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Objective To investigate the clinical data of a patient with IgG4-related disease involving the trachea and paratracheal soft tissue and review the literature so as to improve the understanding level of the disorder.Methods To analyze the clinical manifestation,laboratory examination,imaging,histopathology,treatment and prognosis of a patient with IgG4-related disease trachea and paratracheal soft tissue involved,who was admitted to the Department of Respiratory and Critical Care Medicine at Beijing Chaoyang Hospital.The relevant literatures were reviewed.Results A 18-year-old female was admitted with chief complaint of cough,dyspnea,and neck mass.Neck CT suggested that tracheal stenosis was caused by surrounded soft tissue.Paratracheal mass biopsy showed dense collagen fibers with infiltration of many lymphocytes and plasma cells.Immunohistochemical stain found that IgG4-positive plasma cells were ＞ 50/high power field (HPF) and a ratio of IgG4/IgG positive cells was over 40％.The level of serum IgG4 was significantly increased (2 930 mg/L).She was diagnosed as IgG4-related disease.The patient was treated with 80 mg intravenous methylprednisolone per day for three days,then prednisone 40 mg daily oral.Her dyspnea was significantly relieved.One month later,CT scan showed that the cervical tracheal stenosis was significantly improved.We identified 20 cases of IgG4-related disease involving the trachea and paratracheal soft tissue from databases,in which only 1 case was similar as this patient.The other 19 cases were of extratracheal involvement.Elevated serum IgG4 was detected in 11/12 patients.Most patients were treated with glucocorticoid,some combined with immunosuppressive agents and rituximab.The clinical outcome was good.Conclusion IgG4-related disease involving the trachea and paratracheal soft tissue is a rare condition.Serum IgG4 level and histopathology should be considered for diagnosis.Glucocorticoid is effective.
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Objective To test the hypothesis that nebulised budesonide (NB) might be an alternative to systemic corticosteroids in treatment of patients with exacerbated chronic obstructive pulmonary disease (ECOPD).Methods Patients hospitalised with ECOPD (n = 78) were randomnized into three groups.Group 1 received only standard bronchodilator treatment (SBDT),group 2 received systemic corticosteroids (SC 40 mg methylprednisolone) plus SBDT,and group 3 received nebulised budesonide ( NB 1000 mg budesonide q.i.d.) plus SBDT.Complete blood counts,detailed biochemical analysis,spirometric measurements and arterial blood gas analysis were carried out at admission.In addition,the following were recorded:adverse effects,discharging percentage of patients at 10 day and 15 day after hospitalization,exacerbation and re-hospitalization ratio within 1month after discharge.Results The improvement of SO2,PO2,FEV1 and discharge rates was ( 5.3± 0.9 ) %、(5.9 ±0.4)%、(8.7 ±0.5)% ,(8.1 ±0.8)%,(4.9 ±0.4)% and (7.2 ±0.5)% ,which were higher than that in SBDT group.These indexes were not different between 2 group and 3 group.The fraction of patients discharged on the 10th day and 15th were not different.The deteriorate rate was higher in 1 group than in 2 group and 3 group(P ＜0.05 ).Re-admission ratio in one month is higher in 1 group( 12% ) than in 2 group( 5% ) and 3 group(9% ) ( P ＜0.05 ).Absolute blood glucose level was found to be significantly higher in group 2 in 10th day (7.4 ± 1.6)mmol/L,which is greater than that in 1 group ( 5.1 ± 0.8 ) mmol/L and 3 group ( 5.6 ± 1.2 ) mmol/L ( P ＜ 0.05 ).Dysphoria and deliration appear in one patient in group 2.Conclusions Nebulised budesonide,an effective and safe alternative to systemic corticosteroids in treatment of exacerbated COPD,may substitute systemic corticosteroids in clinical practice.
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BACKGROUND: Lung fibroblasts are believed to play an important role in lung tissue repair and regenerative process. The differentiation potential of lung fibroblasts is not known very well.OBJECTIVE: To investigate the multi-differentiation capacity of human lung fibroblasts.DESIGN: An observational comparative experiment.SETTING: Department of Respiratory Medicine, Beijing Shijitan Hospital and Central Laboratory of the First Hospital of Tsinghua University.MATERIALS: This study was performed at the Central Laboratory of the First Hospital of Tsinghua University from March 2006 to October 2006. Human adult lung fibroblasts were isolated as primary cultures from resected lung of patients with lung cancer.The study was approved by hospital's Medical Ethics Committee, and informed consent was signed. Dulbecco's modified Eagle's medium (DMEM), fetal calf serum (FCS), trypsin- ethylenediamine tetraacetic acid (EDTA), naphthol AS-MX phosphate and Fast Red TR were purchased from Sigma, USA. Mouse anti-human osteopondn antibody was from R&D Systems China Co., Ltd,Polyvinyl difluoride (PVDF) membranes were from Bio-Rad Laboratories Inc, Hercules, CA.METHODS: Human adult lung fibroblasts were isolated as primary cultures. Human lung fibroblasts were cultured in an osteogenic medium (containing 109-10-5 mol/L dexamethasone, 50 mg/L vitamin C and 10 mmol/L β-glycerophospate) and adipogenic medium (containing 15% horseurm, 10-8 mol/L dexamethasone and 10 mg/L insulin), or control medium (10% FCS).Ostcoblasts were detected by alkaline phosphatese (ALP) and calcium salt staining. The expression of osteopontin was measured by Western blotting. Oil Red-O staining was used for identification of mature adipocytes.MAIN OUTCOME MEASURES: The differentiation of lung fibroblasts induced by osteogenie medium; The differentiation of lung fibroblasts induced by adipogenic medium.RESULTS: With the induction of ostcogenic medium for 2 weeks, the differentiation of lung fibroblasts was induced by osteogenic and adipogenic medium, respectively. The expression of ALP and osteopontin was increased and the deposition of calcium salt was detected. After lung fibroblasts were cultured in adipogenic medium for 14 days, part of the cells gradually experienced morphological change from original spindle into oval shape. Oil Red -O staining indicated lipid drops accumulation within cytoplasm.CONCLUSION: Under certain condition, human long fibroblasts could differentiate into osteoblasts or adipocytes that were characterized by bone marrow mesenchymal stem cells.
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Objective To investigate the differentiation potential of human lung fibroblasts.Methods The study was performed in First Hospital of Tsinghua University from March 2006 to October 2006.Human lung fibroblasts were cultured for 2 weeks in an osteogenic medium[containing 10% fetal calf serum (FCS)and 50 g/mL Vitamin C and 10 mmol/L ?-glycerophospate],adipogenic medium(containing 15% horse serum,10-8 mol/L dexmethasone and 10 mg/L insulin),or control medium(10% FCS).Osteoblasts were detected by alkaline phosphatese and calcium salt staining.The expression of osteopontin was measured by Western blotting,Oil Red -O staining for identification of mature adipocytes.Results With the induction of osteogenic medium for 2 weeks,the expression of alkaline phosphatese and osteopontin was increased and the deposition of calcium salt was detected.Mature adipocytes formed after culture with adipogenic medium for 2 weeks.Conclusion Under certain condition,human lung fibroblasts can differentiate into osteoblasts or adipocytes,which were characterized by bone marrow mesenchymal stem cells.