床资料结合相关文献进行回顾性分析,以提高对PTCL的诊治水平.现报道如下.

目的:探讨细胞自噬对多西环素调控脂多糖(LPS)刺激巨噬细胞引发炎症反应的影响及其分子机制.方法:利用LPS刺激人单核/巨噬细胞系THP-1建立炎症反应细胞模型,用多西环素进行干预.通过测定细胞培养上清液中肿瘤坏死因子 α(TNF-α)和白细胞介素8(IL-8)等细胞因子评估炎症水平;通过Western blot法检测LC3B、核因子 κB(NF-κB)和磷酸化哺乳动物雷帕霉素靶蛋白(p-mTOR)等蛋白水平评估细胞自噬水平及对炎症细胞信号通路的影响.利用3-甲基腺嘌呤(3-MA)和雷帕霉素分别抑制和促进细胞自噬,研究自噬对多西环素调控LPS刺激THP-1细胞炎症因子水平的影响.结果:LPS刺激THP-1细胞诱导细胞因子TNF-α 及IL-8快速释放,12 h左右达到峰值;多西环素有效地抑制了LPS诱导的细胞因子产生(P<0.05).多西环素增加了LPS诱导的THP-1细胞自噬水平,且多西环素本身是一种自噬诱导剂.LPS上调p-mTOR蛋白水平,而多西环素抑制p-mTOR的蛋白水平,提示多西环素通过mTOR依赖的途径而LPS通过非mTOR依赖的途径诱导自噬.进一步研究显示,联用LPS、雷帕霉素及多西环素抑制了NF-κB的蛋白水平,雷帕霉素增加了多西环素对细胞因子生成的抑制;反之,自噬抑制剂3-MA减弱了多西环素对NF-κB的抑制效应,同时减弱了多西环素对炎症因子生成的抑制效应.结论:自噬参与多西环素调控LPS刺激单核/巨噬细胞引起的炎症反应.

Background. In this study, we investigated the clinical significance of endobronchial ultrasound elastography for differentiating malignant and benign intrathoracic lymph nodes. Methods. A meta-analysis was performed to evaluate the sensitivity and specificity of endobronchial ultrasound elastography in diagnosing intrathoracic lymph nodes. Publications before October 1, 2017, were included for analysis. Sensitivity, specificity, and other variables were pooled using the bivariate mixed-effects regression model. Results. Seven studies met the inclusion criteria and were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio was 0.93 (95% confidence interval [CI], 0.85 to 0.97), 0.85 (95% CI, 0.78 to 0.90), 6.3 (95% CI, 4.2 to 9.2), 0.08 (95% CI, 0.04 to 0.18), and 74 (95% CI, 33 to 168), respectively. The summary receiver operating characteristic curve was 0.93 (95% CI, 0.91 to 0.95). Conclusions. The results revealed endobronchial ultrasound elastography is a new technique with high sensitivity and specificity. It has a fine performance in diagnosing intrathoracic lymph nodes. (C) 2018 by The Society of Thoracic Surgeons.

1 病历摘要 患者,男性,30岁,因"反复咳嗽咳痰8月余,再发伴发热3天"于2017年6月14日入院.患者于8个月前无明显诱因下出现咳嗽,咳少量白痰,感胸部不适,右侧卧位时明显,曾到当地医院就诊,予抗感染治疗(具体不详),症状仍有,咳痰有所减少.

Objective To study the significance of carcinoembryonic antigen(CEA) from exhaled breath condensate (EBC) in the diagnosis and clinical staging of non-small cell lung cancer(NSCLC).Methods The levels of CEA from EBC were collected and detected from serum in 36 NSCLC patients(NSCLC group) and 30 healthy volunteers(control group) respectively by chemiluminescence enzyme linked immunosorbent assay.Results The levels of CEA from EBC and serum were significantly higher in NSCLC group than in control group,with the difference statistically significant(P ＜ 0.05);CEA levels in EBC and serum were significantly higher in adenocarcinoma patients than squamous cell carcinoma patients,with the difference statistically significant(P ＜0.05);according to the TNM stage,CEA levels in EBC and serum inNSCLC Ⅲ-Ⅳ stages Ⅲ-Ⅳ NSCLC were significantly higher than stages Ⅰ-Ⅱ and control group,and CEA levels in EBC in stages Ⅰ-Ⅱ was significantly higher than control group,with the difference statistically significant(P ＜ 0.05).Conclusion Detection of CEA in EBC is particularly helpful in the early diagnosis and clinical staging of NSCLC.

Kartagener综合征(KS)是一种罕见的常染色体隐性遗传性疾病,由支气管扩张、慢性鼻窦炎、内脏反位三联征组成[1],称为完全性KS,缺少慢性鼻窦炎称为不完全性KS[2].

Objective To observe the value of pro-gastrin-releasing peptide (ProGRP) in the detection of exhaled breath condensate(EBC) in small cell lung cancer (SCLC).Methods 20 SCLC patients were collected,including 14 cases at limited stage and 16 cases at extensive stage.41 NSCLC patients were collected,including 20 cases of squamous carcinoma,21 cases of adenocarcinoma.30 healthy subjects were enrolled in the control group.Fast serum and EBC specimens were collected,and enzyme-linked immunosorbent assay (ELISA) was used for the detection of serum and ProGRP levels in EBC.Results In the SCLC group,the ProGRP levels of serum and EBC were significantly higher than those in NSCLC group and the control group,with the differences statistically significant(P ＜ 0.05).The ProGRP levels in serum at extensive stage were higher than those at the limited stage,with the difference statistically significant (P ＜ 0.05),while there was no statistical significance on the difference of ProGRP levels in EBC between extensive stage and limited stage (P ＞ 0.05).The ProGRP levels of serum and EBC in limited stage were higher than those in the control group,with the differences statistically significant (P ＜0.05).Conclusion There was diagnostic value of detecting ProGRP level in serum and EBC in SCLC patients.The detection of ProGRP in EBC can be used as an early diagnostic and noninvasive index.

目的 探讨非小细胞肺癌(NSCLC)患者呼出气冷凝液中核内不均一核糖核蛋白(hnRNP)A2/B1检测价值.方法 收集NSCLC患者37例为NSCLC组,其中鳞癌17例,腺癌20例,TNM分期的Ⅰ期～Ⅱ期12例,Ⅲ期～Ⅳ期25例,另收集同期健康体检者25例为对照组,采集空腹血清和呼出气冷凝液(EBC)标本,采用ELISA方法检测血清及EBC中hnRNP A2/B1.结果 NSCLC组血清、EBC中hnRNP A2/B1水平均高于对照组,差异有统计学意义(P＜0.05).鳞癌组和腺癌组血清hnRNP A2/B1水平差异无统计学意义(P＜0.05),鳞癌组EBC中hnRNP A2/B1水平高于腺癌组,差异有统计学意义(P＜0.01).Ⅲ期～Ⅳ期血清hnRNP A2/B1高于Ⅰ期～Ⅱ期,差异有统计学意义(P＜0.05),Ⅰ期～Ⅱ期EBC中hnRNP A2/B1水平高于对照组,差异有统计学意义(P＜0.05).结论 检测血液及EBC中hnRNP A2/B1水平对肺癌有辅助诊断价值,其中EBC中hnRNP A2/B1水平检测对早期肺癌的诊断有一定临床意义.

Objective:To investigate the level of leukotrienes C4(LTC4) in exhaled breath condensate(EBC) of patients with asthma and the effect of inflammatory factors after montelukast treatment.Methods:Thirty patients with asthma were enrolled and given 10 mg montelukast once each night for one month.Before therapy and one month later,the levels of LTC4 in EBC were measured.Another 30 healthy controls were selected as control group.Results: LTC4 levels were significantly higher in the asthma patients before and after treatment compared with the control subjects.The level of LTC4 was significantly decreased in patients with asthma after treatment.Conclusion: Detecting the LTC4 level in EBC can monitor asthmatic airway inflammation,which is convenient,noninvasive and safe.Montelukast can decrease the level of LTC4,which is an effective anti-inflammatory reagent.

Objective To investigate the clinical significance of changes of leukotriene C4 (LTC4),8-isoprostane(8-ISO),nitrate levels in condensate of exhaled breath condensates (EBC) both before and after treatment in patients with asthma.Methods Enzymatic and colorimetric method of 30 cases of patients with asthma LTC4,8-in EBC ISO,nitrate for testing,30 cases are healthy control.Results LTC4 in patients with asthma is higher than the control group (55.17 ng/L than 17.95 ng/L,P ＜0.01),the persistent asthma is higher than Intermittent asthma (67.38 ng/L than 41.21 ng/L,P ＜0.01),the persistent asthma is higher than the control group (67.38 ng/L than 17.95 ng/L,P ＜0.01),the intermittent asthma is higher than the control group (41.21 ng/L than 17.95 ng/L,P ＜0.01),the untreated patients is higher than the treated group (55.17 ng/L than 38.36 ng/L,P ＜0.01).8-ISO in patients with asthma is higher than the control group(13.41 ng/L than 6.93 ng/L,P ＜0.01),the persistent asthma is higher than the control group to high (14.29 ng/L than 6.93 ng/L,P ＜0.01),the intermittent asthma is higher than the control group(12.40 ng/L than 6.93 ng/L,P ＜0.05).Nitrate in patients with asthma is higher than the control group (4.17 ng/L than 3.20 ng/L,P ＜0.01),the persistent asthma is higher than the control group (4.50 ng/L than 3.20 ng/L,P ＜0.01).Conclusions LTC4,8-1SO,nitrate levels can reflects the airway inflammation in patients with asthma and montelukast drugs can control and relieve the airway inflammation.